human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: HYPOTHESIS Local application of autologous platelet rich plasma ( PRP ) improves tendon healing in patients undergoing arthroscopic rotator cuff repair . STUDY DESIGN Prospect i ve , r and omized , controlled , double blind study ; considering an alpha level of 5 % , a power of 80 % , 22 patients for group are needed . MATERIAL S AND METHODS Fifty-three patients who underwent shoulder arthroscopy for the repair of a complete rotator cuff tear were r and omly divided into 2 groups , using a block r and omization procedure . A treatment group ( N = 26 ) consisted of those who received an intraoperative application of PRP in combination with an autologous thrombin component . A control group ( N = 27 ) consisted of those who did not receive that treatment . Patients were evaluated with vali date d outcome scores . A magnetic resonance image ( MRI ) was performed in all cases at more than 1 year post-op . All patients had the same accelerated rehabilitation protocol . RESULTS The 2 groups were homogeneous . The pain score in the treatment group was lower than the control group at 3 , 7 , 14 , and 30 days after surgery ( P < .05 ) . On the Simple Shoulder Test ( SST ) , University of California ( UCLA ) , and Constant scores , strength in external rotation , as measured by a dynamometer , were significantly higher in the treatment group than the control group at 3 months after surgery ( strength in external rotation [ SER ] : 3 ± 1.6 vs 2.1 ± 1.3 kg ; SST : 8.9 ± 2.2 vs 7.1 ± 2.7 ; UCLA : 26.9 ± 3 vs 24.2 ± 4.9 ; Constant : 65 ± 9 vs 57.8 ± 11 ; P < .05 ) . There was no difference between the 2 groups after 6 , 12 , and 24 months . The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear . In the subgroup of grade 1 and 2 tears , with less retraction , SER in the PRP group was significant higher at 3 , 6 , 12 , and 24 months postoperative ( P < .05 ) . CONCLUSION The results of our study showed autologous PRP  reduced pain in the first postoperative months . The long-term results of subgroups of grade 1 and 2 tears suggest that PRP positively affected cuff rotator healing OBJECTIVE To determine the efficacy of autologous platelet-rich plasma ( PRP ) compared with dextrose prolotherapy ( DP ) in patients with chronic recalcitrant plantar fasciitis ( PF ) DESIGN : A single-blinded , r and omized , controlled study . SETTING Department of Physical Medicine and Rehabilitation of a university hospital . PARTICIPANTS Twenty-one patients with a clinical diagnosis of chronic PF confirmed by diagnostic ultrasound ( plantar fascia thickness > 4 mm ) were r and omly assigned to the  PRP group ( n = 10 ) or the DP group ( n = 11 ) . INTERVENTIONS Each patient received 2 injections into the plantar fascia through a peppering technique under ultrasound guidance at an interval of 2 weeks , either with 2 mL of autologous PRP or 2 mL of 15 % dextrose/lidocaine solution . MAIN OUTCOME MEASUREMENTS The outcome measures included the pain , disability , and activity limitation subscales , measured by means of the Foot Functional Index . Data were collected before the first injection , at 2 weeks ( before the second injection ) , and at the 2- and 6-month follow-ups . RESULTS All patients completed the follow-ups , with the exception of 1 patient in the PRP group . The mean Foot Functional Index total and subcategory score improvements were greater in the PRP group compared with the DP group ( improvement with PRP vs DP , total : 30.4 % vs 15.1 % , pain : 29.7 % vs 17.1 % , disability : 26.6 % vs 14.5 % , activity limitation : 28.0 % vs 12.4 % ) . However , no statistically significant difference was noted at any follow-up . In the pain and disability subcategories , both groups showed significant improvements at the last re-evaluation . The PRP group also showed significant improvements in the disability and activity limitation subscales at the second re-evaluation . CONCLUSIONS Each treatment seems to be effective for chronic recalcitrant PF , exp and ing the treatment options for patients in whom conservative care has failed . PRP treatment also may lead to a better initial improvement in function compared with DP treatment ABSTRACT Activated blood platelets play a critical , early role in the wound healing response by releasing several types of growth factors at the site of injury which mediate the initial stages of tissue repair . Autologously derived platelet-rich plasma has been applied during surgery as a healing aid and some studies have shown benefit with total joint arthroplasty procedures such as in the knee . However , little has been published regarding the use of platelet-rich plasma during total hip arthroplasty . The hip is especially prone to develop isl and s of heterotopic bone following arthroplasty which can lead to pain , limited motion , and even ankylosis of the joint . If this condition is exacerbated by platelet-rich plasma , this could present a barrier to the use of this adjuvant in total hip arthroplasty . This retrospective , controlled clinical study examined the effect of platelet rich plasma application during closure following total hip arthroplasty on heterotopic ossification . By one year , 21.3 % of the control patients developed heterotopic bone ( 91 patients , 94 hips , Brooker grade s I – III ) compared to 12.9 % of the treatment patients ( 76 patients , 85 hips , Brooker grade s I – II ) . These differences were not significant ( p = 0.478 , power = 0.90 ) . Thus , the use of platelet-rich plasma in this procedure does not appear to influence the incidence or severity of heterotopic ossification which should help to justify further clinical research to more fully underst and whether this autologous blood product has a role in total hip arthroplasty Purpose Syndesmotic sprains are uncommon injuries that require prolonged recovery . The influence of ultrasound-guided injections of platelet-rich plasma ( PRP ) into the injured antero-inferior tibio-fibular ligaments ( AITFL ) in athletes on return to play ( RTP ) and dynamic stability was studied . Methods Sixteen elite athletes with AITFL tears were r and omized to a treatment group receiving injections of PRP or to a control group . All patients followed an identical rehabilitation protocol and RTP criteria . Patients were prospect ively evaluated for clinical ability to return to full activity and residual pain .  Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome . Results All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion – external rotation , and larger neutral tibia – fibula distance on ultrasound . Early diagnosis and treatment lead to shorter RTP , with 40.8 ( ±8.9 ) and 59.6 ( ±12.0 ) days for the PRP and control groups , respectively ( p = 0.006 ) . Significantly less residual pain upon return to activity was found in the PRP group ; five patients ( 62.5 % ) in the control group returned to play with minor discomfort versus one patient in the treatment group ( 12.5 % ) . One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction . Conclusions Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP , re-stabilization of the syndesmosis joint and less long-term residual pain . Level of evidence II Purpose The aim of this study was to evaluate the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections ( PRP ) .  Additionally , this study examined whether certain characteristics , such as activity level or previous treatment affected the results . Methods Patients ( n = 36 ) were asked to fill in the Victorian Institute of  Sports Assessment – Patellar question naire ( VISA-P ) and visual analogue scales ( VAS ) , assessing pain in activities of daily life ( ADL ) , during work and sports , before and after treatment with PRP . Of these patients , 14 had been treated before with cortisone , ethoxysclerol , and /or surgical treatment ( group 1 ) , while the remaining patients had not been treated before ( group 2 ) . Results Overall , group 1 and group 2 improved significantly on the VAS scales ( p < .0.05 ) . However , group 2 also improved on VISA-P ( p = .0.003 ) , while group 1 showed less healing potential ( p = 0.060 ) . Although the difference between group 1 and group 2 at follow-up was not considered clinical ly meaningful , over time both groups showed a clinical ly significant improvement . Conclusion After PRP treatment , patients with patellar tendinopathy showed a statistically significant improvement . In addition , these improvements can also be considered clinical ly meaningful . However , patients who were not treated before with ethoxysclerol , cortisone , and /or surgical treatment showed the improvement Autologous mesenchymal stromal cell (MSC)-based therapies offer one of the most promising and safe methods for regeneration or reconstruction of tissues and organs . Routine procedures to obtain adequate amount of autologous stem cells need their expansion through culture , with risks of contamination and cell differentiation , leading to the loss of cell ability for therapies . We suggest the use of human bone marrow ( BM ) as a physiological bioreactor to produce autologous MSC by injection of autologous platelet-rich plasma activated by recombinant human soluble tissue factor ( rhsTF ) in iliac crest . A trial on 13 healthy volunteers showed the feasibility and harmlessness of the procedure . The phenotype and cellularity of BM cells were not modified , on day 3 after injection . Endothelial progenitor cells ( EPC ) were mobilized to the bloodstream , without stimulation of hematopoietic stem cells ( HSC ) . MSC level in BM increased with a specific commitment to preosteoblastic cell population both in vivo and in vitro . This self-stimulation system of BM seems thus to be a promising feasible process 3 days before clinical cell therapy applications Purpose To assess the outcome of intra-articular platelet-rich plasma ( PRP ) injections into the knee in patients with early stages of osteoarthritis ( OA ) and to determine whether cyclical dosing would affect the end result . Methods This is a prospect i ve , r and omized study in which 93 patients ( 119 knees ) were followed up for a minimum of 2 years . Fifty knees were r and omly selected prior to the first injection , to receive a second cycle at the completion of 1 year . A cycle consisted of three injections , each given at a monthly interval . The outcome was assessed using Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , Visual Analogue Scale ( VAS ) , Tegner and Marx scoring systems , recorded prior to the first injection and then at 12 , 18 and 24 months . Results There was a significant improvement in all scores over time compared to the pre-treatment value ( p < 0.001 ) . At 12 months , both groups showed similar and significant improvement . At 18 months , except for KOOS ( Symptoms ) and Tegner score , all other parameters showed a significant difference between the two groups in favour of the patients who had received the second cycle ( p < 0.001 ) . At 2 years , the scores declined in both groups but remained above the pre-treatment value with no significant difference between the groups despite the patients with two cycles showing higher mean values for all the scores . Conclusion Intra-articular PRP injections into the knee for symptomatic early stages of OA are a valid treatment option . There is a significant reduction in pain and improvement in function after 12 months , which can be further improved at 18 months by annual repetition of the treatment . Although the beneficial effects are ill sustained at 2 years , the results are encouraging when compared to the pre-treatment function . Level of evidence II The recovery of patients undergoing total shoulder arthroplasty ( TSA ) can be adversely affected by a number of complications . Autologous platelet gel ( APG ) , produced by activating platelet-rich plasma ( PRP ) , has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures . Activated platelet-poor plasma ( PPP ) has also been used as a hemostatic agent . This study examines the effects of APG and PPP treatment on TSA patients postoperatively . After Institutional Review Board ( IRB ) approval , 40 patients undergoing TSA at our institution were prospect ively enrolled in our study . They were r and omized into either a control ( n = 20 ) or study ( n = 20 ) group , with the study group receiving APG and PPP treatment .  Preoperative demographic data , pre- and postoperative laboratory data , pain scores , pain medication , complications , pre- and postoperative range of motion measurements , and postoperative lengths of stay were recorded for each group . The preoperative internal rotation index was significantly higher in the control group compared with treatment patients ( 4.64 + /- 4.46 vs. 1.88 + /- 2.44 , p < .05 ) . The percent hemoglobin retained postoperatively was higher in the treatment group at 24 ( 84.54 + /- 5.32 vs. 79.87 + /- 8.73 ) and 72 hours ( 87.46 + /- 16. 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: HYPOTHESIS Local application of autologous platelet rich plasma ( PRP ) improves tendon healing in patients undergoing arthroscopic rotator cuff repair . STUDY DESIGN Prospect i ve , r and omized , controlled , double blind study ; considering an alpha level of 5 % , a power of 80 % , 22 patients for group are needed . MATERIAL S AND METHODS Fifty-three patients who underwent shoulder arthroscopy for the repair of a complete rotator cuff tear were r and omly divided into 2 groups , using a block r and omization procedure . A treatment group ( N = 26 ) consisted of those who received an intraoperative application of PRP in combination with an autologous thrombin component . A control group ( N = 27 ) consisted of those who did not receive that treatment . Patients were evaluated with vali date d outcome scores . A magnetic resonance image ( MRI ) was performed in all cases at more than 1 year post-op . All patients had the same accelerated rehabilitation protocol . RESULTS The 2 groups were homogeneous . The pain score in the treatment group was lower than the control group at 3 , 7 , 14 , and 30 days after surgery ( P < .05 ) . On the Simple Shoulder Test ( SST ) , University of California ( UCLA ) , and Constant scores , strength in external rotation , as measured by a dynamometer , were significantly higher in the treatment group than the control group at 3 months after surgery ( strength in external rotation [ SER ] : 3 ± 1.6 vs 2.1 ± 1.3 kg ; SST : 8.9 ± 2.2 vs 7.1 ± 2.7 ; UCLA : 26.9 ± 3 vs 24.2 ± 4.9 ; Constant : 65 ± 9 vs 57.8 ± 11 ; P < .05 ) . There was no difference between the 2 groups after 6 , 12 , and 24 months . The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear . In the subgroup of grade 1 and 2 tears , with less retraction , SER in the PRP group was significant higher at 3 , 6 , 12 , and 24 months postoperative ( P < .05 ) . CONCLUSION The results of our study showed autologous PRP  reduced pain in the first postoperative months . The long-term results of subgroups of grade 1 and 2 tears suggest that PRP positively affected cuff rotator healing OBJECTIVE To determine the efficacy of autologous platelet-rich plasma ( PRP ) compared with dextrose prolotherapy ( DP ) in patients with chronic recalcitrant plantar fasciitis ( PF ) DESIGN : A single-blinded , r and omized , controlled study . SETTING Department of Physical Medicine and Rehabilitation of a university hospital . PARTICIPANTS Twenty-one patients with a clinical diagnosis of chronic PF confirmed by diagnostic ultrasound ( plantar fascia thickness > 4 mm ) were r and omly assigned to the  PRP group ( n = 10 ) or the DP group ( n = 11 ) . INTERVENTIONS Each patient received 2 injections into the plantar fascia through a peppering technique under ultrasound guidance at an interval of 2 weeks , either with 2 mL of autologous PRP or 2 mL of 15 % dextrose/lidocaine solution . MAIN OUTCOME MEASUREMENTS The outcome measures included the pain , disability , and activity limitation subscales , measured by means of the Foot Functional Index . Data were collected before the first injection , at 2 weeks ( before the second injection ) , and at the 2- and 6-month follow-ups . RESULTS All patients completed the follow-ups , with the exception of 1 patient in the PRP group . The mean Foot Functional Index total and subcategory score improvements were greater in the PRP group compared with the DP group ( improvement with PRP vs DP , total : 30.4 % vs 15.1 % , pain : 29.7 % vs 17.1 % , disability : 26.6 % vs 14.5 % , activity limitation : 28.0 % vs 12.4 % ) . However , no statistically significant difference was noted at any follow-up . In the pain and disability subcategories , both groups showed significant improvements at the last re-evaluation . The PRP group also showed significant improvements in the disability and activity limitation subscales at the second re-evaluation . CONCLUSIONS Each treatment seems to be effective for chronic recalcitrant PF , exp and ing the treatment options for patients in whom conservative care has failed . PRP treatment also may lead to a better initial improvement in function compared with DP treatment ABSTRACT Activated blood platelets play a critical , early role in the wound healing response by releasing several types of growth factors at the site of injury which mediate the initial stages of tissue repair . Autologously derived platelet-rich plasma has been applied during surgery as a healing aid and some studies have shown benefit with total joint arthroplasty procedures such as in the knee . However , little has been published regarding the use of platelet-rich plasma during total hip arthroplasty . The hip is especially prone to develop isl and s of heterotopic bone following arthroplasty which can lead to pain , limited motion , and even ankylosis of the joint . If this condition is exacerbated by platelet-rich plasma , this could present a barrier to the use of this adjuvant in total hip arthroplasty . This retrospective , controlled clinical study examined the effect of platelet rich plasma application during closure following total hip arthroplasty on heterotopic ossification . By one year , 21.3 % of the control patients developed heterotopic bone ( 91 patients , 94 hips , Brooker grade s I – III ) compared to 12.9 % of the treatment patients ( 76 patients , 85 hips , Brooker grade s I – II ) . These differences were not significant ( p = 0.478 , power = 0.90 ) . Thus , the use of platelet-rich plasma in this procedure does not appear to influence the incidence or severity of heterotopic ossification which should help to justify further clinical research to more fully underst and whether this autologous blood product has a role in total hip arthroplasty Purpose Syndesmotic sprains are uncommon injuries that require prolonged recovery . The influence of ultrasound-guided injections of platelet-rich plasma ( PRP ) into the injured antero-inferior tibio-fibular ligaments ( AITFL ) in athletes on return to play ( RTP ) and dynamic stability was studied . Methods Sixteen elite athletes with AITFL tears were r and omized to a treatment group receiving injections of PRP or to a control group . All patients followed an identical rehabilitation protocol and RTP criteria . Patients were prospect ively evaluated for clinical ability to return to full activity and residual pain .  Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome . Results All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion – external rotation , and larger neutral tibia – fibula distance on ultrasound . Early diagnosis and treatment lead to shorter RTP , with 40.8 ( ±8.9 ) and 59.6 ( ±12.0 ) days for the PRP and control groups , respectively ( p = 0.006 ) . Significantly less residual pain upon return to activity was found in the PRP group ; five patients ( 62.5 % ) in the control group returned to play with minor discomfort versus one patient in the treatment group ( 12.5 % ) . One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction . Conclusions Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP , re-stabilization of the syndesmosis joint and less long-term residual pain . Level of evidence II Purpose The aim of this study was to evaluate the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections ( PRP ) .  Additionally , this study examined whether certain characteristics , such as activity level or previous treatment affected the results . Methods Patients ( n = 36 ) were asked to fill in the Victorian Institute of  Sports Assessment – Patellar question naire ( VISA-P ) and visual analogue scales ( VAS ) , assessing pain in activities of daily life ( ADL ) , during work and sports , before and after treatment with PRP . Of these patients , 14 had been treated before with cortisone , ethoxysclerol , and /or surgical treatment ( group 1 ) , while the remaining patients had not been treated before ( group 2 ) . Results Overall , group 1 and group 2 improved significantly on the VAS scales ( p < .0.05 ) . However , group 2 also improved on VISA-P ( p = .0.003 ) , while group 1 showed less healing potential ( p = 0.060 ) . Although the difference between group 1 and group 2 at follow-up was not considered clinical ly meaningful , over time both groups showed a clinical ly significant improvement . Conclusion After PRP treatment , patients with patellar tendinopathy showed a statistically significant improvement . In addition , these improvements can also be considered clinical ly meaningful . However , patients who were not treated before with ethoxysclerol , cortisone , and /or surgical treatment showed the improvement Autologous mesenchymal stromal cell (MSC)-based therapies offer one of the most promising and safe methods for regeneration or reconstruction of tissues and organs . Routine procedures to obtain adequate amount of autologous stem cells need their expansion through culture , with risks of contamination and cell differentiation , leading to the loss of cell ability for therapies . We suggest the use of human bone marrow ( BM ) as a physiological bioreactor to produce autologous MSC by injection of autologous platelet-rich plasma activated by recombinant human soluble tissue factor ( rhsTF ) in iliac crest . A trial on 13 healthy volunteers showed the feasibility and harmlessness of the procedure . The phenotype and cellularity of BM cells were not modified , on day 3 after injection . Endothelial progenitor cells ( EPC ) were mobilized to the bloodstream , without stimulation of hematopoietic stem cells ( HSC ) . MSC level in BM increased with a specific commitment to preosteoblastic cell population both in vivo and in vitro . This self-stimulation system of BM seems thus to be a promising feasible process 3 days before clinical cell therapy applications Purpose To assess the outcome of intra-articular platelet-rich plasma ( PRP ) injections into the knee in patients with early stages of osteoarthritis ( OA ) and to determine whether cyclical dosing would affect the end result . Methods This is a prospect i ve , r and omized study in which 93 patients ( 119 knees ) were followed up for a minimum of 2 years . Fifty knees were r and omly selected prior to the first injection , to receive a second cycle at the completion of 1 year . A cycle consisted of three injections , each given at a monthly interval . The outcome was assessed using Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , Visual Analogue Scale ( VAS ) , Tegner and Marx scoring systems , recorded prior to the first injection and then at 12 , 18 and 24 months . Results There was a significant improvement in all scores over time compared to the pre-treatment value ( p < 0.001 ) . At 12 months , both groups showed similar and significant improvement . At 18 months , except for KOOS ( Symptoms ) and Tegner score , all other parameters showed a significant difference between the two groups in favour of the patients who had received the second cycle ( p < 0.001 ) . At 2 years , the scores declined in both groups but remained above the pre-treatment value with no significant difference between the groups despite the patients with two cycles showing higher mean values for all the scores . Conclusion Intra-articular PRP injections into the knee for symptomatic early stages of OA are a valid treatment option . There is a significant reduction in pain and improvement in function after 12 months , which can be further improved at 18 months by annual repetition of the treatment . Although the beneficial effects are ill sustained at 2 years , the results are encouraging when compared to the pre-treatment function . Level of evidence II The recovery of patients undergoing total shoulder arthroplasty ( TSA ) can be adversely affected by a number of complications . Autologous platelet gel ( APG ) , produced by activating platelet-rich plasma ( PRP ) , has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures . Activated platelet-poor plasma ( PPP ) has also been used as a hemostatic agent . This study examines the effects of APG and PPP treatment on TSA patients postoperatively . After Institutional Review Board ( IRB ) approval , 40 patients undergoing TSA at our institution were prospect ively enrolled in our study . They were r and omized into either a control ( n = 20 ) or study ( n = 20 ) group , with the study group receiving APG and PPP treatment .  Preoperative demographic data , pre- and postoperative laboratory data , pain scores , pain medication , complications , pre- and postoperative range of motion measurements , and postoperative lengths of stay were recorded for each group . The preoperative internal rotation index was significantly higher in the control group compared with treatment patients ( 4.64 + /- 4.46 vs. 1.88 + /- 2.44 , p < .05 ) . The percent hemoglobin retained postoperatively was higher in the treatment group at 24 ( 84.54 + /- 5.32 vs. 79.87 + /- 8.73 ) and 72 hours ( 87.46 + /- 16. 
    Output:
    