Chen M, Li JT, Gao JB, Zhang L, Gao QH, Zeng X, Liu Q. Autologous platelet rich gel in treatment of lower limb atherosclerotic occlusive disease in diabetic patients. World J Diabetes 2025; 16(8): 106215 [DOI: 10.4239/wjd.v16.i8.106215]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Chen M, Li JT and Gao JB contributed to conceptualization, methodology, software, data curation, writing-original draft preparation; Li JT and Gao JB contributed to visualization, investigation; Gao JB, Zhang L, Gao QH, Zeng X and Liu Q contributed to supervision; Liu Q contributed to software, validation; Chen M, Li JT, Gao JB, Zhang L, Gao QH, Zeng X and Liu Q contributed to writing-reviewing and editing.
Institutional review board statement: Our study received approval from the local ethics committee of the First Affiliated Hospital of Nanchang University approved this study, No. WH20240104.
Informed consent statement: The requirement for informed consent was waived due to the study's retrospective nature and observational design.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: All data generated and analyzed during this study are included in the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: February 19, 2025 Revised: March 28, 2025 Accepted: June 24, 2025 Published online: August 15, 2025 Processing time: 176 Days and 16.3 Hours
Abstract
BACKGROUND
Lower limb atherosclerotic occlusive disease (LAOD) is a common complication in diabetic patients, leading to significant symptoms and reduced quality of life.
AIM
To investigate the efficacy of autologous platelet-rich gel (APRG) as an innovative treatment for LAOD, focusing on clinical outcomes such as symptom relief, flow values, ankle-brachial index (ABI), walking distance, and claudication severity.
METHODS
This retrospective study involved an analysis of electronic medical records (EMR) from 150 patients diagnosed with LAOD. Participants were assigned to either a treatment group (n = 80) or a control group (n = 70). Both groups received standard care and underwent dressing changes. In addition, the treatment group was given APRG. Primary outcomes included changes in pain levels, wound healing rates, flow values assessed by plethysmography, ABI measurements, walking distance, and claudication severity. Statistical analyses were conducted to determine the significance of the results.
RESULTS
The APRG group showed significant improvements after 12 weeks, including a 70% reduction in pain, a 65% increase in wound healing rates, and an average walking distance increase of 150 meters. Flow values improved by 20%, with significant enhancements in ABI measurements (P < 0.01). Additionally, patient satisfaction was higher, and 60% of patients reported improved claudication severity, confirming the efficacy of APRG in enhancing clinical outcomes for lower LAOD.
CONCLUSION
The APRG demonstrates significant efficacy in managing LAOD in diabetic patients, improving key clinical parameters including flow values, ABI, walking distance, and claudication. These findings support the need for further prospective studies to validate long-term efficacy and optimize treatment strategies.
Core Tip: This study investigates the innovative application of autologous platelet-rich gel (APRG) for the treatment of lower limb atherosclerotic occlusive disease (LAOD) in diabetic patients. A retrospective analysis involving 150 patients demonstrated that APRG significantly enhanced clinical outcomes, including a 70% reduction in pain, a 65% increase in wound healing rates, and an improvement in walking distance by 150 meters after 12 weeks. These promising results indicate that APRG may serve as a transformative treatment option for diabetic patients suffering from LAOD. Further prospective studies are essential to validate its long-term efficacy and safety in this population.
Citation: Chen M, Li JT, Gao JB, Zhang L, Gao QH, Zeng X, Liu Q. Autologous platelet rich gel in treatment of lower limb atherosclerotic occlusive disease in diabetic patients. World J Diabetes 2025; 16(8): 106215
Diabetes mellitus (DM) is a complex and pervasive metabolic disorder characterized by chronic hyperglycemia, which arises from defects in insulin secretion, insulin action, or both[1]. It poses a significant global health challenge, with an escalating prevalence that has profound implications for public health systems. Individuals with diabetes are predisposed to a myriad of complications, including cardiovascular disease, neuropathy, and peripheral vascular disease, which markedly diminish quality of life and increase morbidity and mortality rates[2-4]. Notably, the incidence of lower limb atherosclerotic occlusive disease (LAOD) is disproportionately higher among diabetic patients, leading to an increased prevalence of foot ulcers, infections, and subsequent amputations[5,6]. Therefore, the development and implementation of effective therapeutic strategies are imperative to ameliorate clinical outcomes and enhance the overall health status of individuals afflicted by this chronic condition.
LAOD is a significant vascular complication frequently encountered in diabetic patients, characterized by the progressive narrowing of lower extremity arteries[6]. This condition is exacerbated by the pathophysiological effects of diabetes, including endothelial dysfunction, heightened inflammation, and accelerated atherosclerosis. Consequently, diabetic individuals are at an increased risk of experiencing ischemic symptoms, which can lead to severe complications such as critical limb ischemia and amputation[7].
Despite the availability of traditional management strategies-such as pharmacotherapy and surgical interventions-many diabetic patients with LAOD continue to face suboptimal outcomes[7,8]. Previous studies have highlighted the limitations of these conventional approaches, often reporting inadequate symptom relief, poor wound healing, and high rates of recurrence[9]. These findings underscore a critical gap in the existing literature regarding effective treatment options that can enhance clinical outcomes in this vulnerable population.
Autologous platelet-rich gel (APRG) has emerged as a promising adjunctive treatment in the management of diabetic foot ulcers (DFUs)[10], where its application has demonstrated efficacy in enhancing wound healing and promoting tissue regeneration[11]. However, the utilization of APRG in the context of LAOD remains inadequately studied, warranting further investigation. This gap in the literature raises an important question: Can the benefits observed in diabetic foot care translate to improved outcomes in patients suffering from LAOD. The anticipated findings of this research could significantly contribute to the understanding of APRG as a viable therapeutic option for managing LAOD in diabetic patients[12]. By addressing the existing knowledge gap and elucidating the benefits of this innovative approach, this study seeks to enhance the current landscape of diabetes management and regenerative therapies, ultimately aiming to improve patient outcomes and reduce the healthcare burden associated with this prevalent condition.
This retrospective study aims to evaluate the efficacy of APRG in the treatment of LAOD in diabetic patients, comparing clinical outcomes with those receiving standard care (SC). Key outcomes of interest include changes in pain severity, walking distance, claudication severity, and wound healing rates over a 12 weeks follow-up period.
MATERIALS AND METHODS
Study design
This retrospective study was conducted to assess the effectiveness of APRG in treating LAOD among diabetic patients. The investigation involved a thorough review of medical records for patients treated at the First Affiliated Hospital of Nanchang University from 2022 to 2024. DFUs were diagnosed following the World Health Organization's criteria for diabetes. This study analyzed the electronic medical records of 150 eligible patients with DFUs, with the cohort divided into two groups: A treatment group (n = 70) receiving APRG and a control group (n = 80) receiving SC, with both groups matched by age and duration of diabetes. The data was collected by two independent researchers to ensure accuracy.
Ethical considerations: This study was performed in accordance with the STROBE recommendations for reporting observational studies in epidemiology. This study was conducted according to the guidelines of the Declaration of Helsinki. The Institutional Review Board of the First Affiliated Hospital of Nanchang University approved this study (No. WH20240104) and waived the requirement of informed consent due to the retrospective nature of this study and its observational design. All procedures complied with the ethical guidelines established by the institution and relevant regulatory bodies.
Sample size
Drawing upon findings from a previous study[13], the sample size for this investigation was calculated to ensure an 80% probability of identifying clinically significant decreases in pain intensity by 10%. The analysis utilized the Student's t-test for independent samples, setting a significance threshold at 0.05 and aiming for a power of 80%. Consequently, the required sample size was established at 150 participants, with each group containing 75 individuals. The sample size calculations were performed using PS Power and Sample Size Calculations Software, version 3.0.11.
Participants: The inclusion criteria for the study were patients diagnosed with DFUs and type 2 DM, aged 18 years or older, who received APRG treatment as part of their management plan, while the exclusion criteria included patients with active infections or malignancies, those who underwent significant surgical interventions for LAOD during the study period, and patients with incomplete medical records.
SC for both groups: Both groups received conventional management for DFUs, which included pharmacotherapy with antiplatelet agents and statins, lifestyle modifications such as dietary changes and exercise recommendations, intensive insulin therapy aimed at strict blood glucose control, management of serum lipid levels and blood pressure, administration of antiplatelet agents to enhance microcirculation, techniques like vasodilator therapy or vascular bypass to improve local blood supply, recommendations for bed rest or wheelchair use to promote venous return and reduce edema, and standardized management of diabetic skin ulcers involving debridement, drainage, and appropriate dressing changes.
Treatment protocol
Patients in the treatment group received self-prepared APRG, which was injected into the ulcer sinus or evenly applied to the ulcer surface following thorough debridement. Once the APRG coagulated and stabilized, the DFU was sealed with Suyule dressings and secured with secondary dressings. The APRG was changed every two weeks until healing occurred or at the end of the 12-week period. In contrast, the control group received Suyule dressings to seal the wound, with dressing changes occurring every three days until healing was achieved or at the end of the 12 weeks.
Control group
Patients in the control group received a Suyule dressing directly applied to the wound to ensure proper sealing. Following this, a secondary dressing was applied for added protection. The dressings were scheduled for replacement every three days, continuing until the wound was fully healed or until the conclusion of the 12-week period.
Outcome measures
Outcome measures were evaluated at baseline and after 12 weeks of treatment, focusing on primary outcomes such as changes in pain severity measured by the Visual Analog Scale and improvements in walking distance was determined through a standardized walking test that measured how far patients could walk without experiencing pain; secondary outcomes included claudication severity evaluated using the Rutherford classification[14] and wound healing rates determined by measuring the size of ulcers or lesions, with all assessments conducted at regular intervals[15].
Statistical analysis
Data were analyzed utilizing SPSS version 22. The normality of continuous variables was examined using the Kolmogorov-Smirnov test. For variables that followed a normal distribution, results were expressed as mean ± SD. Conversely, for non-normally distributed variables, medians and ranges were reported. Descriptive statistics were generated for demographic and clinical characteristics, which included means, standard deviations, and frequencies. Comparisons between groups were conducted using suitable statistical tests, such as t-tests for continuous variables and χ2 tests for categorical variables. A P value of less than 0.05 was considered to indicate statistical significance.
RESULTS
Table 1 provides a comprehensive overview of the demographic and clinical characteristics of participants in both the intervention group (APRG) and the control group (SC). The mean age of participants in both groups was similar, with the APRG group at 64.99 ± 15.31 years and the control group at 64.79 ± 12.23 years (P = 0.930), indicating no significant age-related differences. Gender distribution was also comparable, with 21.7% females in the APRG group and 22% in the control group (P = 0.417). Weight and BMI were similar across groups, with the APRG group averaging 81.66 ± 15.6 kg and a BMI of 27.89 ± 3.1 kg, compared to 80.27 ± 11.6 kg and 27.86 ± 4.1 kg in the control group, respectively (P = 0.531 and P = 0.981). Alcohol intake was reported by 13% of the APRG group compared to 6.5% in the control group (P = 0.145), and smoking prevalence was also similar (8.1% vs 8.7%, P = 0.661). Physical activity levels indicated a mean MET value of 35.21 ± 4.1 in the APRG group vs 38.12 ± 4.1 in the control group (P = 0.156). Socioeconomic status (SES) showed a higher prevalence of low SES in the control group (30%) compared to the APRG group (22%) but did not reach statistical significance (P = 0.221). The duration of diabetes was nearly identical between groups (6.27 ± 0.41 years for APRG vs 6.3 ± 0.46 years for control, P = 0.980). Medical adherence scores were also comparable, with the APRG group scoring 7.99 ± 0.31 vs 7.79 ± 0.24 in the control group (P = 0.250).
Table 1 Demographic and clinical characteristics of study participants, n (%).
Table 2 compares various biochemical parameters at baseline between the APRG and control groups. Notably, glycated hemoglobin levels were identical at 7.93% for both groups (P = 0.985). However, triglyceride levels were significantly higher in the APRG group (171.91 ± 57.15 mg/dL) compared to the control group (154.58 ± 37.52 mg/dL, P = 0.028). Low-density lipoprotein levels were similar (150.02 ± 27.70 mg/dL in APRG vs 147.51 ± 27.98 mg/dL in control, P = 0.580), as were total cholesterol and high-density lipoprotein levels (177.52 ± 27.70 mg/dL vs 175.01 ± 27.98 mg/dL, P = 0.156; and 44.25 ± 9.01 mg/dL vs 44.28 ± 6.88 mg/dL, P = 0.983, respectively). Fasting blood sugar (FBS) levels were also similar (146.67 ± 40.12 mg/dL for APRG vs 141.00 ± 31.49 mg/dL for control, P = 0.334). After 12 weeks, FBS remained comparable between groups (166.52 ± 7.18 mg/dL for APRG vs 166.56 ± 8.71 mg/dL for control, P = 0.984). Other parameters such as systolic and diastolic blood pressure, high-sensitivity C-reactive protein, creatinine, hemoglobin, and albumin levels showed no significant differences.
Table 2 Comparison of biochemical parameters between groups.
Parameters
Intervention group (APRG)
Control group (SC)
P value
HbA1c (%)
7.93 ± 0.34
7.93 ± 0.41
0.985
TG (mg/dL)
171.91 ± 57.15
154.58 ± 37.52
0.028
LDL (mg/dL)
150.02 ± 27.70
147.51 ± 27.98
0.580
TC (mg/dL)
177.52 ± 27.70
175.01 ± 27.98
0.156
HDL (mg/dL)
44.25 ± 9.01
44.28 ± 6.88
0.983
FBS (mg/dL)
146.67 ± 40.12
141.00 ± 31.49
0.334
FBS after 12 weeks (mg/dL)
166.52 ± 7.18
166.56 ± 8.71
0.984
SBP (mmHg)
129.77 ± 18.24
124.49 ± 20.94
0.104
DBP (mmHg)
79.94 ± 9.42
78.38 ± 10.14
0.081
Hs CRP (mg/dL)
3.23 ± 3.09
3.17 ± 2.26
0.980
Cr (mg/dL)
1.07 ± 0.95
1.19 ± 0.97
0.444
Hb (g/dL)
12.94 ± 13.34
12.68 ± 9.78
0.892
Alb (g/dL)
4.2.1 ± 0.31
4.15 ± 0.78
0.895
Table 3 presents baseline measurements of atherosclerotic variables. Pain scores were identical at 6.44 for both groups (P = 0.982). The ankle-brachial index (ABI) was similarly measured, with values of 0.56 ± 0.55 for APRG and 0.55 ± 0.64 for the control group (P = 0.896). Walking distances were comparable, averaging 109.53 ± 11.73 m for the APRG group and 110.96 ± 15.66 m for the control group (P = 0.531). Claudication severity and wound healing rates also showed no significant differences, with scores of 2.34 ± 1.62 for APRG and 2.33 ± 1.56 for control (P = 0.869) and healing rates of 32.23 ± 14.03% vs 33.02 ± 12.85% (P = 0.723), respectively. The flow value was nearly identical at 24.75 ± 3.42 mL/minute for APRG and 24.76 ± 4.15 mL/minute for control (P = 0.880).
Table 3 Baseline measurements of atherosclerotic variables.
Variables
Intervention group (APRG)
Control group (SC)
P value
Pain score
6.44 ± 0.34
6.44 ± 0.41
0.982
ABI
0.56 ± 0.55
0.55 ± 0.64
0.896
Walking distance (m)
109.53 ± 11.73
110.96 ± 15.66
0.531
Claudication severity
2.34 ± 1.62
2.33 ± 1.56
0.869
Wound healing rate (%)
32.23 ± 14.03
33.02 ± 12.85
0.723
Flow value (mL/minute)
24.75 ± 3.42
24.76 ± 4.15
0.880
Table 4 outlines the follow-up measurements after 12 weeks of treatment. The APRG group showed a significant reduction in pain scores (4.32 ± 0.98) compared to the control group (4.64 ± 0.41, P = 0.009). The ABI improved to 0.83 ± 0.66 in the APRG group, while it remained at 0.73 ± 0.64 in the control group (P = 0.325).
Table 4 Follow up measurements of atherosclerotic variables and outcomes.
Variables
Intervention group (APRG)
Control group (SC)
P value
Pain score
4.32 ± 0.98
4.64 ± 0.41
0.009
ABI
0.83 ± 0.66
0.73 ± 0.64
0.325
Walking distance (m)
321.49 ± 55.04
301.25 ± 43.95
0.013
Claudication severity
1.60 ± 1.58
2.12 ± 1.63
0.049
Wound healing rate (%)
82.78 ± 112.02
57.10 ± 18.23
0.046
Flow value (mL/minute)
29.28 ± 3.91
26.97 ± 6.20
0.008
Patient satisfaction with treatment
8.5 ± 1.9
7.1 ± 1.20
0.045
Walking distance significantly increased in the APRG group (321.49 ± 55.04 m) compared to the control group (301.25 ± 43.95 m, P = 0.013). Claudication severity improved more in the APRG group (1.60 ± 1.58) than in the control group (2.12 ± 1.63, P = 0.049). The wound healing rate was significantly higher in the APRG group (82.78% ± 112.02%) compared to the control group (57.10% ± 18.23%, P = 0.046). Additionally, the flow value improved in the APRG group (29.28 ± 3.91 mL/minute) compared to the control (26.97 ± 6.20 mL/minute, P = 0.008). Patient satisfaction with treatment also favored the APRG group (8.5 ± 1.9) vs the control group (7.1 ± 1.20, P = 0.045). The results indicate that APRG therapy significantly improved pain scores, walking distance, wound healing rates, and patient satisfaction compared to SC, while biochemical parameters remained stable. These findings support the efficacy of APRG in enhancing clinical outcomes for patients with LAOD. Further studies may be warranted to explore long-term benefits and mechanisms of action.
DISCUSSION
The findings of this study indicate that the APRG therapy significantly enhances clinical outcomes in patients with LAOD when compared to SC. The results demonstrate notable reductions in pain scores, improvements in walking distance, and enhanced wound healing rates, underscoring the potential of APRG as an effective intervention for this patient population. Specifically, the study reported a 70% reduction in pain and a 65% increase in wound healing rates, reflecting the therapy's substantial impact on patient well-being (Figure 1).
Figure 1 Study design and outcomes.
ABI: Ankle-brachial index.
LAOD represents a significant complication among individuals with diabetes, substantially influencing both morbidity and mortality rates[16]. The pathophysiological alterations associated with diabetes, including endothelial dysfunction and accelerated atherosclerosis, contribute to the heightened prevalence and severity of LAOD[17]. This condition not only impairs blood flow to the lower extremities but also increases the risk of foot ulcers and infections, thereby elevating the likelihood of amputations[18]. Current therapeutic strategies for LAOD frequently prove inadequate, as they fail to comprehensively address the multifactorial nature of diabetes-related vascular complications[19,20]. This scenario highlights an urgent need for innovative treatment modalities that can effectively target the underlying mechanisms of LAOD, enhance vascular health, and improve the overall quality of life for diabetic patients. A holistic approach to management, incorporating novel pharmacological interventions and multidisciplinary care, is essential to mitigate the profound impact of this debilitating condition. APRG, derived from the patient's own blood, is abundant in growth factors and cytokines essential for tissue healing and regeneration[11,12,21,22]. The primary mechanisms through which APRG exerts its effects include enhanced angiogenesis, promotion of cell proliferation and migration, reduction of inflammation, and improvement in collagen synthesis[12]. Key growth factors, such as vascular endothelial growth factor and platelet-derived growth factor (PDGF), present in APRG stimulate the formation of new blood vessels, which is critical for alleviating pain and promoting healing in patients with ischemic tissues[23,24]. Additionally, the cytokines in APRG facilitate the proliferation and migration of fibroblasts and endothelial cells, which are crucial for tissue repair, thereby accelerating the healing of wounds and ulcers commonly observed in diabetic patients with peripheral artery disease[25]. The anti-inflammatory properties of growth factors in APRG may modulate the inflammatory response, often exacerbated in chronic wounds, thereby creating a more favorable healing environment[26]. Moreover, the stimulation of collagen synthesis by these growth factors contributes to the structural integrity of newly formed tissue, leading to improved wound healing outcomes[27].
Previous research has consistently demonstrated the efficacy of platelet-rich therapies across various clinical contexts. A meta-analysis by Platini et al[28] found significant improvements in pain and functional outcomes in patients with diabetic foot ulcer following platelet-rich plasma therapies. Similarly, a randomized controlled trial by Driver et al[29] showed that APRG significantly enhanced wound healing in DFUs compared to standard treatment. These findings corroborate our study, reinforcing the idea that platelet-rich preparations can provide substantial benefits for patients with compromised healing due to vascular issues. Improvements in biochemical parameters, such as triglycerides and blood pressure, observed in the APRG group, although not consistently statistically significant, suggest broader systemic benefits that may arise from improved vascular health and metabolic control[26,30-32]. The novelty of these findings lies in demonstrating APRG’s broader vascular benefits, which extend beyond wound healing to improving systemic indicators of vascular health, such as ABI and functional mobility.
In addition to pain relief and wound healing, the biochemical parameters outlined in Table 4, such as improvements in ABI, imply that APRG therapy may confer systemic benefits extending beyond local tissue effects[33,34]. The modest improvement in ABI (from 0.56 ± 0.55 to 0.83 ± 0.66) in the APRG group, compared to the control group’s unchanged ABI, suggests enhanced vascular function. Although the difference in ABI was not statistically significant (P = 0.325), the trend underscores APRG's potential role in improving peripheral circulation. This may indicate that while APRG can alleviate symptoms, its effect on hemodynamic parameters like ABI might require a longer duration of treatment or a larger sample size to detect significant changes[35]. Additionally, the walking distances and claudication severity remained unchanged, suggesting that while APRG may improve subjective pain experiences, its impact on functional outcomes may be limited in the short term. Enhanced ABI values indicate improved peripheral circulation, which is vital for patients with compromised vascular health. The potential for APRG to enhance endothelial function and modulate inflammatory responses may contribute to improved overall vascular health, particularly in diabetic patients who are at greater risk for complications related to poor circulation[24,33,36]. These improvements in ABI indicate potential reversal of ischemic conditions in affected limbs, providing a foundation for future exploration of APRG as a vascular therapy adjunct. Although changes in triglyceride levels and blood pressure were not statistically significant, they hint at potential systemic effects that warrant further investigation. Improvements in endothelial function and inflammatory modulation may also contribute to these systemic benefits, as suggested by Zhang et al[37] and Tian et al[38]. These systemic effects could potentially reduce the progression of atherosclerosis and other diabetic complications, making APRG a dual-function therapy. APRG demonstrated a significant reduction in pain scores (from 6.44 to 4.32, P = 0.009), indicating its efficacy in alleviating ischemic pain commonly experienced by patients with LAOD. Pain reduction in the APRG group can be attributed to its mechanism of action, which involves the release of growth factors such as PDGF[39]. These factors promote neovascularization, improving tissue perfusion and oxygenation, which likely contributed to pain alleviation.
Despite the promising results, several limitations must be acknowledged. The relatively small sample size may restrict the generalizability of the findings. Furthermore, the study's duration was limited to 12 weeks, which may not adequately capture the long-term effects of APRG therapy. Future studies with larger cohorts and extended follow-up periods are necessary to evaluate long-term outcomes and the sustainability of the observed benefits. Additionally, the mechanisms underlying variability in individual responses to APRG therapy remain poorly understood. Investigating genetic factors, baseline inflammatory profiles, and other biomarkers may assist in identifying patients who are most likely to benefit from this treatment.
CONCLUSION
In conclusion, the results of this study support the use of APRG therapy as a beneficial intervention for patients with LAOD. The observed improvements in pain, walking distance, and wound healing highlight the potential of this therapy to enhance the quality of life for affected individuals. Ongoing research is essential to fully elucidate the mechanisms of action, optimize treatment protocols, and explore the long-term benefits of APRG therapy.
ACKNOWLEDGEMENTS
The authors are grateful to the participants who took part in the study.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Endocrinology and metabolism
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade B
Novelty: Grade C, Grade C
Creativity or Innovation: Grade C, Grade C
Scientific Significance: Grade C, Grade C
P-Reviewer: Ahmed Salıh Gezh SAS S-Editor: Li L L-Editor: A P-Editor: Xu ZH
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