1.
Relationship of cytokine levels and clinical effect on platelet-rich plasma-treated lateral epicondylitis
Lim W, Park SH, Kim B, Kang SW, Lee JW, Moon YL
Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society. 2017;36((3):):913-920
Abstract
Lateral epicondylitis (LE) is difficult to manage and can result in significant patient morbidity. Currently, the clinical use of platelet-rich plasma (PRP) for painful tendons has received attention, but its efficacy remains controversial. This study aimed to investigate the clinical effects of PRP and its biological components. 156 patients with LE were randomly divided into group 1, treated with a single injection of 2-mL autologous PRP, and group 2, treated with a control received only physical therapy without injection. Both groups used a tennis elbow strap and performed stretching and strengthening exercises during 24 weeks' follow-up. Pain and functional improvements were assessed using the visual analog scale (VAS), Modified Mayo Clinic Performance Index for the elbow, and magnetic resonance imaging (MRI). White blood cell count, platelet count, and levels of platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, transforming growth factor-beta (TGF-beta), vascular endothelial growth factor, epithelial growth factor, and interleukin-1 beta in PRP were measured and investigated for statistical correlation with the clinical score. At 24 weeks, all pain and functional variables, including VAS score, Mayo Clinic performance scores, and MRI grade, improved significantly in group 1 (P < 0.05). PDGF-AB, PDGF-BB, and TGF-beta levels were more significantly increased in PRP than in whole blood. TGF-beta level significantly correlated with Mayo Clinic performance score and MRI grade improvement. Thus, TGF-beta level in PRP is considered to play a pivotal role in tendon healing. These results may contribute to identifying the best protocol for PRP application in tendinopathies. This article is protected by copyright. All rights reserved.
2.
The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia
Neunert C, Lim W, Crowther M, Cohen A, Solberg JrL, Crowther MA
Blood. 2011;117((16):):4190-4207.
Abstract
Immune thrombocytopenia (ITP) is commonly encountered in clinical practice. In 1996 the American Society of Hematology published a landmark guidance paper designed to assist clinicians in the management of this disorder. Since 1996 there have been numerous advances in the management of both adult and pediatric ITP. These changes mandated an update in the guidelines. This guideline uses a rigorous, evidence-based approach to the location, interpretation, and presentation of the available evidence. We have endeavored to identify, abstract, and present all available methodologically rigorous data informing the treatment of ITP. We provide evidence-based treatment recommendations using the GRADE system in those areas in which such evidence exists. We do not provide evidence in those areas in which evidence is lacking, or is of lower quality - interested readers are referred to a number of recent, consensus-based recommendations for expert opinion in these clinical areas. Our review identified the need for additional studies in many key areas of the therapy of ITP such as comparative studies of front-linetherapy for ITP, the management of serious bleeding in patients with ITP, and studies that will provide guidance about which therapy should be used as salvage therapy for patients after failure of a first-line intervention. 2011 by The American Society of Hematology.