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The supposition is that the usage of fibrin rich in leukocytes and platelets advanced (A-PRF) in ulcerative osteomyelitis of the diabetic foot allows rehabilitation from this critical illness. In this investigation, the focus was to normalize the use of platelet-rich fibrin (PRF) in patients with osteomyelitis not amputated, to use this second-generation platelet concentrate as a regeneration enabler. The researchers submitted and utilized A-PRF membranes (1300 g × 8 min) in 7 patients (all diabetics) with osteomyelitis and cutaneous injury for 6 months. The membranes, in combination with the supernatant fluid produced by stress, have been integrated into the skin lesion down to the bone after surgical debridement. The advancement of the lesions after some period of time has been analyzed. All 7 subjects had a probe-to-bone positive assay; magnetic resonance imaging indicated cortico-periosteal coagulation and/or foci of cortico-spongeous osteolysis contiguous to the lesion. Gram-positive bacteria were identified in our procedures in 52% of cases. Gram + Cocci, for example, Staphylococcus aureus (15.6%), β-hemolytic Streptococci (12.1%), Streptococcus viridans (7.1%), and Gram-negative bacteria, for example, Pseudomonas (10.6%), Proteus (7.8%), Enterobacter (5.7%) were present. Candida albicans was active in 2.8% of cases. The blood count showed no relevant differences. To date, cutaneous lesions have been cured in 6 of the 7 subjects treated (1 patient for more than 6 years) without any evidence of infection or recurrence. The results obtained on our subjects indicate that PRF membranes may be a therapeutic option in this problematic disease. In fact, this clinical approach may have the potential to promote the healing of diabetic skin lesions with osteomyelitis.

Background: Hypothesis is that the use of fibrin rich in leukocytes and platelets advanced (A-PRF) in ulcer osteomyelitis on diabetic foot, allows recovery from this serious disease. In this study, the goal was to standardize the use of PRF in patients with osteomyelitis, to use this second-generation platelet concentrate, as a facilitator of healing. Methods: Authors produced and used peripheral blood A-PRF (1300 g × 8 min) membranes in 7 patients (all diabetic) with osteomyelitis and skin lesions for at least 6 months. Membranes, together with the supernatant liquid derived from compression, were inserted into the skin lesion down to the bone after surgical debridement. Evolution of the lesions over time was analyzed. Results: All seven patients had a positive Probe-to-Bone test, MRI detected cortico-periosteal thickening and/or foci of cortico-cancellous osteolysis adjacent to the ulcer. Gram-positive bacteria were found in our patients in 52% of cases. Cocci Gram +, such as S. Aureus (15.6%), S. -haemolytic (12.1%), S. Viridans (7.1%), and Bacilli Gram- such as Pseudomonas (10.6%), Proteus (7.8%), Enterobacter (5.7%) are present. Candida Albicans is present in 2.8%. Blood count showed no major changes. To date, skin lesions have healed in 6 of the seven patients treated (one patient for more than five years) with no signs of infection or recurrence. Conclusions: Results obtained on our patients suggest that PRF membranes may be a therapeutic option in this difficult to treat pathology.

Aims: Leiomyosarcomas are infrequent malignant tumors of smooth muscle, mainly derived from blood vessels or viscera. Superficial leiomyosarcomas are rare soft tissue sarcomas resulting from the dermis or subcutaneous tissue. They show a preference for proximal ends and tend to be slow-growing. They clearly show different histological and prognostic characteristics depending on whether they are cutaneous or subcutaneous. Case Report: We reported the case of subcutaneous leiomyosarcoma resulting in the medial subinguinal region of the right thigh in a 58-year-old female. Leiomyosarcoma is an entity whose clinical presentation may appear non-specific, making diagnosis difficult. We discussed the case with a brief review of the literature and the difficulties of a first approach clinical diagnosis. Conclusion: In conclusion, a long period of patient follow-up is recommended to capture a subsequent malignant progression of the disease.

The supposition is that the usage of fibrin rich in leukocytes and platelets advanced (A-PRF) in ulcerative osteomyelitis of the diabetic foot allows rehabilitation from this critical illness. In this investigation, the focus was to normalize the use of PRF in patients with osteomyelitis not amputated, to use this second generation platelet concentrate as a regeneration enabler. The researchers submitted and utilized A-PRF membranes (1300 g × 8 min) in 7 patients (all diabetics) with osteomyelitis and cutaneous injury for 6 months. The membranes, in combination with the supernatant fluid produced by stress, have been integrated into the skin lesion down to the bone after surgical debridement. The advancement of the lesions after some period of time has been analyzed. All seven subjects had a Probe-to-Bone positive assay; MRI indicated a cortico-periosteal coagulation and/or foci of cortico-spongeous osteolysis contiguous to the lesion. Gram-positive bacterium were identified in our procedures in 52% of cases. Gram+ Cocci, for example, S. Aureus (15.6%), S. Hemolytic (12.1%), S. Viridans (7.1%), and Gram-negative Bacteria, for example, Pseudomonas (10.6%), Proteus (7.8%), Enterobacter (5.7%) are present. Candida Albicans is active in 2.8%. The blood count shows no relevant differences. To date, cutaneous lesions have cured in 6 of the seven subjects treated (one patient for more than five years) without any evidence of infection or recurrence. The results obtained on our subjects indicate that PRF membranes may be a therapeutic option in this problematic disease.

Il crescente settore multidisciplinare dell’ingegneria tissutale mira a rigenerare, migliorare o sostituire in modo prevedibile i tessuti danneggiati o mancanti per una varietà di condizioni causate da traumi, malattie e vecchiaia. Per garantire che i metodi per l’ingegneria tissutale siano ampiamente applicabili in ambito clinico, è necessario modificarli in modo da renderli prontamente disponibili e relativamente facili da usare nella routine clinica quotidiana. Pertanto, i passaggi tra la preparazione e l’applicazione devono essere ridotti al minimo e ottimizzati per renderli pratici e l’implementazione realistica. L’obiettivo generale di sviluppare concentrati piastrinici di origine naturale può essere prodotto vicino al paziente e accelerare il processo di impianto essendo finanziariamente realistico per il paziente e per il sistema sanitario. La fibrina ricca di piastrine (PRF) e i suoi derivati sono stati utilizzati in un’ampia varietà di campi medici per la rigenerazione dei tessuti molli. In conclusione, i risultati della presente revisione sistematica evidenziano gli effetti positivi del PRF sulla guarigione delle ferite dopo terapia rigenerativa per la gestione di vari difetti dei tessuti molli riscontrabili nel wound care. Growing multidisciplinary field of tissue engineering aims to regenerate, improve or replace predictably damaged or missing tissues for a variety of conditions caused by trauma, disease and old age. To ensure that tissue engineering methods are widely applicable in the clinical setting, it is necessary to modify them in such a way that they are readily available and relatively easy to use in daily clinical routine. Therefore, the steps between preparation and application must be minimized and optimized to make them realistic implementation. General objective of developing platelet concentrates of natural origin can be produced close to the patient and accelerate the implantation process, being financially realistic for the patient and the health system. Fibrin rich in platelets and leukocytes (PRF) and its derivatives have been used in a wide variety of medical fields for soft tissue regeneration. In conclusion, the results of this systematic review highlight the positive effects of PRF on wound healing after regenerative therapy for the management of various soft tissue defects found in wound care.

Fibrin rich of platelets (PRF®) of Choukroun represents a new step in the therapeutic concept of platelet gel with a simplified processing and biochemical changes little artificial. A valid method of preparation of the PRF must effectively separate the plates by erythrocytes and concentrate without damaging or lysing the plates themselves. In this study the experimental design is to standardize the production of L-PRF in horse directing it to human production. Our hypothesis is that the L-PRF is easy to produce in the horse, without modifications of the human protocol, thus allowing a better standardization of the human protocol. A new device for the preparation and the standardization of L-PRF clots and membranes is the L-PRF Wound Box®. The optical microscopy, most cell bodies were highlighted concentrated in the proximal portion of each membrane, the last 1/4 was observed at the center; the distal part had only residual traces of cell bodies. The L-PRF will form constantly when the phases described above are strictly adhered to. The success of the art L-PRF depends entirely on the speed of blood collection and transfer in centrifuge within a minute and by a temperature of centrifugation and compression is higher than 21°C (between 21 and 30°C). Our experiments on the horse will no doubt be able to improve our understanding on wound healing, in particularly in chronic skin lesions therapy.

Vitamin K antagonists, such as warfarin, used in oral anticoagulation therapy currently represent the standard drugs for the primary and secondary prevention of stroke in non-valvular atrial fibrillation (AF), with a relative risk reduction close to 70%. Newer oral anticoagulants, such as direct thrombin inhibitors (i.e., dabigatran) and direct factor Xa inhibitors (i.e., apixaban and rivaroxaban) have been recently compared with warfarin in large randomized trials for stroke prevention in AF. The new oral anticoagulants showed, compared with warfarin, no statistically significant difference in the rate of stroke or systemic embolism in secondary prevention (patients with previous transient ischemic attack or stroke) subgroups. With regard to safety, the risk of intracranial bleeding was reduced with new anticoagulants compared with warfarin. Indirect treatment comparisons of clinical trials on secondary prevention cohorts showed no significant difference in efficacy among apixaban, rivaroxaban, and dabigatran; but dabigatran 110 mg was associated with less intracranial bleedings than rivaroxaban.

Economy class stroke syndrome consists of ischemic stroke due to paradoxical embolism through patent foramen ovale after a long flight. Few cases have been described in the literature to date. The treatment choice could be tricky. We present the case of a 65-year-old woman, admitted for submassive pulmonary embolism after a long flight, that presented a paradoxical embolic stroke through patent foramen ovale shortly after. The patient was treated with intravenous thrombolysis within 1 h of stroke onset with a definite symptoms improvement. Afterwards, intravenous unfractioned heparin was started with strict partial thromboplastin time monitoring. Cerebral computed tomography scan, obtained after 24 and 72 h, ruled out hemorrhage. Warfarin was started after 72 h. Patent foramen ovale was percutaneously closed 3 months after. In the reported case, the treatment with thrombolysis and subsequent heparin infusion was effective and safe. We discuss the rationale for this treatment in the light of literature data.