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"Background: Platelet-Rich Plasma is believed to repair cartilage degeneration by stimulating tissue regeneration, however the clinical evidence is still insufficient. The aim of this research is to compare the efficacy of intra-articular hyaluronic acid injection (HA) and combined hyaluronic acid and platelet-rich plasma (HA-PRP) on osteoarthritis of the knee, and the association on gender, age, body mass index and osteoarthritis degree towards the efficacy. Methods: This is a cross-setional study using 58 patients’ medical records. 27 patients received HA injections, and 31 patients received HA-PRP injections. Patients were evaluated weekly using IKDC and WOMAC score until 2 months after the injections. Results: On the 2nd month of follow up, AH-PRP shows greater increase in IKDC (p=0,146) and WOMAC (Pain p=0,004; Stiffness p=0,008; Knee function p=0,007) score compared to HA injection. There’s no association on gender, age, and body mass index towards the IKDC and WOMAC score increase on either HA or combined HA-PRP injection. There’s no significant difference on osteoarthritis degree towards IKDC and WOMAC score increase on HA injection. However, there’s a significant difference between osteoarthritis degree 2 and 4 towards IKDC (p=0,002) and WOMAC score (Pain p=0,042; Stiffness p=0,018; Knee function p=0,042) and between osteoarthritis degree 2 and 3 towards WOMAC Pain (p=0,008) and WOMAC Knee function (p=0,018). Conclusions: HA-PRP injection shows better results to reduce osteoarthritis symptoms compared to HA injections. Better results were observed in patients with less severe osteoarthritis degree."

"Pendahuluan: Kejadian ruptur tendon Achilles meningkat dalam beberapa dekade terakhir dengan insiden tertinggi didapatkan pada kelompok usia 30-39 tahun. Penanganan terkini untuk ruptur tendon Achilles adalah pembedahan dengan penjahitan primer, serta dapat juga secara konservatif pada kondisi-kondisi tertentu. Karena komplikasi adhesi dan gliding tendon sering terjadi pasca tindakan pembedahan, para peneliti berusaha menemukan bahan yang secara efektif mampu memperbaiki proses penyembuhan tendon. Platelet-rich plasma (PRP) dan membran amnion merupakan bahan yang dinyatakan memiliki potensi dalam memperbaiki proses penyembuhan tendon, mencegah adhesi dan gliding tendon. Namun, penelitian mengenai efek kombinasi keduanya masih belum pernah dilakukan.Metode: Model ruptur tendon Achilles dilakukan pada 24 ekor kelinci putih New Zealand yang terbagi dalam 4 kelompok perlakuan, yaitu kelompok kontrol, kelompok dengan pemberian membran amnion, kelompok dengan pemberian PRP dan kelompok dengan pemberian kombinasi membran amnion dan PRP. Evaluasi dilakukan pada 6 minggu setelah tindakan pembedahan berdasarkan penilaian terhadap pemeriksaan gliding tendon dengan USG, Tang score gambaran makroskopis adhesi tendon, grading adhesi secara makroskopis, Tang score gambaran histopatologis adhesi, grading adhesi secara histopatologis, serta Tensile strength tendon dengan uji tarik. Data yang didapatkan diuji secara statistik dengan jenis data dan jumlah kelompoknya.Hasil: Kelompok perlakuan membran amnion serta kelompok kombinasi membran amnion dan PRP memiliki perbedaan bermakna terhadap dalam hal gliding tendon secara USG, Tang score makroskopis dan histopatologis serta grading adhesi makroskopis dan histopatologis. Kelompok perlakuan PRP dan kombinasi membran amnion dan PRP menunjukkan perbedaan bermakna terhadap kelompok kontrol dalam hal nilai tensile strength test.

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Background: The incidence of Achilles tendon rupture has increased in the last few decades with the highest incidence found in the 30-39 years of age group. The current treatment for Achilles tendon rupture is surgery with primary suturing, and can also be conservative under certain conditions. Because adhesion complications and gliding tendons often occur after surgery, the researchers tried to find a material that is able to effectively improve the tendon healing process. Platelet-rich plasma (PRP) and amniotic membrane are substances that have the potential to improve tendon healing processes, prevent adhesion and gliding tendons. However, research on the effects of the combination of both has never been done.

Methods: The Achilles tendon rupture model was carried out in 24 New Zealand white rabbits, which were divided into 4 treatment groups, namely the control group, the group with the administration of amniotic membrane, the group with the administration of PRP and the group with the combination of amniotic membrane and PRP. The evaluation was carried out at 6 weeks after surgery based on an assessment of gliding tendon examination with ultrasound, Tang score macroscopic image of tendon adhesion, macroscopic adhesion grading, Tang score histopathological adhesion, histopathological adhesion grading, and Tensile strength tendon with the tensile test. The data obtained were tested statistically with the type of data and the number of groups.

Results: Amniotic membrane treatment group and combined amniotic membrane and PRP treatment group had significant differences in terms of gliding tendon by ultrasound, macroscopic and histopathological Tang scores and macroscopic and histopathological adhesion grading. The PRP treatment group and combined amniotic membrane and PRP treatment group showed significant differences compared to the control group in terms of tensile strength test values.

Conclusion: The administration of amniotic membrane can reduce the formed paratenon adhesion, however, it does not have statistical significance in influencing tendon strength. Giving Platelet-rich Plasma (PRP) does not affect the formation of paratenon adhesion statistically, but it affects the increase in tendon strength. The combination of amniotic membrane and PRP has a significant effect in reducing paratenon adhesion and increasing tendon strength."

"Xenoprotein yang terkandung dalam medium ekspansi standar yang digunakan untuk kultur sel punca hematopoietik (SPH) CD34+ berisiko menyebabkan graft-versus-host disease pada pasien penerima cangkok SPH CD34+. Diperlukan suplementasi medium ekspansi xeno-free untuk menurunkan risiko graft-versus-host disease pada pasien penerima cangkok. Suplementasi medium kultur ekspansi menggunakan platelet-rich plasma (PRP) dan human serum albumin (HSA) yang keduanya berasal dari manusia diharapkan dapat menggantikan suplementasi xenoprotein dalam kultur. Platelet-rich plasma diketahui mampu meningkatkan laju proliferasi sel punca, sementara human serum albumin mampu mempertahankan kepuncaan sel punca lebih baik dari fetal bovine serum. Kombinasi PRP dan HSA sebagai suplementasi medium ekspansi diharapkan mampu meningkatkan proliferasi dan mempertahankan kepuncaan SPH CD34+. Pengaruh kombinasi PRP dan HSA, rasio optimal persentase gradien suplementasi PRP dan HSA, serta durasi optimal kultur yang mampu mendukung proliferasi dan mempertahankan sifat kepuncaan SPH CD34+ perlu diketahui. Jumlah sel hidup dihitung menggunakan metode eksklusi trypan blue untuk melihat kemampuan medium uji dalam mendukung proliferasi. Fenotipe SPH CD34+ dianalisis menggunakan flow cytometry untuk mengetahui kemampuan medium uji dalam mempertahankan kepuncaan. Kombinasi suplementasi PRP dan HSA mampu meningkatkan proliferasi dan mempertahankan kepuncaan hingga hari ke-7. Persentase gradien PRP : HSA terbaik merupakan 3 : 2 berdasarkan kemampuannya dalam meningkatkan proliferasi dan mempertahankan sifat kepuncaan SPH CD34+. Kombinasi PRP dan HSA memiliki efek positif terhadap kultur SPH CD34+

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Xenoprotein contained in CD34+ hematopoietic stem cell standard culture expansion medium has the risk of causing graft-versus-host disease (GVHD) in recipient of CD34+ HSC graft. Xeno-free supplementation in expansion medium is required to reduce the risk of GVHD in graft recipient. Supplementation of expansion medium using platelet-rich plasma (PRP) and human serum albumin (HSA), both originate from humans, hopefully has the ability to replace xenoprotein supplementation in culture. Platelet-rich plasma is known to increase the rate of stem cell proliferation, while human serum albumin is able to maintain stem cell’s stemness better than fetal bovine serum. The combination of PRP and HSA as expansion medium supplementation is expected to increase proliferation and maintain the stemness of CD34+ HSC. The effect of PRP and HAS combination, the optimal ratio of the percentage gradient of PRP and HSA supplementation, as well as the optimal duration of culture that can support proliferation and maintain CD34+ HSC stemness are to be studied. Live cells were counted using the trypan blue exclusion method to see the ability of the test medium to support proliferation. CD34+ HSC phenotype was analyzed using flow cytometry to determine the ability of test medium to maintain stemness. Combination of PRP and HSA supplementation are able to increase proliferation and maintain peaks until the 7th day. The best PRP : HSA gradient percentage is 3 : 2 based on its ability to increase proliferation and maintain SPH CD34+ stem properties. PRP and HSA combination has positive effects on CD34+ HSC culture."

"Latar belakang: Inkontinensia urin tekanan (IUT) atau Stress Urinary Incontinence (SUI) didefinisikan sebagai kebocoran urin yang tidak disengaja saat aktivitas fisik atau saat bersin atau batuk. Jenis inkontinensia urin ini merupakan yang paling umum terjadi, dengan prevalensi sebesar 23–35% pada kelompok wanita dewasa. Biaya perawatan IUT diperkirakan lebih dari 16 milliar US dollar per tahunnya. Saat ini, terdapat beberapa pilihan terapi IUT, baik bedah hingga non–bedah. Jenis prosedur yang ditanggung oleh sistem Jaminan Kesehatan Nasional (JKN) di Indonesia adalah teknik Plikasi Kelly dengan efektifitas yang rendah dan rekurensi yang tinggi. Kemampuan regenerasi dari PRP (Platelet–Rich Plasma) menjadi salah satu pertimbangan yang dapat diberikan bagi pasien–pasien IUT yang dilakukan pembedahan Plikasi Kelly. Kemampuan PRP sebagai perekat, diharapkan mampu mengembalikan struktur dan fungsi Ligamentum Pubouretralis melalui aktivasi fibroblas untuk memacu pembentukan kolagen baru dengan biaya yang cukup murah menjadi pertimbangan untuk meningkatkan efektivitas tindakan Plikasi Kelly di Indonesia. Objektif: Penelitian ini bertujuan untuk mengetahui perbedaan–perbedaan perbaikan gejala klinis berupa perbaikan kualitas hidup (dinilai menggunakan kuisioner IIQ–7), penurunan berat Tes Pembalut serta kenaikan kadar serum IGF–1 pada pasien IUT yang diberikan penambahan PRP pada saat prosedur pembedahan Plikasi Kelly. Metode: Uji klinis acak tersamar tunggal yang berlangsung di 2 center penelitian, yaitu di RSUPN Dr. Cipto Mangunkusumo Jakarta dan RSUP Dr. Kariadi Semarang. Penelitian berlangsung dari bulan Maret 2021 hingga Desember 2021. Sampel penelitian adalah wanita dengan IUT yang menjalani prosedur pembedahan Plikasi Kelly.Hasil: Tidak terdapat perbedaan kualitas hidup (berdasarkan skor kuisioner IIQ–7) antara kelompok studi yang menerima adjuvan PRP dengan kelompok kontrol (4,8 vs 14,3; p=0,104). Rerata perubahan delta Tes Pembalut pada kelompok studi didapatkan lebih tinggi bermakna dibanding kelompok kontrol (49,8 vs 10,8; p=0,03), namun perbedaan hasil ini dipengaruhi oleh derajat keparahan IUT. Rerata kenaikan kadar serum IGF–1 pada kelompok studi ditemukan lebih tinggi bermakna dibanding kelompok kontrol pasca 3 bulan tindakan operatif (33,5 vs 13; p = 0,000). Kesimpulan: Pemberian PRP sebagai terapi adjuvan pada pasien IUT yang menjalani tindakan Plikasi Kelly memberikan manfaat perbaikan Ligamentum Pubouretralis yang dinilai berdasarkan perbaikan klinis (penurunan berat Tes Pembalut), kenaikan kadar IGF–1, dan peningkatan kualitas hidup (kuisioner IIQ–7). Prosedur injeksi PRP dinilai relatif aman dan efektif dalam meningkatkan efektifitas tindakan Plikasi Kelly. Hasil ini diharapkan dapat memberi bukti klinis untuk rejimen baru terapi IUT yang dapat dilakukan di Indonesia.

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Background: Stress urinary incontinence (SUI) is defined as involuntary urine leakage that occurs during physical activity, sneezing, or coughing. It is the most common type of urinary incontinence, with a prevalence of 23–35% in adult women. The treatment cost for SUI was approximately more than 16 billion US dollars each year. There are plenty of choices for SUI management, from surgical to non–surgical therapies. The procedure covered by Indonesia’s National Health Insurance is Kelly Plication surgery with a low rate of effectiveness and a high chance of recurrent. The Platelet–Rich Plasma (PRP), with its regenerative ability, is considered to be given for patients with SUI that underwent Kelly Plication surgery. The PRP injection, with its ability to act as an adhesive agent, is expected to help restore the Pubourethal Ligament’s structure and function through fibroblast activation to help trigger new collagen formation. Due to it’s low cost required, the PRP injection could be considered to help improve the effectiveness of Kelly Plication Surgery in Indonesia.

Objective: The aim of this study was to find the differences in clinical improvements, including the quality of life (measured with IIQ–7 questionnaire), decreased in weight of Pad test results, and increase in IGF–1 serum level in patients with SUI that were given the PRP injection as an adjuvant during Kelly Plication surgery.

Methods: Experimental single–blind randomized control trial study in a group of women with SUI that underwent the Kelly Plication Surgery. The study was conducted at 2 study centers in Dr. Cipto Mangunkusumo Central General Hospital, Jakarta, and Dr. Kariadi Central General Hospital, Semarang, from March 2021 to December 2021.

Result: There was no significant difference in the quality of life (measured with IIQ–7 questionnaire scores), between the study group which received the PRP adjuvant with the control group (4,8 vs 14,3; p = 0,104). The mean difference score for the weight of Pad test results in the study group was significantly higher than the control group (49,8 vs 10,8; p = 0,03). But this result was influenced by the severity of IUT. The mean increased score for the IGF–1 serum level in the study group was significantly higher than the control group, 3 months after the surgery (33,5 vs 13; p = 0,000).

Conclusion: The PRP injection as adjuvant therapy is considered to give more benefits for patients with SUI that underwent Kelly Plication surgery. The repair of the Pubouretral Ligament is measured by the improvement of the symptom (decreased of the Pad Test score), increased IGF–1 serum level, and quality of life improvement (increased of IIQ–7 Questionnaire). The procedure is considered safe and helps improve the effectiveness of the surgery. This result helps to provide clinical evidence for a new therapy regimen that could be applied in Indonesia."