Jeffery J. Ericksen

A Preliminary Study on the Potential of Manuka Honey and Platelet-Rich Plasma in Wound Healing

Aim. The purpose of this study was to determine the in vitro response of cells critical to the wound healing process in culture media supplemented with a lyophilized preparation rich in growth factors (PRGF) and Manuka honey. Materials and Methods. This study utilized cell culture media supplemented with PRGF, as well as whole Manuka honey and the medical-grade Medihoney (MH), a Manuka honey product. The response of human fibroblasts (hDF), macrophages, and endothelial cells (hPMEC) was evaluated, with respect to cell proliferation, chemotaxis, collagen matrix production, and angiogenic potential, when subjected to culture with media containing PRGF, MH, Manuka honey, and a combination of PRGF and MH. Results. All three cell types demonstrated increases in cellular activity in the presence of PRGF, with further increases in activity seen in the presence of PRGF+MH. hDFs proved to be the most positively responsive cells, as they experienced enhanced proliferation, collagen matrix production, and migration into an in vitro wound healing model with the PRGF+MH-supplemented media. Conclusion. This preliminary in vitro study is the first to evaluate the combination of PRGF and Manuka honey, two products with the potential to increase regeneration individually, as a combined product to enhance dermal regeneration.

A case report on the use of sustained release platelet-rich plasma for the treatment of chronic pressure ulcers

Abstract Background/objectives: Chronic pressure ulcers affect patient health, emotional state, and quality of life, causing considerable morbidity and mortality in addition to contributing to significant health care costs from lengthy hospitalizations to advanced home care and surgical care costs. The conventional treatment of these wounds can be slow due to their chronic inflammatory state and the senescence of local reparative cells. Platelet-rich plasma (PRP) therapy has been growing as a viable treatment alternative for a number of clinical applications and has potential benefit for use in chronic wounds. The sustained release of large quantities of autologous growth factors, cytokines, and other mediators found in PRP plus the favorable mononuclear cell profile of PRP may help us to stimulate wound healing and resolve chronic inflammation. Methods: Three veterans with spinal cord injury (SCI), presenting with chronic stage IV pressure ulcers, were treated with a sustained release PRP therapy to stimulate wound healing. Results: PRP treatment consistently resulted in the formation of granulation tissue and improved vascularity for each of the three patients treated, while reducing the overall ulcer area and volume. Conclusion: The controlled release of growth factors from PRP demonstrated a positive stimulatory effect on the healing rate of chronic pressure ulcers in individuals with SCI.

Clinical Examination Results in Individuals With Functional Ankle Instability and Ankle-Sprain Copers

CONTEXT Why some individuals with ankle sprains develop functional ankle instability and others do not (ie, copers) is unknown. Current understanding of the clinical profile of copers is limited. OBJECTIVE To contrast individuals with functional ankle instability (FAI), copers, and uninjured individuals on both self-reported variables and clinical examination findings. DESIGN Cross-sectional study. SETTING Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS Participants consisted of 23 individuals with a history of 1 or more ankle sprains and at least 2 episodes of giving way in the past year (FAI: Cumberland Ankle Instability Tool [CAIT] score = 20.52 ± 2.94, episodes of giving way = 5.8 ± 8.4 per month), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers: CAIT score = 27.74 ± 1.69), and 23 individuals with no history of ankle sprain and no instability (uninjured: CAIT score = 28.78 ± 1.78). INTERVENTION(S) Self-reported disability was recorded using the CAIT and Foot and Ankle Ability Measure for Activities of Daily Living and for Sports. On clinical examination, ligamentous laxity and tenderness, range of motion (ROM), and pain at end ROM were recorded. MAIN OUTCOME MEASURE(S) Questionnaire scores for the CAIT, Foot and Ankle Ability Measure for Activities of Daily Living and for Sports, ankle inversion and anterior drawer laxity scores, pain with palpation of the lateral ligaments, ankle ROM, and pain at end ROM. RESULTS Individuals with FAI had greater self-reported disability for all measures (P < .05). On clinical examination, individuals with FAI were more likely to have greater talar tilt laxity, pain with inversion, and limited sagittal-plane ROM than copers (P < .05). CONCLUSIONS Differences in both self-reported disability and clinical examination variables distinguished individuals with FAI from copers at least 1 year after injury. Whether the deficits could be detected immediately postinjury to prospectively identify potential copers is unknown.

The influence of platelet‐rich plasma on myogenic differentiation

The ability to expand and direct both precursor and stem cells towards a differential fate is considered extremely advantageous in tissue engineering. Platelet‐rich plasma (PRP) possesses a milieu of growth factors and cytokines, which have the potential to have either a differentiative or proliferative influence on the cell type tested. Here, we investigated the effect of PRP on C2C12 myoblasts. A range of PRP concentrations in differentiation media was used to determine whether a concentration dependence existed, while PRP embedded in fibres of aligned electrospun polydioxanone and polycaprolactone was used to determine whether this presence of fibres would cause any differences in response. In both cases, it was found that late myogenic markers were suppressed after 7 days in culture. However, an early differentiation marker, MyoD, was upregulated during this same time period. The results from this study represent the ability of PRP to have an influence over both myogenic proliferation and differentiation, a factor which could prove useful in future studies involved with skeletal muscle tissue engineering. Copyright

The Creation of Electrospun Nanofibers from Platelet Rich Plasma

Activated platelet rich plasma (a PRP) contains supra physiologic amounts of autologous growth factors and cytokines known to enhance wound healing and tissue regeneration. Here we report the first results of electro spinning nanofibers from a PRP to create fibrous scaffolds that could be used for various tissue engineering applications. Human platelet rich plasma (PRP) was created, activated by a freeze-thaw-freeze process, and lyophilized to form a powdered preparation rich in growth factors (PRGF). It was dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol (HFP) at different concentrations to form fibers with average diameters of 0.3 ? 3.6 ?m. A sustained release of protein from the PRGF scaffolds was demonstrated up to 35 days, and cell interactions with the PRGF scaffolds confirmed cell infiltration after just 3 days. As electro spinning is a simple process, and PRGF contains naturally occurring growth factors in physiologic ratios, creating nanofibrous structures from PRGF has the potential to be beneficial for a variety of tissue engineering applications.

The impact of diabetes mellitus on stroke acute rehabilitation outcomes.

Ripley DL, Seel RT, Macciocchi SN, Schara SL, Raziano K, Ericksen JJ: The impact of diabetes mellitus on stroke acute rehabilitation outcomes. Am J Phys Med Rehabil 2007;86:754–761. Objective:To examine the impact of diabetes mellitus (DM) on functional outcomes after acute rehabilitation for cerebrovascular accident (CVA). Design:A retrospective research design was used to analyze outcomes in patients with a primary diagnosis of unilateral stroke (n = 367) admitted to an urban, acute rehabilitation center in the Southeastern United States. Results:Multivariable hierarchical regression revealed that DM did not contribute statistically significant variance to stroke acute rehabilitation prediction models. Rehabilitation admission functioning scores, rehabilitation length of stay, age, and stroke type were significant predictors of poststroke rehabilitation motor outcomes (r 2 = 0.603) and cognitive outcomes (r 2 = 0.712). Diabetes also had no significant impact on acute stroke rehabilitation lengths of stay or rehabilitation discharge setting. Conclusions:Diabetes does not seem to significantly impact short-term acute rehabilitation outcomes after stroke. Persons with diabetes who suffer a stroke seem to benefit and improve during their acute rehabilitation stay at levels equivalent to peers who are not diagnosed with diabetes. Future research should examine the impact of diabetes subtypes and undiagnosed diabetes on short- and long-term outcomes.

Intra-rater Reliability of Ultrasound Imaging of Wrist Extensor Muscles in Patients With Tetraplegia

(i) To determine the intra‐rater reliability and precision of the ultrasound cross‐sectional area (CSA) measurements of the wrist extensors in individuals with spinal cord injury (SCI), and (ii) to determine whether tetraplegia has a negative influence on the reliability and precision for these measurements.

Gynecological surgery and low back pain in older women: testing the association with sacroiliac joint stiffness and pelvic floor movements.

Objective: To determine sacroiliac joint compliance characteristics and pelvic floor movements in older women relative to gynecological surgery history and back pain complaints. Design: Single-visit laboratory measurement. Setting: University clinical research center. Participants: Twenty-five women aged 65 years or older. Outcome Measures: Sacroiliac joint compliance measured by Doppler imaging of vibrations and ultrasound measures of pelvic floor motion during the active straight leg raise test. Results: Doppler imaging of vibrations demonstrated test reliability ranging from 0.701 to 0.898 for detecting vibration on the ilium and sacrum sides of the sacroiliac joint. The presence of low-back pain or prior gynecological surgery was not significantly associated with a difference in the compliance or laxity symmetry of the sacroiliac joints. No significant difference in pelvic floor movement was found during the active straight leg raise test between subject groups. All P values were ≥.4159. Conclusions: Prior gynecological surgery and low-back pain were not significantly associated with side-to-side differences in the compliance of the sacroiliac joints or in significant changes in pelvic floor movement during a loading maneuver in a group of older women.