Vasorelaxant and Antioxidant Activities of Spilanthes acmella Murr.

This study reports the effect of Spilanthes acmella Murr. extracts on phenylephrine-induced contraction of rat thoracic aorta as well as their antioxidant activity. Results show that the extracts exert maximal vasorelaxations in a dose-dependent manner, but their effects are less than acetylcholine-induced nitric oxide (NO) vasorelaxation. Significant reduction of vasorelaxations is observed in both NG-nitro-l-arginine methyl ester (l-NAME) and indomethacin (INDO). In the presence of l-NAME plus INDO, synergistic effects are observed, leading to loss of vasorelaxation of both acetylcholine and the extracts. Similarly, the vasorelaxations of the extracts are completely abolished upon the removal of endothelial cells. This demonstrates that the extracts exhibit vasorelaxation via partially endothelium-induced NO and prostacyclin in a dose-dependent manner. Significantly, the ethyl acetate extract exerts immediate vasorelaxation (ED50 76.1 ng/mL) and is the most potent antioxidant (DPPH assay). The chloroform extract shows the highest vasorelaxation and antioxidation (SOD assay). These reveal a potential source of vasodilators and antioxidants

OUTCOME OF USING PLATELET, PLASMA AND GROWTH FACTORS AS AN ORTHOBIOLOGIC DERIVATIVE TO AVOID INVASIVE SURGICAL PROCEDURES FOR TREATING KNEE OSTEOARTHRITIS AMONG ELDERLY PATIENTS

Background: The application of platelet, plasma and growth factors (PP&amp;GF) is an intra-articular orthobiologic intervention that has been proven to be safe, having less systemic complications compared with conventional treatments and could constitute an option for treating elderly patients with knee osteoarthritis (OA). However, an intermediate result of using PP&amp;GF has yet to be well established.&#x0D; Objectives: This study aimed to report the survival analysis of 24-month follow-up treatment using PP&amp;GF among elderly patients with knee OA as primary outcome. The secondary outcomes were functional improvement in terms of international knee documentation committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score and visual analog scale (VAS) pain score.&#x0D; Methods: A prospective cohort study was performed among patients with knee OA (Kellgren and Lawrence (KL) grade I-IV), aged more than 65 years who did not respond to conservative treatments. All patients received intra-articular PP&amp;GF treatment and were followed up to 24 months. Primary outcome was recorded as any surgical treatment at any time point post-PP&amp;GF injection. Secondary outcomes including IKDC, WOMAC and VAS pain score were also assessed.&#x0D; Results: A total of 184 participants were enrolled in this study. The overall survival rate of patients not undergoing any surgical procedures during 24-month follow-up was 87.50%±2.44%. The mean IKDC, WOMAC and VAS pain scores were 39.59±0.58, 55.9±1.09 and 6.63±0.13, respectively at baseline while those at 24-month follow-up were 46.77±0.81, 38.32±1.33 and 4.92±0.13, respectively. The mean platelet concentrations before and after centrifugation were 1.85x105 cells/μL (1.20-3.36x105 cells/μL) and 1.4x106 cells/μL (5.80x105-3.5 x106) cells/μL, respectively, which showed final PP&amp;GF products contained 6-10 times higher platelet concentration than those in the peripheral blood.&#x0D; Conclusion: Intra-articular injection of PP&amp;GF is a potential treatment for severe knee OA especially among elderly patients. This method provided 87.50% survivorship from surgical intervention at 24-month follow-up. Most patients improved both pain and functional outcomes. We propose that the optimal preparation technique for PP&amp;GF is the key step for improving patients’ clinical outcomes and regaining their quality of lives.</jats:p

SAFETY AND CLINICAL EFFICACY OF PLATELET RICH GROWTH FACTORS (PRGF) IN MANAGING KNEE OSTEOARTHRITIS AFTER FAILED CONSERVATIVE TREATMENT: EVIDENCE FROM REAL PRACTICES

Background:  Platelet rich growth factors (PRGF) comprise a biological treatment of knee osteoarthritis (OA).  Due to its limitation concerning the articular cartilage lesions’ healing potential, chondrocyte differentiation and external environment factors, clinical improvement of knee OA using PRGF treatment depends on preparation techniques.&#x0D; Objectives: The study aimed to demonstrate clinical outcomes of PRGF treatment in real practices.&#x0D; Methods: A prospective cohort study was conducted from February 2018 to 2019 at the Biomedical Technology Research and Development Center, Police General Hospital, Bangkok, Thailand. We enrolled patients above 60 years old with knee OA that failed conservative treatment. The exclusion criteria included meniscus and ligament injury and knee deformity of the tibiofemoral angle more than 5 degrees. The primary endpoint was safe PRGF while secondary endpoints included changes of weight bearing pain and delayed surgery until an appropriate time for intervention.&#x0D; Results: A total of 240 patients with knee OA, Kellgren-Lawrence (KL) grades II, III or IV were enrolled including 90 males and 150 females. The average age was 68 (60-81) years. Mode of conservative treatment failure included 140 cases of oral medication, 60 cases of oral medication and steroid injection and 40 cases of oral medication, steroid and intra-articular hyaluronic injections (IA-HA). Based on the KL system, 194 were classified as grades II-III, and 46 patients were grade IV. The PRGF was collected according to the protocol. The average initial platelet concentration before and after centrifugation was 165x103 cells/µL (140-195x103 cells/µL) and 990x103 cells/µL (825-1,650x103 cells/µL), respectively. At average of 3.3 (3-8) months follow-up, no major complications were observed, but 17 cases (7.9%) had minor complications. Average VAS (visual-analog-scale for pain: 0-100) scores before and after injection were 71 (65-80) and 52 (50-72, respectively. Surgical intervention in KL II-III totaled 11 cases (5.6%) and KL IV totaled 5 cases (10.8%).&#x0D; Conclusion: Our technique of adjusting platelet concentration, fibrin concentration, leukocyte population and activator status improved clinical efficacy of PRGF treatment. PRGF is a safe, simple and effective treatment for patients with knee OA experiencing conservative treatment failure.</jats:p