In association with the Cuban Institute of Hematology and Immunology,The Cuban Society of Hematology, and The Cuban Ministry of Health and REGENESTEM LLC, a U.S. company, that provides cell therapy solutions to both patients and staff physicians around the world.
President: DrC. Consuelo Macías Abraham, Director of the Institute of Hematology and Immunology
Vice President: DrC. Antonio Bencomo Hernández, President of the Cuban Hematology Society
Professional Congress (OPC) Organizer, Palacio de Convenciones de La Habana: Alicia García Gonzalez
Regenestem: Ricardo DeCubas, CEO
Travel Arrangements: Havanatur
9:00 am - 4:30 pm Registration
6:00 pm - 8:00 pm Cocktail Reception “El Bucan” Restaurant
9:30 am - 10:00 am Lectures - Get cutting-edge research and updated best practices in PRP, Bone Marrow, Adipose, and more - Q&A, expert panel discussions, and audience interaction
9:00 am - 5:30 pm Lectures - Lectures, more Q&A, expert panel discussions, and audience interaction - Network with global thought leaders and like-minded professional
6:00 pm Closing Reception Dinner
8:00 am - 5:00 pm Workshops
- Lipoaspirate & Bone Marrow Concentrate: Basic science, optimal harvest techniques, and injection protocols
- Beginner Basics: PRP current science, literature, review and MSK ultrasound guided injection protocols
- Vitamin Infusion Therapies
In recent years there has been a notable increase in the local use of platelet-rich plasma (PRP) in epithelial regeneration of eye injuries, accelerating the physiological process of regeneration and healing of injured tissue. At the Institute of Hematology and Immunology, a study was conducted to evaluate the effectiveness and safety of topical platelet lysate applied to 10 patients diagnosed with moderate or severe dry eye. The eyedrops was prepared under strict sterile conditions in a biological safety cabinet from the patient’s own blood without the addition of any preservative. The patients underwent venous blood in a volume between 20 -50 mL in sterile tubes containing anticoagulant solution in a ratio of 1:9. It was centrifuged at 200 g for 10 min and then proceeded to extraction of PRP, which was filled into eyedrop bottles approximately 5 mL volume. Immediately cryopreservation of the samples was performed at – 40ºC. The PRP was performed prior freezing quality control, platelet count, counting residual cells (erythrocytes and leukocytes) and microbiological culture was analyzed. The application of PRP will not produce any adverse effects and was well tolerated by all patients, maintaining its stability over time.
Stem cell therapy has revolutionized significantly hitherto known concepts of healing and rehabilitation of almost every medical specialty treatment, including Maxillofacial Surgery. In Santiago de Cuba and consistent with the research project the Bank of Provincial Blood and the beginning of Ambulatory Service regenerative medicine, our specialty is conducting a research and development with the objective of evaluating the effectiveness of the application of mononuclear cells autologous peripheral blood in patients with consequent to surgery that meet the inclusion criteria residual bone defects. They are evaluated with the variables size and location of the bone defect, bone regeneration, radiographic evaluation of bone regeneration, clinical evaluation and comprehensive response to the periodic inspection a month, three months, six months and one year. So far we have treated fifteen patients with bone diseases of the jaws, as large cysts of dental origin or development with seven cases, ameloblastoma, four cases and four cases with bone defects by invasive surgeries in the surgical treatment of impacted teeth, still under study, the results have been favorable in all cases, only one experienced infection after treatment, receiving antimicrobial therapy with infection control and yet the result was surprising. In maxillofacial surgery has been proven highly effective and implantation of mononuclear cells, even in the early research results are very encouraging.
The treatment of chronic periodontitis is usually long lasting due to difficulties in controlling the inflammatory process in affected tissue. The use of regenerative medicine has allowed a new treatment thanks to its regenerative and antiinflammatory effects. Case presentation: female 44 years old patient, diagnosed with periodontitis, without treatment for over a year who has been unable to undergo surgical procedures due the persistent inflammation. She was referred to the practice of Periodoncy of “Enrique Cabrera” General Hospital to receive treatment with regenerative medicine. It was assessed to also use autologous platelets lysate, after a blood panel with platelet count. The platelet concentrate was obtained from an autologous full blood sample of some 80 ml, from which enriched in platelets plasma 3 aliquots of some 6-7 ml each were separated. A 3 cycles of freezing and defrost ensued in order to get the platelet lysate. Then, the bone defects were treated with implant of mononuclear cells, resulting in a notorious improvement of the clinical and radiologic variables, with new bone formation six months after the beginning of this treatment.The use of combined autologous platelet lysate and autologous mononuclear stem cell is effective in the treatment of chronic periodontitis.
The search for therapeutic strategies for the treatment of psoriasis is a challenge in the field of dermatology. Regenerative medicine has offered encouraging alternatives to patients with few therapeutic options. An investigation to assess the application of autologous platelet-rich plasma in patients diagnosed with psoriasis, using a quasi-experimental study, in the period between September 2014 and February 2016, the consultation of Dermatology was performed at Military Hospital “Comandante Manuel Fajardo” of Santa Clara city, and evaluated in the multidisciplinary consultation regenerative therapy at Biomedical Research Unit of the University of Medical Sciences of Villa Clara. Nine patients, whom met the criteria designed for this purpose are included. Autologous platelet-rich plasma was applied perilesional every 21 days, periodically each lesion was evaluated. Behind the second application the injuries diminished of size in 66.6 % of the patients, to the fourth treatment in the 77.7 % the injuries had attenuated intensely. Behind the fifth application five patients were asymptomatic. The perilesional application of platelet-rich plasma was effective in the treatment of psoriasis.
This case involves a patient with a short-blunt wound in the facial region compromising important anatomical regions. Tissue reconstruction and coping was performed, which generally have postoperative aftermaths such as facial asymmetry, lack of motor skills and sensitivity. This patient was treated with stromal vascular fraction and growth factors. Mesenchymal stem cells were obtained from adipose tissue (stromal vascular fraction) and growth factors, preparing seven syringes of 1 ml mixed 50 % mesenchymal stem cells MSC and 50% growth factors, injected into the superficial and deep layers of the wound, also into the emergencies of the facial and trigeminal nerves, applying them with intervals of 6 months. After two applications it was observed by clinical checkup every month and with scale of 1 to 10, a significant improvement to reach a scale 8 for 8 for sensitivity and motor function. Stem cells and growth factors in maxillofacial injuries can yield positive results for the regeneration and repair of tissues including nerve endings and also: decreasing facial asymmetry, improving facial motor skills, improving sensitivity, improved facial harmony, improving scars, improving self-esteem.
Regenerative therapy is an alternative in chronic arterial insufficiency in some advanced stages. Effectiveness of intra-arterial transplantation of mononuclear cells of peripheral blood in patients with chronic lower limb arterial insufficiency stage IIb applying external compression during cell contribution was assessed. 20 patients randomly divided into groups of 10 members were studied; group A was classified as study and B as control. In A, during implantation of 40 mL of cell concentrate into the femoral artery, external compression was applied on lower limb blood pressure with a mean calculated and B not. The patients were assessed at one, three, six months and one year after treatment evaluating claudication distance and ankle pressure index arm. In both groups claudication distance increased progressively from the first month, with no significant differences between them, in group A rate pressures in relation to its initial state showed better performance with significant from the three-month increments, which no it occurred in B. evaluation of the contra-lateral member showed progression of the disease in 90% of patients a and only 40% of B. External compression allows better performance of the index ankle pressure arm member implemented and highest percentage of cases of disease progression contralateral limb in the study, indicators of greater tendency to increased blood flow group without.
Chronic arterial insufficiency of the lower limbs is a major health problem not only because of its direct impact on the quality of life of patients, but by the systemic nature of the process. Amputation of the lower limbs is necessary in many cases thus increasing the risk of death. Arteriosclerosis obliterant is the most common cause of arterial occlusive disease in adults. Its incidence increases annually and it is recorded between 15-20% of subjects older than 70 years. The application of cell therapy with autologous mononuclear cells offers encouraging prospects. This study is aimed at evaluating in this entity, the response to treatment with this therapy. A quasi-experimental study was conducted from January 2014 to December 2015, in 36 patients who met the criteria for the study. Different variables were evaluated: symptoms, blood state and a CT angiography was performed to determine the type of occlusive pattern. At three months of treatment there was a clear improvement in 80% of patients, while mild improvement resulted in 20%. At 6 months all had an evident improvement, and no limb amputation was performed. The implant of autologous mononuclear cells was beneficial, supporting this as a valid therapeutic option in patients diagnosed with chronic lower limb arterial insufficiency.
Recent work raises the beneficial effect of cell therapy in patients with chronic arterial insufficiency by atherosclerosis obliterans. The objective was to evaluate the effect of intra-arterial autologous whole blood stimulated IIb stage atherosclerosis in lower limbs. 32 patients treated at the Angiology Service of HGD Enrique Cabrera, who were stimulated with Filgrastim subcutaneous daily for 7 days included. After it were extracted 70 ml of heparinized venous blood and immediately, without further processing, it was injected through the femoral artery in one of the lower limbs affected. In 84.4% rate increase implemented pressures member and 79.1% of the contralateral limb was achieved. 98% of cases claudication distance improved from month to more than 400 m, which remained at 2 years. a remarkable improvement was observed in the quality of life of these patients
The research was conducted in the HGD “Enrique Cabrera Cossio” to evaluate feasibility, efficacy and safety of the implantation members with lymphoedema of adult stem cells, mobilized peripheral blood by applying stimulating factor granulocyte colony (G-CSF). It is a research-based development uncontrolled clinical trial that included 30 adult patients with lymphedema of the lower limbs. We proceeded to obtaining hematopoietic stem cells by mobilizing peripheral blood stem cells autologous hematopoietic and obtaining and concentration of adult hematopoietic stem cells. Mononuclear cells were then implanted patients, keeping the treatments deemed necessary medical assistance to control the symptoms of the patient or the presence of infection. In the case of the analgesic these measures were phased out as the improvement of pain associated with treatment was expressed. Clinical tests including measurements of the lower extremities cell preimplantation were planned. Evolutionary studies a month, 3 months, 6 months and 1 year after cell implantation are performed. After these periods, patients were evaluated every 6 months for 2 years. Patients show marked improvement of the clinical manifestations of the disease presenting product, specifically decreasing the volume of the affected lower limb and the formation of new lymphatic vessels. Therefore the quality of life shown previously affected favorably restored.
Given the high prevalence and incidence of diabetes mellitus, which causes that more than 69% of patients be hospitalized because of a diabetic foot (DF) new therapeutic options have been investigated, including cell therapy. The objective was to evaluate the effect of autologous mononuclear cells (MNCs) derived from the bone marrow in patients with diabetic skin ulcers in the lower limbs. Twenty patients with ischemic DF were randomly divided into two groups. In Group I injected MNCs were taken directly from the bone marrow (BM-MNCs) and in the group II taken from peripheral blood (PB-MNCs) but without previous stimulation with Filgrastim, and therefore with fewer stem cells. The cells were injected deep into edges and bottom of the lesion. This procedure was done only once. In both groups was improvement although more appreciated in group I. Histologically, were observed abundant newly formed vessels, fibroblasts, areas of fibrosis and faster healing in group I; while in the group II there was little active granulation tissue, with little fibrosis at the second week. Group I patients achieved complete healing on average at 9 weeks, while in group II complete healing was achieved after 12 weeks. In any case limb amputation of the affected lower limb was performed. These results demonstrate the safety and efficacy of the MNCs derived from bone marrow in the treatment of DF
Diabetic foot (DF) is a very common complication of diabetes mellitus, which treatment is complex and not always effective, so new procedures including those related to regenerative medicine are been investigated. Recently important insights into the regenerative properties of the platelets have been provided. Considering this knowledge, our objective was evaluate the effect of intralesional implantation of platelets in patients with ischemic DF. Thirty patients with this diagnosis received implantation of platelet-rich plasma (PRP) intralesional in a single dose and in an amount dependent on the size of the lesion. The evaluation criteria of responses were based on the formation of granulation tissue and epithelialization. Clinical measurements and photos of the lesion were made weekly, and preimplantation biopsies, and at the second and sixth weeks were made. The results were effective in 28 patients for the formation of granulation tissue and for to accelerating epithelization useful for healing by second intention. Histologically, the implant quickly promoted fibrosis and healing. In many healing was achieved at 2 months of platelet implantation. These results demonstrate the benefits of PRP implantation in DF ulcers.
Legs ulcers are one of the most mutilating clinical manifestations of sickle cell disease, which often are chronic, very painful, with limited movement and cause disfiguring effects in relation to the time of evolution and clinical extension; besides being difficult to treat. To evaluate the effectiveness of topical treatment with platelet lysate, as well as side effects, 51 patients with sickle cell disease and legs ulcers were studied; separated into 2 groups: 30 treated with allogeneic platelet lysates preserved, useless for hemostasis more conventional treatment and 21 patients treated with usual therapeutic methods, as control group. The response was rated as good, when at or before 4 weeks of treatment the patient had partial or complete response. In 90% of patients treated with platelet lysate good response it was obtained with 19, 04% in the control group (p 0.00). The observed adverse events were intensified pain and rash appearance in the perilesional area in 4 patients (13, 3%). The study showed that the platelet lysate is effective with few side effects and is recommended as a novel outpatient treatment option that prevents or reduces hospitalization and costs in treating ulcers maleolares patients with sickle cell disease.
Introduction: The regenerative medicine does not just limit to the used of the stem cell, it also includes the therapeutic application of divers stimulants factors and others soluble elements which interview in various biological processes.
Méthod: A comparative, longitudinal and prospective study of 60 adults with deep burns, assisted in “Dr. Juan Bruno Zayas Alfonso” Teaching General Hospital was carried out in Santiago de Cuba, from February, 2013 to the same month of 2014, to evaluate the effectiveness of the regenerative therapy with platelets rich plasma for the scaring of these lesions. The sample was divided into 2 groups of 30 members each: in those of the first group platelets rich plasma allogenic platelets obtained in the Blood Provincial Bank, for external used on the burn, covering it with gauze with an interval of three days; to the other group it was applied silver sulfadiazine through an occlusive cure in alternate days. In both groups the evaluation of the cicatrization was evaluated through the clinical method and the measuring of the cicatrization area as well as carrying out photography of control at the 7, 14 and 21 days.
Results: 30.0 % of patients treated with platelet-rich plasma healed between 7-13 days. The 11.6 % of patients who had complications belonged to silver sulfadiazine treated group being the most common local infection (13.3 %) and deepening (10.0 %).
Conclusions: The treatment was successful in 76.7 % of patients treated with platelet-rich plasma demonstrating the effectiveness of treatment as a therapeutic alternative to be used in deep dermal burns.
Hair plays no vital role in human, but do not underestimate their psychological contribution to be a symbol of masculinity in men and a crown of glory in women. Non-scarring alopecia is hair loss nonpermanent scalp, with reversible involvement of hair follicles, not only impact on health but also psychological and aesthetic. The objective of this research was to evaluate the efficacy and safety of platelet rich plasma in the treatment of patients with non-scarring alopecia of the scalp at the Polyclinic Centre. Eight patients with a clinical diagnosis, dermoscopic and histopathological androgenetic alopecia areata and included. With a syringe was injected 2.3 mL of platelet rich plasma, subcutaneously, in the affected in four directions for alopecia and multiple small injections in 1 cm linear pattern separation for androgenetic area. The treatment was repeated every 2 weeks to complete 4 doses. Predominance of males, white skin and alopecia areata with resettlement of plates; only 2 cases with androgenetic alopecia and hair pull test and shedding hair were negative, confirming the improvement after treatment. The only adverse event was pain in the injection site. Treatment response was favorable in most patients so it is recommended to continue research in this branch of clinical trichology and regenerative medicine.
Introduction: The plasma rich in platelests contains not only a high level of platelets as well as the growth factors that are secrete actively by the platelets.
Method: An observational, descriptive, longitudinal and prospective study was done to evaluate the effectiveness of the plasma rich in platelets in 27 patients from both sexes therefore the surgical exéresis of the tattoos in the Plastic Surgery Service of the Dr. Juan Bruno Zayas Alfonso Teaching General Hospital during the period 2012 – 2014. The plasma rich in allogenic platelets was obtained in the Ambulatory Service of the regenerative medicine from the Blood Bank. It was taken to the transfusion service of the hospital where it was defrosting, activating it in the moment of application with 0.05 ml of calcic chloride at 10% by 1 ml of plasma. The application was done each three days with a weekly evaluation and measuring of the size of the bloody zone, presence of secretions, slough, characteristics of the granulated tissues and characteristics of the surrounding tissues.
Results: Predominated patients who had surgical area with an area less than 4999 mm2 to 48.2% and that healed between 15 and 21 days with an average of 15.8 days to achieve healing.
Conclusion: The application of platelet-rich plasma significantly decreased healing time without using skin grafts. The treatment was successful in 92.6% of our patients.
Ophthalmology is part of the pioneering specialty in the field of Regenerative Medicine. Knowledge of the beneficial effects of autologous serum they make part of this nobel discipline, favoring humidification of the ocular surface very similar to the tear characteristics in terms of pH and osmolarity, immunologically innocuous, composed of multiple growth factors, assisting the regeneration processes. It was decided to evaluate the response to treatment with autologous serum eye drops to 20% in patients with corneal diseases.
Method: A quasi-experimental analytical research was conducted in the Ophthalmology Department of the University Hospital “Arnaldo Milián Castro” in conjunction with the Biomedical Research Unit of the University of Medical Sciences Dr. “Serafin Ruiz de Zarate Ruiz” Villa Clara, January 2014 to March 2016. 89 patients were included (37 men and 52 women) distributed in 4 basic ophthalmologic diagnoses, who met the inclusion criteria for the study: dry eye, corneal ulcer, limbic insufficiency and keratitis.
Results: The symptomatic improvement was significant after 12 weeks of treatment. The evolution was satisfactory ranging from a slight improvement (9%) to the disappearance of symptoms and signs, (40%). 46% of patients completed treatment with full recovery. The clinical evolution, extent of injuries considering healing and vascularization and test results of Schirmer was studied.
Conclusions: the application of autologous serum to 20% in patients in tax corneal diseases of this therapy, achieved satisfactory results.
Selection of the most effective administration route is a decisive step for the success of the cellular transplant therapy approach. Different routes are commonly used for the administration of stem cells to humans with relatively safety margins: Local injection, intra-articular injection, intra-parenchymal injection, and intravenous infusion. Local and intra-articular injection of stem cells are very effective because produce a significant increment of stem cells locally with relative safety. Intra-parenchymal injection of stem cells implies a significantly invasive method with little margin of safety and potential risk for complications. The intravenous route of infusion of stem cells is commonly used for cellular therapy with minimal risk for complications reported. Stem cells are present in most tissues. Among the sources most commonly used we find adipose tissue, bone marrow, and peripheral blood. Other tissues yield a low count of viable stem cells, hence expansion and culture are necessary to increment the cell population to levels adequate to exert therapeutic effects. For the procedures related here, we exclusively used stem cells derived from adipose tissue isolated using a proprietary protocol and cell extraction medium. A more effective route of administration and more reliable source of stem cells is needed to deliver autologous, non-cultured, minimally manipulated stem cells directly to target organs. The source tissue of stem cells should be one that yields a high count of cells ready to transplant within few hours after harvesting. With this setting in place, the harvesting of tissue, isolation of cells, and autologous transplant could be performed as a single procedure and within four hours. Intra-arterial infusion of ADASC is a novel approach that provides an effective route for delivery of a higher count of stem cells directly into the target organ. This is an advanced therapeutic approach for different medical conditions affecting organs and limbs. The adipose tissue is an excellent source for stem cells. Harvesting adipose tissue is fast and easy, has low risk for complications, and tissue is readily and abundantly available. A larger amount of tissue harvested yields a significantly larger count of viable cells.
The illness of La Peyronie is a dysfunction of connective tissue that affects to the tunic albuginea of the penis. It is presented like some indurations or badges, painful in the early phase of their evolution, mainly with the erection and causing during the same one the member’s bend that hinders in advanced grades or it impedes the sexual activity. In certain occasions it also accompanies of loss of rigidity in the erection. It is a disease of unknown etiology, epidemiology and natural history unknown, although documental references exist on the same one from very old times. Nowadays it is admitted that it is an acquired inflammatory illness.
Objective: To evaluate the effectiveness of implant of mononuclear cells mobilized to the peripheral blood in this illness.
Method: A quasi-experimental study, that included 123 patients with age between 40 to 62 years, with other associated comorbidities, was carried out. Cell infiltration was performed with needle 21, around the indurated plate previously located by the clinical method. Ultrasound and Xray penis were made preimplantation, at 6 months and a year after implantation.
Results: Marked decrease of diameter of indurated plate to six months was observed. Seven cases required a second implant that was associated with induration greater than 20 mm; in these cases recovery achieved three months after and stiffness in erection between 3-5 months
Conclusions: The cell implant done is a simple, safe and effective in cases without response to previous conventional therapies.
Bladder exstrophy is a severe congenital anomaly of lower urinary tract that affects the bladder, pelvic bones, abdominal wall, external genitalia, perineum and in some cases the intestine. Conventional treatments are based on surgical techniques, in order to reconstruct the bladder, genitals and close the wall defect. We present a case of a 3 –year- old girl, in which surgical treatment was applied 6 times without results. It was decided to combine the surgical treatment with application of regenerative medicine. It was applied platelet lysate in the bladder wall and the edges of the abdominal wall at the rate of 1 mL weekly for 4 weeks, achieving tissue regeneration. It enabled to face the edges of those structures and perform conventional surgical technique. As a result, we achieved a total closure of bladder, urethra and abdominal wall without fistulas neither between these structures nor outside. Therefore, the use of platelet lysate promote growth and tissue regeneration comprising the urinary tract, decrease the number of interventions, time Exposition structures of the abdominal cavity, and post surgical complications such as fistulas granulation tissue and scarring in pilonidal fistula.
Intergluteal pilonidal disease or pilonidal fistula is a condition presenting along the cleft between the buttocks, which runs from the bone at the bottom of the spine (sacrum) to the anus. This condition involves the hair follicles of presacral region, which penetrates into the subcutaneous tissue and forms a cyst around. It is presented as one or more pits or depressions of small diameter emerging punctate by hairs. As part of medical treatment local measures, broad-spectrum antibiotic therapy and surgical treatment are described. In latest open and closed resection techniques are described. We present a case of a 16- year- old female teenager, diagnosed last year and half with a pilonidal fistula that required surgical treatment in 3 occasions, with local measures and vitamin therapy; dehiscence of the surgical site, poor tissue granulation and poor healing. It was applied platelet lysate throughout the area of the fistula at 1 ml alternate days for two weeks; infiltration was continued for 4 obtaining weeks following the total closure of the same. Therefore the use of platelet lysate promote
Rheumatoid arthritis Is considered an articular inflammatory disease, chronicle of unknown etiology. The regenerative medicine has ample possibilities of use at the rheumatology field; what one decided evaluating for, the application of rich plasma in autologous platelet, for road intra-articular in knees of patients with diagnosis of rheumatoid arthritis. Came true a quasi-experimental, among February 2015 and January 2016, in the “Capitán Roberto Fleites” Universitary Policlinic of Santa Clara city. A total of 11 patients included beyed the American College of Rheumatology diagnostic criteria, with clinical prevailing expression in the knee joint. The pharmacologic specific therapy was not suspended. Evaluated variables were: volume of the concentrate, count platelet (x 109 /L), quantity of leucocytes (x 109 /L) and erythrocytes (x 1012 /L), variable clinics: characteristics of the pain, morning rigidity and range of articular mobility, another one: microbiological control and adverse effects. Patients were evaluated each 15 days in three occasions. The average of the score the platelet of the concentrate was of 707.6 x 109 /L. Decrease of the pain had pressure to the 15 days and the articular mobility (81.8%). The range of articular mobility increased to the mobilization of the articulation to 30 days (72.7%). The morning rigidity diminished in the 100 % of the patients. Microbiological control was negative. they did not yield adverse events. The results suggest that the treatment with autologous platelet-rich plasma in would be able to decrease the inflammatory changes that produce in rheumatoid arthritis.
The degenerative shoulder disease provokes incapacity and unfavorable repercussions in the quality of life of the affected patient. The application of autologous growth factors-rich plasma has proved to be advantageous, stating from the benefits that natural and traditional medicine provides to its acupunctural methods. An experimental study was made during the months of February 2014 until December 2016 in a Traditional and Natural Medicine Consultation belonging to “Chiqui Gómez Lubian” Policlinic and University of Santa Clara where by 42 patients were involved and tested by the Orthopedic Department with more than 3 months of no response to the conventional treatment complied with the appropriate clinical and sonographic criteria established. The autologous growth factors-rich plasma was applied in various acupunctural points in the areas of study where the patient felt pain. Two sessions of treatment were applied and each patient received five evaluations under the required conditions (at onset, on the 7th day, on 1st month, on 3rd month and on the 6th month). The measuring variables used were the clinical evolution and sonography, time of remission of symptoms, recurrence of symptoms, use of medications and complications. The results were favorable (95 %), thus satisfactory, with minimum duration of remission, lack of recurrence, reduced use of medications, no complications reported. The application of autologous growth factor-rich plasma through acupunctural methods in the degenerative shoulder disease showed satisfactory results.
Introduction. The modification of the quality of life is the patient’s main aspiration when it demands the medical care. For people with chronic illnesses as the osteoartrosis of the knees, it is not only important the cure of the illness, but also to achieve a more functional and more satisfactory life.
Method. The evaluation of the quality of perceived life was carried out in 275 patients with the diagnosis of osteoartrosis of the knee implanted with Rich Plasm in Platelets (RPP); the questionnaire SF-36 was applied, with the variables of health: Functional state and emotional Well-being, the quality of life was classified from the qualitative point of view in Bad, to Regulate and Good. The questionnaire was applied in the consultations pre and posts it implants.
Results. The quality of life perceived by the patients in the one pre-implants it was 61% with the functional Bad state and 38% to Regulate and the emotional well-being 48% responded that it was bad and 52% to regulate. The improvement was observed starting from the six months; the evolution until one year after the treatment was improving until achieving in the state Good functional 86.7% and in well-being emotional 91.4%. The patients that evolved satisfactorily were reinstated to their social and labor activities, which previously were not they possible.
Conclusions: The application of Rich Plasm in Platelets in patient with knee osteoartrosis contributed to the improvement of the quality of emotional and functional life.
The high incidence of patients with degenerative arthropathy of several joints in our midst, is a leading cause of consultation in orthopedics. The development of regenerative medicine and new therapies allow functional recovery of joints, with the use of growth factors and biologically active proteins present in the platelet rich plasma, is increasingly used. a study of therapeutic intervention to evaluate the effectiveness of platelet-rich plasma in patients with degenerative joint was performed. In regenerative medicine outpatient blood bank rich plasma frozen autologous platelets it was obtained. In the hospital transfusion service they were thawed, activated at the time of application with 0.05 mL of 10% calcium chloride per 1 mL of plasma. 10 mL intra-articularly in both knees, on hips 10 mL was applied in 0.1 mL in each hand interphalangeal joint, shoulder, elbow and ankle were applied 5 mL was applied; for three consecutive weeks. A clinical assessment was performed and the Kellgren Lawrence radiological classification was used. The highest incidence was in the female and aged between 50 and 79 años.Se have treated a total of 345 patients; of them 324 knees, hips 7, 3 hands, shoulders 8, ankle and elbow 1 2; using the method of triple implant. Patients were evaluated clinically in terms of pain, joint function, joint mobility and gait, and radiologically compared to the previous radiography; a month and then quarterly. Results was 80.5% Well, Regular 16.1% No response 3.4%. The implant of platelet-rich plasma showed clinical and radiological response degenerative joint disease in more than 60% in patients treated good.
Introduction: In recent years, Regenerative Medicine and Cell Therapy, has demonstrated its effectiveness as a regenerating articular cartilage and particularly in the treatment of gonarthrosis.
Method: A study of therapeutic intervention was performed in order to evaluate the effectiveness of platelet-rich plasma knee osteoarthritis in 171 patients with stage I and II classification Ahlbäck which had not achieved good results with a first cycle, and which held joint pain as the main symptom. In the Ambulatory Service Regenerative Medicine Blood Bank, the platelet-rich plasma frozen by self-giving was obtained weekly, and in the transfusion service hospital they were thawed, then activated at the time of application with 0.05 ml of calcium chloride at 10% for each 1 ml plasma, it was applied intraarticular 7 ml in both knees in repeating the application for 3 weeks in a second cycle. The monitoring and evaluation was conducted a month, at 3, 6 months and a year.
Results: Improvement of symptoms and signs from the 6th month, including pain, limited movement and swelling, was observed and evaluated for a year; more than 50% of patients were asymptomatic.
Conclusion: The second cycle of implant platelet-rich plasma demonstrated effectiveness and was an alternative in the treatment of patients with knee osteoarthritis.
The province of Villa Clara has a population considered among the more aged ones belonging to Cuba, correlating him to him a lofty incidence of inflammatory degenerative diseases. The osteoarthrosis of knee proves to be the more frequent within this group of diseases. The quest of therapeutic alternatives from the regenerative medicine, she proves to be necessary; the realized study evaluated the answer to the treatment with rich plasma in autologous platelet and re-qualifying therapy in gerontes group with osteoarthrosis of knee. A study accomplished quasi-experimental, between March 2015 and May 2016 itself, in the service of physical medicine and rehabilitation, belonging to “Chiqui Gómez” Universitary Policlinic of Santa Clara city. Thirty-two geriatric patients with diagnosis of osteoarthrosis of knee, excluding the grade IV, previous informed consent they evaluated pre to them and after implantation, the articular show (WOMAC’s scale), muscular strength (Lucy Danielsy’s test) and the pain (visual analogical scale). Platelet-rich plasma in autologous was administrated by road intra-articular, getting his bearings rehabilitation with fortifying exercises of quadriceps to the third day of the implantation. In the 78.1 % a month had disappeared the pain, with partial recuperation of the articular show and muscular strength. The 71.8 % maintained the previous condition to the three months, to six months 56.2 % of patients he had achieved the functional recuperation and social reincorporation. Therapy with rich plasma in platelet and the physical rehabilitation, he was for patients with osteoarthrosis of knee processed favorably.
The platelets have an unquestionable role in homeostasis and are a natural source of growth factors that have demonstrated to play a significant role in the regeneration and repair of the connective tissue. The osteoartrosis of the knee is an affection of the cartilage hyaline characterized by the progressive loss of the joint cartilage. From May 2009 until May 2015, a study with 285 mature patients with osteoartrosis, assisted in the consultation of regenerative medicine, without answer to conventional treatments, was carried out. Platelet concentrate was carried out with autologous or allogenic platelets, in that patients who have some pathology or limitation to carry out blood donation. In all the cases prevailed pain and difficulty to the march, at the beginning of the treatment. At six months, clinical improvement was observed in 267 patients (93,6 %), and only 18 (6,3 %), there was not wanted answer, coinciding these with those that presented marked alignment dysfunctions, in which pain didn’t disappear, but existed intensity modification.
Introduction: Knee degenerative arthritis or gonarthrosis is a frequent disease on daily medical practice and it is responsible of partial or total dysfunction on the people which are affected.
Method: A prospective and descriptive study was carried out from February 2014 to Februry 2016, in all patients, affected of knee osteoarthritis which were treated by intrarticular adult’s stem cells implantation during the period. The information was analyzed by means of descriptive statistical techniques, and the injured were clinical and radiographically evaluated.
Objective: Its main objectives are: the updating of knowledge for managing the illness and the characterization of the results obtained from the surgical treatment applied at “Dr. Ernesto Guevara de la Serna” Hospital in Las Tunas during this period.
Results:On regenerative medical clinic room, were implanted adults stem cells on 460 knees belong to patients affected of gonarthrosis with poor outcomes at the conservative treatment during 6 months. 9 months after performing the procedure were seen clinical improvement in 386 knee and in 32 were not satisfactory results.
Conclusions: Intrarticular adult’s stem cells implantation on knee osteoarthritis is a feasible and reasonable method, which provides an important option to approach the treatment of this invaliding disease.
BHI Therapeutic Sciences, LLC is a healthcare research and consulting company with focus on high-quality advanced stem cell therapies for regenerative medicine. BHI Therapeutic Sciences offers a novel method of arthritis therapy using a patient’s own stromal vascular fraction (SVF) cells including mesenchymal stem cells. The therapy is available at Malacky Hospital in Slovakia. Malacky Hospital is staffed with expertly-trained medical professionals and is one of the premiere hospitals in Central Europe. Blue Horizon International Slovakia is licensed by the Ministry of Health of Slovak Republic to provide adipose stem cell treatments for orthopedic joint applications – knees, hips, shoulders, and ankles. Procedures utilize cutting-edge technology and adult stem cells only. In 2015, 73 patients underwent the therapy with own stromal vascular fraction cells. 64 patients have follow-up evaluation results. Affected area includes knees (37 patients), hips (25 patients), hips and knees (2 patients). Follow-up examination results conducted 10 days, 3 and 6 months after treatment have shown significant improvement of clinical conditions relating to pain relief, improved mobility, which was shown also on the follow-up MRI scans of the affected joints. Results from patients’ follow-up examinations and MRI scans showed that stem cell therapy was safe and effective in the improvement of symptoms related to musculoskeletal conditions. Further close monitoring of subjects, inclusion of more subjects are important to fully characterize the advantages of stem cell therapy of symptoms related to musculoskeletal conditions.
Taking into account as a foundation, the contributions of the Psychoneuroimmunology, this investigation had as objective to describe, how the influence of the psychoneuroimmunology particularities associated to stress, in the evolution of the patients treated with autologous mononuclear cells as part of the applied cellular therapy. An observational descriptive study in 254 patients treated in the Unit of Biomedical Investigations of “Dr. Serafin Ruiz de Zárate Ruiz” University of Medical Sciences, between July of 2012 and March of 2016. The period of research was of approximately 30 days. Variables associated to the stress process were evaluated, as the conflicts and the patients’ expectations, the confrontation strategies to the illness, main stressful ideas, emotional associated state, as well as hematological clinical variables that comprise the protocol of these procedures (global leucocytes count and platelet count), a system of technical psychological and laboratory exams was used. The experience of the cellular therapy became a generating source of high stress levels, to which different stressful ideas were associated different. Confrontation strategies to the illness prevailed, centered in the somatization and emotional reaction. In a same way it was verified that those patients that presented bigger destabilization from the emotional and cognitive point of view took much time in reaching the prospective clinical recovery, without taking into account the hematological variables. It was evident that the fundamental components of the stress process, have a psiconeuroinmunological impact that influences in the evolution of the patients treated with autologous mononuclear cells.
The Regenerative Medicine, a reality of the last decade claims for the impact of its results as generalizations. The creation of teams-work that from the trans disciplinary field, sum up the application of the therapies at the community level is necessary; that’s why this investigation was carried out in order to evaluate the application of the treatment with growth factors-rich plasma in patient tributary of this therapy from a community perspective. An analytic, quasi-experimental study was carried out, between January 2013 and February 2016, in three medical services offered at the community level (physical medicine and rehabilitation, orthopedics and periodontia), belonging to “Chiqui Gómez” Universitary Policlinic of Santa Clara city. A total of 224 patients were studied that completed the inclusion approaches. Evolution was satisfactory varying from a light improvement (9%) until the disappearance of all symptoms and signs that motivated the therapeutic option (40%). The 46% of the patients concluded the treatment with total recovery. Regenerative Medicine applied from the communitary perspective was favorable in all of patients.
The regenerative medicine was not applied in Santiago from Cuba up to 2011, existing scarce knowledge on the cellular therapy and an area didn’t exist with appropriate conditions to carry out the obtaining and prosecution of cellular products. It was carried out an investigation of technological innovation with a project of the Bank of Blood, for the training of the professionals in the obtaining and application of the rich plasm in platelets and of the mononuclear cells autólogas. The incorporation of sanitary technologies for the organization of procedures and processes in an ambulatory service of regenerative medicine and the integration of the services with the assistance units, from the selection of patient, the delivery of the cellular products, the one implants for the specialists and the evolutionary pursuit of the illnesses. The evaluation of the effectiveness of the cellular products applied in illnesses of eleven medical specialties and Stomatology, with institutional projects carried out in three hospitals, Center of Sport and Clinical Medicine Stomatology. Qualified in graduate degree courses in medicine regenerative 253 professionals, the beginning of the new service, 6 projects in execution, 1322 treated cases in an ambulatory and applied way the integration methodology with the assistance units. The ambulatory service of regenerative medicine has contributed to the development of the cellular therapy in Santiago of Cuba.
Advances in regenerative medicine represent a hope in the treatment of various diseases. A descriptive investigation was conducted, in order to assess the scope of application of regenerative cell therapy in the province as well as the safety and efficacy of the introduction of these techniques. Hematology Service records were reviewed to obtain data regarding indications, procedures made per year and per service. The information on the evolution of patients was obtained from medical records, pick-up visits. The results are presented in absolute and relative values by using tables and graphs. Cienfuegos was the fourth province to introduce this new technique in 2007. By 2015, 685 patients have been treated, about half of the cases belong to Angiology specialty and the most frequent indication is arteriosclerosis obliterans. In the last three years of the study, it ranks first as an indication, knee osteoarthritis (292 cases). The results have been favorable, including highlights: reducing the number of amputations in patients with critical limb ischemia and decreased pain in those with degenerative lesions of the knee joint. Adverse events that have occurred are mild, reversible and mostly related to the administration of stimulating factors granulocyte growth.
In the continuous search for the ideal for increased soft tissue injectable autologous material, has used different variants of treatment, these emerging technologies are based on the supply of growth factors and bioactive proteins to trigger the healing and regenerative processes. In this research, a descriptive and retrospective study of patients treated at the department Blood Bank HCQ Hermanos Ameijeiras, from the service of Aesthetic Surgery for the years 2013 and 2014, with the aim of addressing the process was carried out obtaining platelet-rich plasma for cellular therapies. These cell therapies were applied to 73 patients, 79 applications; 70 women (95.89%) and 3 men (4.10%); one patient diagnosed with facial lipodystrophy and the others treated for cosmetic purposes. Cell counts were adequate and of samples taken for microbiology, 76 were no bacterial growth (96.20%) and 3 positive samples, 3.79%. Patients were predominantly female and of age group between 18-40 years. Controls and microbiological laboratory safety ensured proceed
The increasing incidence of lesions of bone, cartilage, tendon and ligament is stimulating the development of less invasive surgical procedures. The process of tissue repair is a complex cascade of biological events controlled by numerous cytokines and growth factors. the experience is addressed in the Blood Bank HCQ Hermanos Ameijeiras, a descriptive and retrospective study with a sample of 268 patients seen during the years 2013 and 2014, with the aim of addressing the process of obtaining soluble products derived from platelets for cellular therapies, being specific in the recruitment process, demographic variables and behavior results in cell counters and microbiological studies. 1,505 applications for a total of 268 patients, demographically predominance of females and patients less than or equal to 60 years were made. Osteoarthritis was mostly treated lesion, the 35.41% of the applications had a cell count considered adequate and 96.94% of microbiological studies were no bacterial growth. The recruitment process ensured the absence of complications during procederes, the predominance of women under 60 years with osteoarthritis between treated patients and a high percentage of cell counts in appropriate parameters predominance of negative microbiological studies of bacterial growth and no signs with clinical sepsis in the application sites.
González Iglesias AI, González Suárez T, Salgado Arocena O, Olivares Mustelier D, Fernández Delgado N, Forrellat Barrios M, Hernández Rego Y, Hernández Ramírez P
Instituto de Hematología e Inmunología, La Habana, Cuba
Platelet soluble factors have been used for regenerative purposes by its action in the repair and regeneration of tissues. Institute of Hematology and Immunology has promoted the use of platelets for regenerative purposes. This work shows the characteristics of platelet preparations used in the institution. A retrospective and comparative analysis of platelet preparations used in regenerative medicine was made. Platelet concentrates were obtained from thromboapheresis and extraction, autologous and allogeneic platelets with the platelet lysate was prepared. Means and standard deviations were calculated and compared using the Student t test for independent samples (p0.05). Concentration of erythrocytes and leukocytes were within permissible limits. Microbiological study was negative in all cases. A significantly higher concentration in autologous platelets (p <0.001) relative to allogeneic was obtained. No significant differences between the autologous preparations (p = 0.38) and the volume obtained by thromboapheresis was greater. Significant differences in relation to the volume of concentrated (p <0.001) were found. The characteristics of the preparations were similar to those of other studies which use natural and some commercial platelets. The advantage over most is that the method is simple, fast, inexpensive and reproducible, does not require the use of activators, is safe and provides a number of platelets can release growth factors needed for tissue repair.
The benefits of the use of the platelets growth factors in the repair and regeneration of different tissues are well identified in multiple investigations and, it has been extended with the employment of different methods for obtaining and use of allogeneic platelet-rich plasma (APRP), in two variants, as a lysate or as a gel. The APRP obtained at the blood bank, preserved in liquid phase at 22 ºC during 5 days, not useful as hemostatic agent, without changes in color, not hemolyzed and with a platelet count in an accepted index of quality, was transferred to the Service of Regenerative Medicine, after the registry of data given in the bag. It was frozen to -30 ºC, and defrosted quickly in water bath during 10 minutes, obtaining a rich-growth factors homogeneous lysate, with a total volume of 50-60 mL, average platelets counts higher to 5.5 x 1010/L and a negative microbiological study result. The gel was obtained adding 3 mL of Calcium Chloride at 10%, to the bag content mixing and in refrigeration until the gel is formed. The ABO blood typing was carried out to all patients in order to use isogroup platelets. A gel topic application was done in chronic cutaneous ulcers and the lysates were applied in burnings and in removal of tattoo, and all patients treated had a good clinical recovery in less time that with the conventional treatment. The use of the APRP is effective in the treatment of dermatologic and aesthetic disorders.
In autologous mononuclear cell implant, employs stimulating factors ofgranulocyte colony. Technical Scientific Service created for this purpose in BiomedicalResearch Unit of Villa Clara, uses the Hebervital for mobilizing mononuclear cells into theperipheral blood. This research was conducted to characterize the stimulating effect of Hebervital through some hematological clinical variables. A quasi-experiment was performed in 246 tributaries patients (in the specialties: angiology, orthopedics and periodontics), from July 2012 to January 2016. The Hebervital was delivered subcutaneously (total dose of 40 μg/kg, distributed in 4 subdoses of 10 μg/kg administered every 12 hours). Variables were determined: total volume of concentrate mononuclear cells, cellnumber, viability and adverse effects to stimulant treatment. Baseline white blood cell countand post mobilization was assessed by parametric tests (T test for related samples). The total volume was between 5 and 30 mL of concentrate with 97.6% viability and anaverage cell count of 228.75 x 10 9/L. The baseline WBC count showed an average of 7.4 x10 9/L, increasing to 41.2 x 10 9/L post mobilization. 17% of mild adverse reactions, among which bone pain was the most frequent report. Mobilization of autologous mononuclear cells with the use of Hebervital was effective, reporting few adverse effects.
In different studies it has raised a negative impact of age on the mobilization of hematopoietic progenitors, and even if it is over 55 years negatively affects the production of CD34 + cells. The influence of age on response to the mobilization of patients selected for cell therapy was evaluated. We studied 250 patients with an average age of 62.8 years. The mobilization of mononuclear cells (MNC) was performed using G-CSF domestic production at doses of 40 mg/kg divided into 4 sub-doses of 10 mg/kg every 12 hours. The collection and separation of the CMN autologous peripheral blood was performed using the method designed at the Institute of Hematology and Immunology. The difference between the leukocyte count before and after mobilization was calculated and was classified as low: <20 x 109/ L, normally between 20 and 40 x 109/ L and high:> 40 x 109/ L. When analyzing the degree of response to the mobilization according to age, a predominance of cases with normal and high response was observed. No significant differences were found in response to stimulation by comparing older and younger than 60 years of age (p = 0.35). This is an important element to consider in response to the increasing number of centers that communicate using precursors encouraging results obtained by apheresis of peripheral blood
At the Institute of Hematology and Immunology a method of obtaining and processing of hematopoietic progenitor cells (CPH) mobilized to peripheral blood using the granulocyte colony stimulating factor (G-CSF or Neupogen®Filgrastim) was normalized. Besides the stimulating effect of two G-CSF domestic production was evaluated: Hebervital® (Heber-Biotec SA, Havana) and ior®-LeukoCIM (CIMAB SA, Havana) for the mobilization of peripheral blood CPH to, and they were compared with a control group mobilized the Neupogen (Roche SA, Switzerland) commercial factor. Were included 250 patients selected for cell therapy Angiology Service of the Hospital “Enrique Cabrera”; the patients were randomized to treatment groups according to G-CSF form. The total test dose delivered was 40 μg/kg, distributed in 4 sub-doses of 10 μg/kg administered every 12 hours subcutaneously. To assess the efficacy variables were analyzed the content of nucleated cells and mononuclear cells (MNC). No significant differences were observed in the concentration of leukocytes and CMN present in the cell concentrates obtained with each of the G-CSF or the degree of mobilization obtained (p = 0.76), the effectiveness of the G-CSF of national production was demonstrated. Adverse effects of light and independent mobilization were stimulating factor. Mobilization of hematopoietic progenitor cells with the use of Hebervital® (Heber-Biotec SA, Havana) and ior®-LeukoCIM (CIMAB SA, Havana) was effective, reporting few adverse effects.
Application of Regenerative Medicine since 2012, in Villa Clara, hasbenefited more than 3000 patients. Fourteen specialties have incorporated this discipline to their therapeutic arsenals. The aim of this study was to describe the resultsof the implementation of a protocol for Regenerative Medicine in Biomedical ResearchUnit of Villa Clara. A descriptive observational study involving 2068 patients treated in Regenerative Therapy Consultation during the period between July/2012 and March/2016 was performed. It was used the method of density gradient Ficoll to isolate mononuclear cells and Anitua method for obtaining platelet rich plasma. Calcium chloride 10% was used to stimulate alpha platelet granules. Between 5 and 30 mL was the total volume of the concentrate of mononuclear cells, the average of thesecells was 216.6 x 109/L, with a viability of 97.2%. It was reported (17.3%) of mildadverse reactions, with stimulant treatment. There was clinical and / or radiologicimprovement in 96% of patients. The final volume of plasma rich in growth factors was3 to 4 mL; the mean platelet count of the concentrate was 697.4 x 109/L. Themicrobiological control in all samples was negative. 82% of the procedures wereperformed on an outpatient basis. The implementation of the protocol ofaction made possible the application of Regenerative Medicine in 14 specialties in Villa Clara province.
Patients with diseased or injured organs may be treated with transplanted tissues. There is a severe shortage of donor organs and tissues which is worsening yearly due to the aging population. Regenerative medicine and tissue engineering apply the principles of cell transplantation, material sciences, and bioengineering to construct biological substitutes that may restore and maintain normal function in diseased and injured tissues. Stem cells may offer a potentially limitless source of cells, and 3D bioprinting applications are being utilized for potential therapies. Recent advances that have occurred in regenerative medicine will be reviewed. This includes the use of cell therapies to treat various medical conditions, such as burns and kidney disease, as well as the engineering of tissues and organs implanted in patients, such as blood vessel and bladders. Applications of these new technologies that may offer novel therapies for patients with tissue injury and organ failure will be described.