THE EFFICACY OF PLATELET GROWTH FACTORS (PRP) IN THE COMPLEX TREATMENT OF TMJ MALFUNCTIONS

Background. Joint pain is often associated not only with disc displacement but also due to the level of inflammatory mediators in the synovial fluid. Injections of platelet growth factor not only expand the joint cavity, performing a purely mechanical function but also create a high concentration of growth factor in the synovial fluid, which favorably affects the cartilage tissue, joint capsule, ligamentous apparatus. Objectives ― to study the effectiveness of platelet growth factor in the complex treatment of patients with TMJ malfunctions. Methods. A clinical examination of two groups of patients (50 people) aged 18 to 67 years with a malfunctions of TMJ was conducted. Were used in all patients in the complex: splint therapy, myogymnastics, and manual traction drive. For the first group (25 people), concentrated growth factor in the liquid phase (PRP) was used in the treatment. For the second group (PRP) was not used. The patients were divided into two groups randomly. Results. The results of the study were carried out according to the following criteria: pain in TMJ with a maximum opening of the mouth, protrusion, laterotruzii, sound phenomena in TMJ, myofascial pain (palpation), the presence of deviation/deflection of the lower jaw, incisional distance. Conclusions. 1. Complex therapy, including splint therapy, myogymnastics, manual traction of the disc, the use of platelet growth factor, showed good results in the treatment of TMJ malfunctions. 2. According to all the studied criteria (pain in TMJ with a maximum opening of the mouth, protrusion, laterotruzii, sound phenomena in TMJ, myofascial pain (palpation), the presence of deviation/deflection of the lower jaw), the most effective result of treatment was obtained after 1 month.

Multidisciplinary treatment of ischemic forms of diabetic foot

Purpose of the study. The phototherapy, platelet growth factor and coating materials in the treatment complex using for improve the results of wound treatment in patients with the ischemic form of diabetic foot. Materials and methods. The analysis of the results of treatment of 48 patients with ischemic forms of diabetic foot syndrome has been performed in the work. The patients were divided into the study and comparative groups. The patients were treated at the clinic of the State institution «V. T. Zaitsev Institute of General and Emergency Surgery National Academy of Medical Sciences of Ukraine» from 2012–2018, and all patients had II stage diabetes mellitus and IV degree of ischemia by Fontaine. Patients in both groups performed open and hybrid reconstructions. In the patients of the study group, the developed treatment technology was applied, containing phototherapy and photodynamic therapy with a range of: λ 470, 525 or 405 nm in the preoperative period, closure with synthetic coating with application plasma enriched of transforming growth factor. The implementation of the developed tactics allowed to achieve complete wound healing in 91,7% of patients, partial healing – in 8,3% of patients. The terms treatment terms for these patients did not exceed 2 months, high amputation was not required. Conclusions. Plastic closure of the wounds of the lower extremities after revascularization operations in an ischemic diabetic foot syndrome is indicated in cases where wounds do not tend to spontaneous healing. The use of a treatment complex consisting of phototherapy and photodynamic therapy, the closure of wounds with a synthetic coating of transforming growth factor is the effective stimulator of development of granulation tissue in the wound, suitable for further autodermoplasty. Keywords: foot ischemic diabetic syndrome, dermoplasty, synthetic coatings, photodynamic therapy, platelet growth factor.

Tactic of treatment of ischemic diabetic foot syndrome

The aim of the study was to improve the results of wound treatment in patients with ischemic and neuro-ischemic forms of diabetic foot syndrome through the use of phototherapy, platelet growth factor and modern coating materials in the treatment complex. The paper presents the results of surgical treatment of 48 patients with ischemic and neuroischemic diabetic foot syndrome, which, in accordance with the objectives of the study, were divided into two groups — the study (24 patients) and comparative (24 patients). All patients suffered from diabetes mellitus type II and had IV degree of foot ischemia according to Fontaine. The following reconstructive operations were performed in both groups of patients: femoral-tibialis and femoral-popliteal shunting, as well as hybrid reconstructions. In patients of the study group, the treatment technology developed by us was applied. Using the developed tactics, it was possible to achieve complete healing of wounds in 91,7 % of patients and partial healing (over 50 %) in 8.3 % of patients in the study group. The terms of treatment of these patients did not exceed 2 months, the execution of high amputations was not required.

Increased sympathetic tone of the autonomic nervous system as a factor for coronary heart disease

Cardiovascular disease (CVD) in the XXI century continues to hold the lead as the leading cause of death worldwide and in Ukraine (65.2%). Coronary heart disease (CHD) is the leading place among the causes of death and disability in working-age people worldwide. In Ukraine, the analysis of mortality from CHD is 491.91 per 100 thousand population. Numerous epidemiological studies have shown that the increased activity of the sympathetic nervous system (SNS) leads to an increase in cardiovascular disease and mortality. It is known that SNS may participate in the formation of atherosclerosis by activating platelets with the subsequent formation of platelet growth factor and contributes to mechanical damage to the vessel wall as a result of high blood pressure and increased blood flow velocity. There are data on the mechanisms of interaction of SNS the vascular endothelium. Vasoconstrictor effect of endothelin-1 plays an important role in the pathogenesis of various cardiovascular diseases, among which includes the CHD.

Correlation Between Spleen Size, Thrombocytopenia and Meld Score in Chronic Liver Disease and Their Relation with Hospital Readmission

Introduction: Cirrhosis of liver due to chronic hepatitis B and/or C is a significant health care burden globally. Thrombocytopenia is one of the significant co-morbid conditions associated with cirrhosis. Splenomegaly had been pointed as one of the main factors behind thrombocytopenia in multiple studies. Another important aspect of this clinical condition is its high economic impact in the national health care budget. In this study, we re-evaluated the relation between thrombocytopenia, MELD score and spleen size in liver cirrhosis associated with chronic hepatitis B and/or C. We also evaluated the impact of these 3 factors over readmission of the patients at 30 and 90 days. Method: In this retrospective study, the medical records of patients admitted to Saint Joseph Hospital, Chicago, IL between January 1st, 2005 and December 31st, 2010 were queried for a discharge diagnosis of Chronic liver disease due to Hepatitis B and/or C. Result: Data Summary To examine the relationship between the biomarkers, scatter plot was generated for visual inspection. There was no apparent relationship between platelet count and MELD or spleen size. Correlation analysis by Spearman method showed a weak negative correlation between platelet count and MELD score (P=0.0051, coefficient = -0.26). To predict the probability of re-admission by the biomarkers, logistic regression was used to select significant predictors. From univariate analysis, only MELD was a significant predictor in 30-day re-admission (P=0.012, AUC=0.665). For 90-day re-admission, both MELD (P=0.0034, AUC=0.691) and platelet count (P=0.030, AUC=0.647) were significant predictors in univariate analysis. Summary In this study, all subjects have chronic liver disease due to viral infection. Platelet count is not related to MELD score or spleen size in these hepatitis B, C, or B/C patients. The combination of MELD, platelet count, and spleen size fairly predicts 30-day re-admission occurrence with an AUC of 0.726. Discussion: Thrombocytopenia is a common hematological complication in patient with chronic liver disease. The mechanism of thrombocytopenia classically is thought to be caused by pooling and destruction of platelets within the enlarged spleen. Other proposed mechanisms are impaired platelet production in the bone marrow, production of inhibitors of platelet production in the spleen, and decreased platelet growth factor thrombopoietin production from liver as well as increased degradation of thrombopoietin by platelets sequestered in the congested spleen. A recent study showed that in more severe chronic hepatitis due to hepatitis-c virus where severity was assessed with Child-Pugh score, both mature and premature platelet counts are low and this inverse relation also correlates with platelet growth factor thrombopoietin level which is low in more severe liver disease. Since Child-Pugh scoring system has some degree of limitation due to subjective variation, we decided to use MELD score for our patients to assess the severity of the chronic liver disease. Our study interestingly showed no correlation between platelet count, MELD score and spleen size. Study revealed only MELD was a significant predictor in 30-day re-admission (P=0.012, AUC=0.665). For 90-day re-admission, both MELD (P=0.0034, AUC=0.691) and platelet count (P=0.030, AUC=0.647) No correlation was observed even when cohorts were broken down into separately for male and female, for patients below and above 62 years old (the median age), and for each hepatitis subtype. 30-day re admission was clearly not related Platelet count or spleen alone but in combination they were linearly related to 30 and 90 day readmission. This study was important for multiple reasons. Firstly, 30 day readmission was calculated to be 16% and 90 day readmission was found to be 29% including the 16% from 30-day readmission. Surprisingly MELD alone was not a good predictor for 30 day readmission, but in combination with other parameters Spleen size and platelet count, predictions were fairly accurate. Table 1. Statistical Analysis and Results Table 1. Statistical Analysis and Results Figure 1. ROC of 30-day re-admission. Figure 1. ROC of 30-day re-admission. Figure 2. ROC of 90-day re-admission. Figure 2. ROC of 90-day re-admission. Disclosures No relevant conflicts of interest to declare.