Since Choukroun introduced the use of platelet-rich fibrin (PRF) for oral surgical procedures in 2000, PRF has been researched as autologous biologic material to aid in accelerated healing, regulation of inflammation and surgical site integrity. Autologous fibrin glue (AFG) was introduced by Sohn in 2010 to fabricate a growth-factor-enriched bone graft matrix, also called sticky glue, for bone augmentation. Currently, PRF and AFG are widely used in maxillofacial surgeries to improve healing and predictability of procedures. Various studies evaluated the release kinetics of specific growth factors (PDGF-BB, TGFβ-1, VEGF and IGF-1) from PRF. However, an evaluation of an extensive array of available growth factors in PRF and AFG has not been conducted. This study evaluated the presence of 41 human growth factors within PRF and AFG and their change over time over a 3-hour period, replicating the potential handling time associated with usage of PRF in a clinical setting. 3 healthy volunteers were recruited from the UCSF Division of Periodontology. Venous blood from each volunteer was collected in three 10ml glass tube and one 10ml plastic tube and centrifuged at 2700rpm for 13 minutes to obtain 3 tubes of PRF and 1 tube of AFG. Each sample was separated into three equal parts and analyzed using a human growth factor antibody array kit. Samples were evaluated at 0, 1.5 and 3 hours after collection. The array data revealed significant peak level concentrations for several growth factors at 1.5 hour and the presence of high concentrations of IGFBP and MCSF R growth factors. The latter growth factors have not been previously reported in studies of PRF and AFG.  

Objectives

Methodology

Results

Conclusion

Background and Objectives: Cancer and coronary artery disease (CAD) often coexist. Compared to quantitative coronary angiography (QCA), fractional flow reserve (FFR) has emerged as a more reliable method of identifying significant coronary stenoses. We aimed to assess the specific management, safety and outcomes of FFR-guided percutaneous coronary intervention (PCI) in cancer patients with stable CAD. Materials and Methods: FFR was used to assess cancer patients that underwent coronary angiography for stable CAD between September 2008 and May 2016, and were found to have ≥50% stenosis by QCA. Patients with lesions with an FFR > 0.75 received medical therapy alone, while those with FFR ≤ 0.75 were revascularized. Procedure-related complications, all-cause mortality, nonfatal myocardial infarction, or urgent revascularizations were analyzed. Results: Fifty-seven patients with stable CAD underwent FFR on 57 lesions. Out of 31 patients with ≥70% stenosis as measured by QCA, 14 (45.1%) had an FFR ≥ 0.75 and lesions were reclassified as moderate and did not receive PCI nor DAPT. Out of 26 patients with <70% stenosis as measured by QCA, 6 (23%) had an FFR < 0.75 and were reclassified as severe and were treated with PCI and associated DAPT. No periprocedural complications, urgent revascularization, acute coronary syndromes, or cardiovascular deaths were noted. There was a 22.8% mortality at 1 year, all cancer related. Patients who received a stent by FFR assessment showed a significant association with decreased risk of all-cause death (HR: 0.37, 95% CI 0.15-0.90, p = 0.03). Conclusions: Further studies are needed to define the optimal therapeutic approach for cancer patients with CAD. Using an FFR cut-off point of 0.75 to guide PCI translates into fewer interventions and can facilitate cancer care. There was an overall reduction in mortality in patients that received a stent, suggesting increased resilience to cancer therapy and progression.