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Wang D, Shimamura N, Miwa N, Xiao L. Combined use of hydrogen-rich water and enzyme-digested edible bird's nest improves PMA/LPS-impaired wound healing in human inflammatory gingival tissue equivalents. Hum Cell 2024; 37:997-1007. [PMID: 38679666 DOI: 10.1007/s13577-024-01065-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024]
Abstract
Gingival wound healing plays a critical role in maintaining oral health. However, this process can be delayed by oxidative stress and excessive inflammatory responses. In this study, we established a human inflammatory gingival tissue equivalent (iGTE) to investigate the inhibitory effects of hydrogen-rich water (HW), enzyme-digested edible bird's nest (EBND) and sialic acid (SA) on PMA (an inducer of oxidative free radicals)- and LPS (an inflammatory stimulus)-impaired wound healing. The iGTE was constructed by human gingival fibroblasts (hGFs), keratinocytes and macrophages under three-dimensional conditions. Wounds in the iGTE and hGF/keratinocyte monolayers were created by mechanical injury. Tissues and cells were pretreated with HW, EBND, and SA, and then exposed to the inflammatory and oxidative environment induced by PMA (10 ng/mL) and LPS (250 ng/mL). The inflammatory cytokines IL-6 and IL-8 were quantitatively analyzed by ELISA. Histopathological image analysis was performed by HE and immunofluorescence staining. In the iGTE, PMA/LPS significantly reduced the epithelial thickness while causing a decrease in K8/18, E-cadherin, laminin and elastin expression and an increase in COX-2 expression along with ulcer-like lesions. In mechanically scratched hGFs and keratinocyte monolayers, PMA/LPS significantly impaired wound healing, and promoted the secretion of IL-6 and IL-8. Pretreatment of HW, EBND, and SA significantly suppressed PMA/LPS-induced wound healing delay and inflammatory responses in cell monolayers, as well as in the iGTE. Remarkably, the combined use of HW and EBND exhibited particularly robust results. Combined use of HW and EBND may be applied for the prevention and treatment of wound healing delay.
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Affiliation(s)
- Dongliang Wang
- Hebei Edible Bird's Nest Fresh Stew Technology Innovation Center, Bazhou Economic Development Zone, Langfang, 065700, China
| | - Naohiro Shimamura
- Department of Dental Anesthesiology, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
| | - Nobuhiko Miwa
- Prefectural University of Hiroshima, Faculty of Life Sciences, Hiroshima, 727-0023, Japan
- Incorporated Association Hydrogen Medical Institute, Minatojima Minamicho 1-6-4, ChuOh-Ku, Kobe, 650-0047, Japan
| | - Li Xiao
- Department of Physiology, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-Ku, Tokyo, 102-8159, Japan.
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Herring SA, Kibler WB, Putukian M, Boyajian-O'Neill LA, Chang CJ, Franks RR, Hutchinson M, Indelicato PA, O'Connor FG, Powell A, Roach R, Safran M, Statuta SM, Sutton K. Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Med Sci Sports Exerc 2024; 56:385-401. [PMID: 37847756 DOI: 10.1249/mss.0000000000003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
ABSTRACT Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.
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Herring SA, Kibler WB, Putukian M, Boyajian-O'Neill LA, Chang CJ, Franks RR, Hutchinson M, Indelicato PA, O'Connor FG, Powell A, Roach R, Safran M, Statuta SM, Sutton K. Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Curr Sports Med Rep 2024; 23:86-104. [PMID: 38437494 DOI: 10.1249/jsr.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
ABSTRACT Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.
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Sabesan V, Lapica H, Fernandez C, Fomunung C. Evolution of Perioperative Pain Management in Shoulder Arthroplasty. Orthop Clin North Am 2023; 54:435-451. [PMID: 37718083 DOI: 10.1016/j.ocl.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Historically, opioids have been used as a primary conservative treatment for pain related to glenohumeral osteoarthritis (GHOA). However, this practice is concerning as it often leads to overuse, which has contributed to the current epidemic of addiction and overdoses in the United States. Studies have shown that preoperative opioid use is associated with higher complication rates and worse outcomes following surgery, particularly for shoulder arthroplasty. To address these concerns, perioperative pain management for shoulder arthroplasty has evolved over the years to the use of multimodal analgesia.
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Affiliation(s)
- Vani Sabesan
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA.
| | - Hans Lapica
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| | - Carlos Fernandez
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
| | - Clyde Fomunung
- Department of Orthopedics, JFK/University of Miami, Palm Beach, FL, USA
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Roemer FW, Hochberg MC, Carrino JA, Kompel AJ, Diaz L, Hayashi D, Crema MD, Guermazi A. Role of imaging for eligibility and safety of a-NGF clinical trials. Ther Adv Musculoskelet Dis 2023; 15:1759720X231171768. [PMID: 37284331 PMCID: PMC10240557 DOI: 10.1177/1759720x231171768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Nerve growth factor (a-NGF) inhibitors have been developed for pain treatment including symptomatic osteoarthritis (OA) and have proven analgesic efficacy and improvement in functional outcomes in patients with OA. However, despite initial promising data, a-NGF clinical trials focusing on OA treatment had been suspended in 2010. Reasons were based on concerns regarding accelerated OA progression but were resumed in 2015 including detailed safety mitigation based on imaging. In 2021, an FDA advisory committee voted against approving tanezumab (one of the a-NGF compounds being evaluated) and declared that the risk evaluation and mitigation strategy was not sufficient to mitigate potential safety risks. Future clinical trials evaluating the efficacy of a-NGF or comparable molecules will need to define strict eligibility criteria and will have to include strategies to monitor safety closely. While disease-modifying effects are not the focus of a-NGF treatments, imaging plays an important role to evaluate eligibility of potential participants and to monitor safety during the course of these studies. Aim is to identify subjects with on-going safety findings at the time of inclusion, define those potential participants that are at increased risk for accelerated OA progression and to withdraw subjects from on-going studies in a timely fashion that exhibit imaging-confirmed structural safety events such as rapid progressive OA. OA efficacy- and a-NGF studies apply imaging for different purposes. In OA efficacy trials image acquisition and evaluation aims at maximizing sensitivity in order to capture structural effects between treated and non-treated participants in longitudinal fashion. In contrast, the aim of imaging in a-NGF trials is to enable detection of structural tissue alterations that either increase the risk of a negative outcome (eligibility) or may result in termination of treatment (safety).
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Affiliation(s)
- Frank W. Roemer
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Maximiliansplatz 3, 91054 Erlangen, Germany
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | | | - John A. Carrino
- Department of Radiology & Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | - Andrew J. Kompel
- Chobanian & Avedisian School of Medicine, Boston University, Boston MA, USA
| | - Luis Diaz
- Chobanian & Avedisian School of Medicine, Boston University, Boston MA, USA
| | - Daichi Hayashi
- Tufts Medical Center, Tufts Medicine, Boston, MA, USA
- Chobanian & Avedisian School of Medicine, Boston University, Boston MA, USA
| | - Michel D. Crema
- Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France
- Chobanian & Avedisian School of Medicine, Boston University, Boston MA, USA
| | - Ali Guermazi
- Chobanian & Avedisian School of Medicine, Boston University, Boston MA, USA
- Boston VA Healthcare System, West Roxbury, MA, USA
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Oral Ketorolac as an Adjuvant Agent for Postoperative Pain Control After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Controlled Study. J Am Acad Orthop Surg 2022; 30:e1580-e1590. [PMID: 36476466 DOI: 10.5435/jaaos-d-21-00721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 07/05/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Successful outpatient anterior cruciate ligament (ACL) reconstruction hinges on effective analgesia. Routinely, oral narcotic agents have been the preferred analgesic postoperatively in orthopaedic surgery. However, these agents have several known adverse effects and are associated with a potential for abuse. This study evaluates the efficacy of ketorolac, a nonsteroidal anti-inflammatory drug with analgesic properties, as an adjuvant agent for postoperative pain control after ACL reconstruction. METHODS Adult patients undergoing primary ACL reconstruction were prospectively enrolled. Exclusion criteria involved patients with a history of bleeding diathesis, renal dysfunction, chronic analgesia use, or alcohol abuse. Eligible patients were randomized into one of two groups. The control group received a standard-of-care pain protocol involving oxycodone-acetaminophen 5 to 325 on discharge. The ketorolac group additionally received intravenous ketorolac postoperatively and 3 days of oral ketorolac on discharge. Pain levels and total narcotic utilization were recorded three times per day for the first 5 days after surgery. Pain and functional outcomes were obtained at 2 and 6 weeks postoperatively. RESULTS The final analysis included 48 patients; the mean age of the cohort was 32 ± 11.6 years, and 60.4% of patients were female. No differences were observed in preoperative demographics, comorbidities, and preoperative functional scores between the two groups. Over the first 5 days after surgery, patients in the ketorolac group consumed a mean of 45.4% fewer narcotic pills than the control group (P < 0.001). In addition, mean postoperative pain scores were 22.36 points lower for patients in the ketorolac group (P < 0.001). There was no difference in functional outcome scores at up to 6 weeks postoperatively or adverse events between the two groups with no reported cases of gastrointestinal bleeding. DISCUSSION The use of adjunctive intravenous and short-term oral ketorolac substantially reduces narcotic utilization and pain levels after ACL reconstruction. CLINICALTRIALGOV REGISTRATION NUMBER NCT04246554.
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Rozinthe A, Ode Q, Subtil F, Fessy MH, Besse JL. Impact of smoking cessation on healing after foot and ankle surgery. Orthop Traumatol Surg Res 2022; 108:103338. [PMID: 35643365 DOI: 10.1016/j.otsr.2022.103338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/14/2021] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Perioperative smoking is the main risk factor for the development of postoperative cutaneous wound healing complications. We require that all patients undergoing elective foot and ankle surgery stop smoking (6 weeks before and 3 months after) and this abstinence is monitored with a preoperative cotinine test. We therefore wanted to understand how this impacted wound healing in elective foot and ankle surgery: do wounds heal differently in patients who quit smoking for surgery, former smokers and nonsmokers? HYPOTHESIS Our hypothesis was that patients who stopped smoking for an upcoming surgery had the same wound healing complications as nonsmokers and former smokers. MATERIALS AND METHODS This was a historical, single-center, single-surgeon cohort study of adult patients who underwent an elective ankle or foot surgery between June 2016 and July 2017. Patients were divided into 3 groups: group 1 smokers who stopped for surgery, group 2 former smokers, and group 3 nonsmokers. The primary endpoint was the occurrence of wound healing complications during the wound care consult scheduled 3 weeks after surgery. RESULTS A total of 256 patients with a mean age of 58±14.2 years (range, 18-88) were included. Group 3 had more women and a lower BMI than the other groups, but all the other demographic characteristics were similar. Smoking cessation was achieved in group 1 on average 2.5±1.3 months (range, 1-6) before surgery. There were a total of 20 wound healing complications or 7.5% of the cohort: 13% in group 1, 11.1% in group 2 and 6.4% in group 3. The univariate analysis found that the odds ratio was 2.3 when comparing Group 1 to Group 3 and 1.85 when comparing group 2 to group 3 (p=413). No significant risk factors for wound healing complications were found. DISCUSSION/CONCLUSION Smoking cessation for foot and ankle surgery seems to limit the risk of wound healing complications, with results close to those of former smokers and nonsmokers. Mandatory smoking cessation before surgery could be one of the solutions to prevent this frequent complication. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anouk Rozinthe
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
| | - Quentin Ode
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Fabien Subtil
- Pôle santé publique, service de biostatistique-bioinformatique, hospices civils de Lyon, Lyon, France; CNRS, laboratoire de biométrie et biologie évolutive UMR 5558, université de Lyon, université Lyon 1, Villeurbanne, France
| | - Michel-Henri Fessy
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; IFSTTAR, LBMC UMR-T 9406, laboratoire de biomécanique et mécanique des chocs, université Lyon 1, 69675 Bron cedex, France
| | - Jean-Luc Besse
- Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; IFSTTAR, LBMC UMR-T 9406, laboratoire de biomécanique et mécanique des chocs, université Lyon 1, 69675 Bron cedex, France
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8
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Günter CI, Ilg FP, Hapfelmeier A, Egert-Schwender S, Jelkmann W, Giri S, Bader A, Machens HG. Relation Between Gender and Concomitant Medications With Erythropoietin-Treatment on Wound Healing in Burn Patients. Post Hoc Subgroup-Analysis of the Randomized, Placebo-Controlled Clinical Trial “EPO in Burns”. Front Pharmacol 2022; 13:812888. [PMID: 35847006 PMCID: PMC9284535 DOI: 10.3389/fphar.2022.812888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/25/2022] [Indexed: 11/21/2022] Open
Abstract
Burns are leading causes of mortality and morbidity, including prolonged hospitalization, disfigurement, and disability. Erythropoietin (EPO) is a well-known hormone causing erythropoiesis. However, EPO may play a role in healing acute and chronic wounds due to its anti-inflammatory and pro-regenerative effects. Therefore, the large, prospective, placebo-controlled, randomized, double-blind, multi-center clinical trial “EPO in Burns” was initiated to investigate the effects of EPO versus placebo treatment in severely burned patients. The primary endpoint of “EPO in Burns” was defined as the time elapsed until complete re-epithelialization of a defined split skin graft donor site. Additional analyses of post hoc defined subgroups were performed in view of the primary endpoint. The verum (n 45) and control (n 39) groups were compared with regard to the time it took for study wounds (a predefined split skin graft donor site) to reach the three stages of wound healing (re-epithelialization levels). In addition, the effects of gender (females n 18) and concomitant medications insulin (n 36), non-steroidal anti-inflammatory drugs (NSAIDs) (n 41), and vasopressor agents (n 43) were tested. Life tables were used to compare study groups (EPO vs. placebo) within subgroups. The Cox regression model was applied to evaluate interactions between the study drug (EPO) and concomitant medications for each re-epithelialization level. Using our post hoc defined subgroups, we observed a lower chance of wound healing for women compared to men (in terms of hazard ratio: hr100%: 5.984 [95%-CI: (0.805–44.490), p = 0.080]) in our study population, regardless of the study medication. In addition, results indicated an earlier onset of re-epithelialization in the first days of EPO treatment (EPO: 10% vs. Placebo: 3%). Moreover, the interpretation of the hazard ratio suggested EPO might have a positive, synergistic effect on early stages of re-epithelialization when combined with insulin [hr50%: 1.307 (p = 0.568); hr75%: 1,199 (p = 0.715)], as well as a stabilizing effect on critically ill patients [reduced need for vasopressors in the EPO group (EPO: 44% vs. Placebo 59%)]. However, additional high-quality data from clinical trials designed to address these endpoints are required to gain further insight into these effects.
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Affiliation(s)
- Christina Irene Günter
- Clinic for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- *Correspondence: Christina Irene Günter,
| | - Felicitas Paula Ilg
- Clinic for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Silvia Egert-Schwender
- Müncher Studienzentrum, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Shibashish Giri
- Institute for Cell Techniques and Applied Stem Cell Biology, University of Leipzig, Leipzig, Germany
| | - Augustinus Bader
- Institute for Cell Techniques and Applied Stem Cell Biology, University of Leipzig, Leipzig, Germany
| | - Hans-Günter Machens
- Clinic for Plastic and Hand Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Lees P, Toutain PL, Elliott J, Giraudel JM, Pelligand L, King JN. Pharmacology, safety, efficacy and clinical uses of the COX-2 inhibitor robenacoxib. J Vet Pharmacol Ther 2022; 45:325-351. [PMID: 35460083 PMCID: PMC9541287 DOI: 10.1111/jvp.13052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
Abstract
Robenacoxib is a veterinary‐approved non‐steroidal anti‐inflammatory drug (NSAID) of the coxib group. It possesses anti‐hyperalgesic, anti‐inflammatory and anti‐pyretic properties. Robenacoxib inhibits the cyclooxygenase (COX)‐2 isoform of COX selectively (in vitro IC50 ratios COX‐1:COX‐2, 129:1 in dogs, 32:1 in cats). At registered dosages (2 mg/kg subcutaneously in dogs and cats, 1–4 mg/kg orally in dogs and 1–2.4 mg/kg orally in cats), robenacoxib produces significant inhibition of COX‐2 whilst sparing COX‐1. The pharmacokinetic (PK) profile of robenacoxib is characterized by a high degree of binding to plasma proteins (>98%) and moderate volume of distribution (at steady state, 240 ml/kg in dogs and 190 ml/kg in cats). In consequence, the terminal half‐life in blood (<2 h) is short, despite moderate body clearance (0.81 L/kg/h) in dogs and low clearance (0.44 L/kg/h) in cats. Excretion is principally in the bile (65% in dogs and 72% in cats). Robenacoxib concentrates in inflamed tissues, and clinical efficacy is achieved with once‐daily dosing, despite the short blood terminal half‐life. In dogs, no relevant breed differences in robenacoxib PK have been detected. Robenacoxib has a wide safety margin; in healthy laboratory animals daily oral doses 20‐fold (dog, 1 month), eight‐fold (cat, 6 weeks) and five‐fold (dog, 6 months) higher than recommended clinical doses were well tolerated. Clinical efficacy and safety have been demonstrated in orthopaedic and soft tissue surgery, and in musculoskeletal disorders in dogs and cats.
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Affiliation(s)
- Peter Lees
- Royal Veterinary College, University of London, London, UK
| | - Pierre-Louis Toutain
- Royal Veterinary College, University of London, London, UK.,INTHERES, INRA, ENVT, Université de Toulouse, Toulouse, France
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Ang PPJ, Hugo B, Silvester R. Acute postoperative pain management protocols in podiatric surgery within Australia: a Delphi study. J Foot Ankle Res 2022; 15:27. [PMID: 35410248 PMCID: PMC9004200 DOI: 10.1186/s13047-022-00535-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is limited evidence in the literature to describe an analgesic protocol that takes into consideration the extent of foot and ankle surgery. The aim of this study was to develop a guide for acute postoperative pain management for podiatric surgery in Australia, and to identify opportunities to improve the current list of scheduled medicines available to podiatric surgeons.
Methods
A Delphi method involving 3 survey rounds was employed for this study. Twelve expert panellists in the field of podiatric surgery and anaesthesiology were invited to participate, and 10 panellists remained by the end of the study. Round 1 involved 15 open-ended questions. These answers formed the basis of the 55 statements that were developed for the following 2 survey rounds, where panellists rated the appropriateness of each statement on a 9-point Likert scale. The third survey round was an opportunity for panellists to revise their answers to each statement in light of the majority response.
Results
For mild acute postoperative pain, non-opioid oral analgesics were recommended as an appropriate management option. For moderate and severe acute postoperative pain, both non-opioid and opioid products were found to be appropriate by the majority. It was agreed that oral opioids be reserved for breakthrough pain at all severity levels. All other statements in the Delphi study pertaining to drug hypersensitivities or allergies, stratification of pain management, opioid prescription concerns, and access to pain medications were accepted as appropriate by the majority of panellists.
Conclusion
The agreed approach to acute postoperative pain management for podiatric surgeons in Australia was with a stepwise approach, utilising multimodal therapy, and reserving oral opioids for breakthrough pain. Additionally, there was consensus for podiatric surgeons in Australia to have wider access to alternative analgesics and anti-emetics that have similar or improved efficacies with better safety profiles.
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How Do Drugs Affect the Skeleton? Implications for Forensic Anthropology. BIOLOGY 2022; 11:biology11040524. [PMID: 35453723 PMCID: PMC9030599 DOI: 10.3390/biology11040524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2022] [Accepted: 03/18/2022] [Indexed: 01/10/2023]
Abstract
Simple Summary Forensic anthropologists analyze human remains to assist in the identification of the deceased, predominantly by assessing age-at-death, sex, stature, ancestry and any unique identifying features. Whilst methods have been established to create this biological profile of the skeleton, these may be influenced by a number of factors. This paper, for the first time, provides an overview from a reading of the clinical and pharmacological literature to explore whether the intake of drugs can affect the skeleton and whether these may have implications for forensic anthropology casework. In effect, drugs such as tobacco, heroin, and prescription medications can alter bone mineral density, can increase the risk of fractures, destroy bone and changes to the dentition. By considering how drugs can affect the skeleton, forensic anthropologists can be aware of this when attempting to identify the deceased. Abstract Forensic anthropologists rely on a number of parameters when analyzing human skeletal remains to assist in the identification of the deceased, predominantly age-at-death, sex, stature, ancestry or population affinity, and any unique identifying features. During the examination of human remains, it is important to be aware that the skeletal features considered when applying anthropological methods may be influenced and modified by a number of factors, and particular to this article, prescription drugs (including medical and non-medical use) and other commonly used drugs. In view of this, this paper aims to review the medical, clinical and pharmacological literature to enable an assessment of those drug groups that as side effects have the potential to have an adverse effect on the skeleton, and explore whether or not they can influence the estimation of age-at-death, sex and other indicators of the biological profile. Moreover, it may be that the observation of certain alterations or inconsistencies in the skeleton may relate to the use of drugs or medication, and this in turn may help narrow down the list of missing persons to which a set of human remains could belong. The information gathered from the clinical and medical literature has been extracted with a forensic anthropological perspective and provides an awareness on how several drugs, such as opioids, cocaine, corticosteroids, non-steroidal anti-inflammatory drugs, alcohol, tobacco and others have notable effects on bone. Through different mechanisms, drugs can alter bone mineral density, causing osteopenia, osteoporosis, increase the risk of fractures, osteonecrosis, and oral changes. Not much has been written on the influence of drugs on the skeleton from the forensic anthropological practitioner perspective; and this review, in spite of its limitations and the requirement of further research, aims to investigate the current knowledge of the possible effects of both prescription and recreational drugs on bones, contributing to providing a better awareness in forensic anthropological practice and assisting in the identification process of the deceased.
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Kulesza A, Zielniok K, Hawryluk J, Paczek L, Burdzinska A. Ibuprofen in Therapeutic Concentrations Affects the Secretion of Human Bone Marrow Mesenchymal Stromal Cells, but Not Their Proliferative and Migratory Capacity. Biomolecules 2022; 12:biom12020287. [PMID: 35204788 PMCID: PMC8961564 DOI: 10.3390/biom12020287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/28/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) are able to modulate the immune system activity and the regeneration processes mainly through the secretion of multiple soluble factors, including prostaglandin E2 (PGE2). PGE2 is produced as a result of cyclooxygenases (COX) activity. In the present study, we investigated how ibuprofen, a nonselective COX inhibitor, affects the proliferation, migration and secretion of human bone marrow MSCs (hBM-MSCs). For this purpose, six hBM-MSCs populations were treated with ibuprofen at doses which do not differ from maximum serum concentrations during standard pharmacotherapy. Ibuprofen treatment (25 or 50 µg/mL) substantially reduced the secretion of PGE2 in all tested populations. Following ibuprofen administration, MSCs were subjected to proliferation (BrdU), transwell migration, and scratch assays, while its effect on MSCs secretome was evaluated by Proteome Profiler and Luminex immunoassays. Ibuprofen did not cause statistically significant changes in the proliferation rate and migration ability of MSCs (p > 0.05). However, ibuprofen (25 µg/mL for 3 days) significantly decreased mean secretion of: CCL2 (by 44%), HGF (by 31%), IL-6 (by 22%), VEGF (by 20%) and IL-4 (by 8%) compared to secretion of control MSCs (p < 0.05). Our results indicate that ibuprofen at therapeutic concentrations may impair the pro-regenerative properties of hBM-MSCs.
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Affiliation(s)
- Agnieszka Kulesza
- Department of Immunology, Transplantology and Internal Diseases, Faculty of Medicine, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland; (A.K.); (J.H.); (L.P.)
| | - Katarzyna Zielniok
- Department of Clinical Immunology, Faculty of Medicine, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland;
| | - Jakub Hawryluk
- Department of Immunology, Transplantology and Internal Diseases, Faculty of Medicine, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland; (A.K.); (J.H.); (L.P.)
| | - Leszek Paczek
- Department of Immunology, Transplantology and Internal Diseases, Faculty of Medicine, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland; (A.K.); (J.H.); (L.P.)
- Department of Bioinformatics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Pawińskiego 5A, 02-106 Warsaw, Poland
| | - Anna Burdzinska
- Department of Immunology, Transplantology and Internal Diseases, Faculty of Medicine, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland; (A.K.); (J.H.); (L.P.)
- Correspondence:
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13
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Chen W, Liu J, Yang Y, Ai Y, Yang Y. Ketorolac Administration After Colorectal Surgery Increases Anastomotic Leak Rate: A Meta-Analysis and Systematic Review. Front Surg 2022; 9:652806. [PMID: 35223972 PMCID: PMC8863852 DOI: 10.3389/fsurg.2022.652806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This meta-analysis aimed to evaluate whether ketorolac administration is associated with an increased anastomotic leak rate after colorectal surgery. Methods The literature was searched using the Web of Science, Embase, and PubMed databases, and the search ended on May 31, 2020. The Newcastle–Ottawa Scale was used to assess methodological quality. Statistical heterogeneity was assessed using the Chi-square Q test and I2 statistics. Subgroup analysis was performed, and Egger's test was used to assess publication bias. Results This meta-analysis included seven studies with 400,822 patients. Our results demonstrated that ketorolac administration after surgery increases the risk of anastomotic leak [OR = 1.41, 95% CI: 0.81–2.49, Z = 1.21, P = 0.23]. Low heterogeneity was observed across these studies (I2 = 0%, P = 0.51). The results of subgroup analysis showed that the use of ketorolac in case–control and retrospective cohort studies significantly increased the risk of anastomotic leak (P < 0.05). Furthermore, the subgroup analysis revealed that ketorolac use increased anastomotic leak rate in patients in the United States and Canada, and ketorolac plus morphine use did not increase anastomotic leak rate in Taiwanese patients (P < 0.05). No significant publication bias was observed (P = 0.126). Moreover, the analysis of risk factors related to anastomotic leak rate indicated that the total use of ketorolac did not increase the risk of anastomotic leak similar to the control group (P > 0.05). Conclusion The meta-analysis indicates that the use of ketorolac increases the risk of anastomotic leak after colorectal surgery. Systematic Review Registration PROSPERO, identifier CRD42020195724.
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Affiliation(s)
- Wen Chen
- Department of Anus and Intestine Surgery, Shijiazhuang People Hospital, Shijiazhuang, China
- *Correspondence: Wen Chen
| | - Jing Liu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China
| | - Yongqiang Yang
- Department of General Surgery, Shijiazhuang People Hospital, Shijiazhuang, China
| | - Yanhong Ai
- Department of General Surgery, Shijiazhuang People Hospital, Shijiazhuang, China
| | - Yueting Yang
- Department of General Surgery, Shijiazhuang People Hospital, Shijiazhuang, China
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14
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White MS, Brancati RJ, Lepley LK. Relationship between altered knee kinematics and subchondral bone remodeling in a clinically translational model of ACL injury. J Orthop Res 2022; 40:74-86. [PMID: 33295680 PMCID: PMC8187469 DOI: 10.1002/jor.24943] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/04/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
Abnormal joint kinematics are commonly reported in the acute and chronic stages of recovery after anterior cruciate ligament (ACL) injury and have long been mechanistically implicated as a primary driver in the development of posttraumatic osteoarthritis (PTOA). Though strongly theorized, it is unclear to what extent biomechanical adaptations after ACL injury culminate in the development of PTOA, as data that directly connects these factors does not exist. Using a preclinical, noninvasive ACL injury rodent model, our objective was to explore the direct effect of an isolated ACL injury on joint kinematics and the pathogenetic mechanisms involved in the development of PTOA. A total of 32, 16-week-old Long-Evans rats were exposed to a noninvasive ACL injury. Marker-less deep learning software (DeepLabCut) was used to track animal movement for sagittal-plane kinematic analyses and micro computed tomography was used to evaluate subchondral bone architecture at days 7, 14, 28, and 56 following injury. There was a significant decrease in peak knee flexion during walking (p < .05), which had a moderate-to-strong negative correlation (r = -.59 to -.71; p < .001) with subchondral bone plate porosity in all load bearing regions of the femur and tibia. Additional comprehensive analyses of knee flexion profiles revealed dramatic alterations throughout the step cycle. This occurred alongside considerable loss of epiphyseal trabecular bone and substantial changes in anatomical orientation. Knee flexion angle and subchondral bone microarchitecture are severely impacted after ACL injury. Reductions in peak knee flexion angle after ACL injury are directly associated with subchondral bone plate remodeling.
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Affiliation(s)
- McKenzie S. White
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ross J. Brancati
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey K. Lepley
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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15
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Sinniah A, Yazid S, Flower RJ. From NSAIDs to Glucocorticoids and Beyond. Cells 2021; 10:cells10123524. [PMID: 34944032 PMCID: PMC8700685 DOI: 10.3390/cells10123524] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 12/31/2022] Open
Abstract
Our interest in inflammation and its treatment stems from ancient times. Hippocrates used willow bark to treat inflammation, and many centuries later, salicylic acid and its derivative aspirin’s ability to inhibit cyclooxygenase enzymes was discovered. Glucocorticoids (GC) ushered in a new era of treatment for both chronic and acute inflammatory disease, but their potentially dangerous side effects led the pharmaceutical industry to seek other, safer, synthetic GC drugs. The discovery of the GC-inducible endogenous anti-inflammatory protein annexin A1 (AnxA1) and other endogenous proresolving mediators has opened a new era of anti-inflammatory therapy. This review aims to recapitulate the last four decades of research on NSAIDs, GCs, and AnxA1 and their anti-inflammatory effects.
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Affiliation(s)
- Ajantha Sinniah
- Department of Pharmacology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence:
| | - Samia Yazid
- Trio Medicines Ltd., Hammersmith Medicines Research, London NW10 7EW, UK;
| | - Rod J. Flower
- Biochemical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK;
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16
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Bolia IK, Haratian A, Bell JA, Hasan LK, Saboori N, Palmer R, Petrigliano FA, Weber AE. Managing Perioperative Pain After Anterior Cruciate Ligament (ACL) Reconstruction: Perspectives from a Sports Medicine Surgeon. Open Access J Sports Med 2021; 12:129-138. [PMID: 34512045 PMCID: PMC8426642 DOI: 10.2147/oajsm.s266227] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
Anterior cruciate ligament reconstructions (ACLR) are a relatively common procedure in orthopedic sports medicine with an estimated 130,000 arthroscopic operations performed annually. Most procedures are carried out on an outpatient basis, and though success rates of ACLR are as high as 95%, pain remains the most common postoperative complication delaying patient discharge, and thereby increasing the costs associated with patient care. Despite the success and relative frequency of ACLR surgery, optimal and widely accepted strategies and regimens for controlling perioperative pain are not well established. In recent years, the paradigm of pain control has shifted from exclusively utilizing opiates and opioid medications in the acute postoperative period to employing other agents and techniques including nerve blocks, intra-articular and periarticular injections of local anesthetic agents, NSAIDs, and less commonly, ketamine, tranexamic acid (TXA), sedatives, gabapentin, and corticosteroids. More often, these agents are now used in combination and in synergy with one another as part of a multimodal approach to pain management in ACLR, with the goal of reducing postoperative pain, opioid consumption, and the incidence of delayed hospital discharge. The purpose of this review is to consolidate current literature on various agents involved in the management of postoperative pain following ACLR, including the role of classically used opiate and opioid medications, as well as to describe other drugs currently utilized in practice either individually or in conjunction with other agents as part of a multimodal regimen in pain management in ACLR.
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Affiliation(s)
- Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Jennifer A Bell
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Nima Saboori
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ryan Palmer
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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17
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Put PEP in your step with a Podiatric Enhanced Recovery After Surgery Protocol in the outpatient adult population: a best practice implementation project. JBI Evid Implement 2021; 19:39-55. [PMID: 33570333 DOI: 10.1097/xeb.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The goal of this implementation project was to improve postoperative outcomes in the Day Surgery Podiatric patient population with the implementation of an enhanced recovery after surgery (ERAS) protocol at a large urban health system in the northeastern United States. We aimed to improve postoperative patient pain scores and reduce patient length of stay (LOS) with the implementation of the podiatric ERAS protocol (PEP). INTRODUCTION ERAS provides an evidence-based interdisciplinary approach to the preparation and care of surgical patients. The core goals of ERAS promote accelerated patient recovery after surgery by incorporating broad patient education with strategies to reduce the physiologic stress associated with surgery and anesthesia. This strategy has been applied to many major surgical specialties but has not been established in podiatric patients. METHODS The PEP evidence implementation initiative integrates two Joanna Briggs Institute tools: the Getting Research into Practice audit and feedback tool, and Practical Application of Clinical Evidence System, by incorporating proactive planning and data analyses. Baseline electronic health record data were collected in July 2019, followed by interdisciplinary PEP review, revision, implementation, and three data collection cycles. Strategic education was provided to stakeholders throughout data collection cycles. RESULTS This use of ERAS in the outpatient podiatric surgery population demonstrated excellence in compliance with best practice recommendations. The proactive multimodal approach of PEP revealed improvement in four measures of patient pain, with improvement from 83 to 100% of patients having a pain goal higher than their admission postoperative pain score. Patient pain goal greater than discharge pain score was also found but not sustained. Baseline data collection established that 29% of podiatric patients had a LOS less than 90 min, which improved to 42% with PEP. This finding was also not sustained in the third cycle of audit data. Missing data may have influenced these results, reinforcing the need for further study. CONCLUSION The use of ERAS in orthopedic patients has an established empirical basis for use, demonstrating a reduction in both postoperative pain and LOS. This novel use of ERAS in a podiatric surgery outpatient population has similar findings but was not sustained in all audit criteria. PEP demonstrated promising reductions in postoperative pain and LOS; however, further implementation replication is needed to confirm this expansion of ERAS and the promising results.
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Bimonte S, Cascella M, Forte CA, Esposito G, Cuomo A. The Role of Anti-Nerve Growth Factor Monoclonal Antibodies in the Control of Chronic Cancer and Non-Cancer Pain. J Pain Res 2021; 14:1959-1967. [PMID: 34234542 PMCID: PMC8253925 DOI: 10.2147/jpr.s302004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022] Open
Abstract
Nerve growth factor (NGF) belongs to the neurotrophin family and plays a fundamental role in the endurance of sensory and sympathetic neurons during embryogenesis. NGF, by interacting with tropomyosin receptor kinase A receptor (TrkA), modulates the pain pathway through the enhancement of the neurotrophic and nociceptor functions. Moreover, it has been demonstrated that NGF is upregulated in patients with chronic pain syndromes, which are difficult to treat. Thus, new non-pharmacological approaches, based on the use of different species-specific monoclonal antibodies (mAbs) targeting the NGF pathway, have been tested for the treatment of chronic pain in preclinical and clinical studies. With regard to preclinical investigations, anti-NGF mAbs have been used for the management of osteoarthritis (OA) and chronic low back pain animal models, with encouraging results. Moreover, anti-NGF mAb therapy is effective in animal models of neuropathic cancer pain. As regards patients with OA, although phase II and phase III clinical trials with tanezumab led to pain reduction, the safety was not observed in all these patients. Here, we review the preclinical and clinical studies on anti-NGF mAb therapy in chronic syndromes, dissect the role of NGF in pain transduction, and highlight the use of anti-NGF mAbs in humans.
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Affiliation(s)
- Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Cira Antonietta Forte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Gennaro Esposito
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale dei Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
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Thaller PH, Wolf F. [33/f-Complex deformity left lower limb : Preparation for the medical specialist examination: part 81]. Unfallchirurg 2021; 124:232-239. [PMID: 33779779 DOI: 10.1007/s00113-021-00990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Peter H Thaller
- Klinik für Allgemeine, Unfall -und Wiederherstellungschirurgie, Bereich für 3D-Chirurgie, Klinikum der Universität München, LMU München, Nussbaumstr. 20, 80336, München, Deutschland.
| | - F Wolf
- Klinik für Allgemeine, Unfall -und Wiederherstellungschirurgie, Bereich für 3D-Chirurgie, Klinikum der Universität München, LMU München, Nussbaumstr. 20, 80336, München, Deutschland
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20
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Bernthal NM, Hart CM, Sheth KR, Bergese SD, Ho HS, Apfel CC, Stoicea N, Rojhani A, Jahr JS. Local and Intra-articular Administration of Nonsteroidal Anti-inflammatory Drugs for Pain Management in Orthopedic Surgery. Am J Ther 2020; 29:e219-e228. [PMID: 33315593 DOI: 10.1097/mjt.0000000000001309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although growing evidence demonstrates the benefits of locally administered nonsteroidal anti-inflammatory drugs (NSAIDs) for postoperative pain management, there is ongoing debate regarding NSAID use in orthopedic surgery. AREAS OF UNCERTAINTY Current data largely support a local site of NSAID action and suggest that effective pain control can be achieved with delivery of NSAIDs intra-articularly (IA) and/or locally at the site of injury, where they can block peripheral production of inflammatory mediators and may desensitize nociceptors. Improvements in postoperative pain control with locally administered NSAIDs have been widely reported in the total joint arthroplasty literature and may offer benefits in patient's undergoing arthroscopic procedures and those with osteoarthritis as well. The purpose of this review is to examine the available evidence in the literature regarding the efficacy and safety profile of the use of local and IA NSAIDs in orthopedic surgery. DATA SOURCES Narrative literature review using keywords, expert opinion, either during or from live conference. THERAPEUTIC ADVANCES Local and IA administration of NSAIDs for pain management in orthopedic surgery. CONCLUSION There is convincing evidence that NSAIDs administered locally in and around the joint reduce postoperative pain scores and opioid consumption in patients undergoing total joint arthroplasty, yet further research is required regarding the risks of potential chondrotoxicity and the inhibition of bone and soft-tissue healing with locally administered NSAIDs.
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Affiliation(s)
- Nicholas M Bernthal
- Department of Orthopaedic Surgery, University of California Los Angeles David Geffen School of Medicine, UCLA Medical Center, Santa Monica, CA
| | - Christopher M Hart
- Department of Orthopaedic Surgery, University of California Los Angeles David Geffen School of Medicine, UCLA Medical Center, Santa Monica, CA
| | - Ketan R Sheth
- Department of General Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| | - Sergio D Bergese
- Department of Anesthesiology, School of Medicine, Stony Brook University, Health Sciences Center, Stony Brook, NY
| | - Hung S Ho
- Department of Surgery, University of California Davis, Sacramento, CA
| | - Christian C Apfel
- Department of Epidemiology and Biostatistics, University of California San Francisco, CA
| | - Nicoleta Stoicea
- Department of Biological Chemistry and Pharmacology, Ohio State University, Columbus, OH
| | - Allen Rojhani
- Drexel University College of Medicine, Philadelphia, PA
| | - Jonathan S Jahr
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA
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21
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The evolution of nerve growth factor inhibition in clinical medicine. Nat Rev Rheumatol 2020; 17:34-46. [PMID: 33219344 DOI: 10.1038/s41584-020-00528-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 02/08/2023]
Abstract
Nerve growth factor (NGF) is a neurotrophin that activates nociceptive neurons to transmit pain signals from the peripheral to the central nervous system and that exerts its effects on neurons by signalling through tyrosine kinase receptors. Antibodies that inhibit the function of NGF and small molecule inhibitors of NGF receptors have been developed and tested in clinical studies to evaluate the efficacy of NGF inhibition as a form of analgesia in chronic pain states including osteoarthritis and chronic low back pain. Clinical studies in individuals with painful knee and hip osteoarthritis have revealed that NGF inhibitors substantially reduce joint pain and improve function compared with NSAIDs for a duration of up to 8 weeks. However, the higher tested doses of NGF inhibitors also increased the risk of rapidly progressive osteoarthritis in a small percentage of those treated. This Review recaps the biology of NGF and the studies that have been performed to evaluate the efficacy of NGF inhibition for chronic musculoskeletal pain states. The adverse events associated with NGF inhibition and the current state of knowledge about the mechanisms involved in rapidly progressive osteoarthritis are also discussed and future studies proposed to improve understanding of this rare but serious adverse event.
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22
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Patel MS, Abboud JA, Sethi PM. Perioperative pain management for shoulder surgery: evolving techniques. J Shoulder Elbow Surg 2020; 29:e416-e433. [PMID: 32844751 DOI: 10.1016/j.jse.2020.04.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 02/08/2023]
Abstract
Improving management of postoperative pain following shoulder surgery is vital for optimizing patient outcomes, length of stay, and decreasing addiction to narcotic medications. Multimodal analgesia (ie, controlling pain via multiple different analgesic methods with differing mechanisms) is an ever-evolving approach to enhancing pain control perioperatively after shoulder surgery. With a variety of options for the shoulder surgeon to turn to, this article succinctly reviews the pros and cons of each approach and proposes a potential pain management algorithm.
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Affiliation(s)
- Manan S Patel
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul M Sethi
- Orthopaedic & Neurosurgery Specialists, Greenwich, CT, USA
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Hua K, Ji S, Li T, Chen C, Zha Y, Gong M, Sun W, Lu S, Jiang X. Correlation between modified trochleocapitellar index and post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. J Shoulder Elbow Surg 2020; 29:1876-1883. [PMID: 32446760 DOI: 10.1016/j.jse.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to propose the modified trochleocapitellar index (mTCI), assess its reliability, and evaluate its correlation with post-traumatic elbow stiffness in type C2-3 distal humeral fractures among adults. METHODS From January 2013 to June 2017, a total of 141 patients with type C2-3 distal humeral fractures were included. The mTCI was calculated as the ratio between the modified trochlear and capitellar angles relative to the humeral axis (mTCI-HA), lateral humeral line (mTCI-LHL), and medial humeral line (mTCI-MHL) from anteroposterior radiographs taken immediately after the operation. The patients were divided into group A (with elbow stiffness) and group B (without elbow stiffness) based on follow-up results. To determine risk factors for elbow stiffness, univariate and logistic regression analyses were performed on each radiographic parameter separately, together with other clinical variables. Interrater reliability was assessed for all measurements. RESULTS Specific optimal ranges of value were identified for mTCI-HA (0.750-0.875), mTCI-LHL (0.640-1.060), and mTCI-MHL (0.740-0.900), beyond which the likelihood of elbow stiffness significantly increased (P < .001). By multivariate analysis, mTCI-HA (odds ratio [OR] 26.22, 95% confidence interval [CI] 3.39-203.07, P = .002), mTCI-LHL (OR 5.37, 95% CI 2.17-13.28, P < .001), and mTCI-MHL (OR 5.95, 95% CI 1.91-18.56, P = .002) values beyond the optimal ranges were identified as the independent risk factors for elbow stiffness. The interrater reliability of mTCI-HA, mTCI-LHL, and mTCI-MHL was 0.986, 0.983, and 0.987, respectively. CONCLUSION The mTCI measurement method is reliable. Either too small or too large mTCI values were associated with post-traumatic elbow stiffness among adult patients with type C2-3 distal humeral fractures. The mTCI-HA showed a better predictive value than mTCI-LHL and mTCI-MHL.
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Affiliation(s)
- Kehan Hua
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Shangwei Ji
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Chen Chen
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yejun Zha
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Maoqi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Weitong Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Shuai Lu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xieyuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China.
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24
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Johnson KA, Muzzin N, Toufanian S, Slick RA, Lawlor MW, Seifried B, Moquin P, Latulippe D, Hoare T. Drug-impregnated, pressurized gas expanded liquid-processed alginate hydrogel scaffolds for accelerated burn wound healing. Acta Biomater 2020; 112:101-111. [PMID: 32522716 DOI: 10.1016/j.actbio.2020.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Abstract
While the benefits of both hydrogels and drug delivery to enhance wound healing have been demonstrated, the highly hydrophilic nature of hydrogels creates challenges with respect to the effective loading and delivery of hydrophobic drugs beneficial to wound healing. Herein, we utilize pressurized gas expanded liquid (PGX) technology to produce very high surface area (~200 m2/g) alginate scaffolds and describe a method for loading the scaffolds with ibuprofen (via adsorptive precipitation) and crosslinking them (via calcium chelation) to create a hydrogel suitable for wound treatment and hydrophobic drug delivery. The high surface area of the PGX-processed alginate scaffold facilitates >8 wt% loading of ibuprofen into the scaffold and controlled in vitro ibuprofen release over 12-24 h. In vivo burn wound healing assays demonstrate significantly accelerated healing with ibuprofen-loaded PGX-alginate/calcium scaffolds relative to both hydrogel-only and untreated controls, demonstrating the combined benefits of ibuprofen delivery to suppress inflammation as well as the capacity of the PGX-alginate/calcium hydrogel to maintain wound hydration and facilitate continuous calcium release to the wound. The use of PGX technology to produce highly porous scaffolds with increased surface areas, followed by adsorptive precipitation of a hydrophobic drug onto the scaffolds, offers a highly scalable method of creating medicated wound dressings with high drug loadings. STATEMENT OF SIGNIFICANCE: While medicated hydrogel-based wound dressings offer clear advantages in accelerating wound healing, the inherent incompatibility between conventional hydrogels and many poorly water-soluble drugs of relevance in wound healing remains a challenge. Herein, we leveraged supercritical fluids-based strategies to both process and subsequently impregnate alginate, followed by post-crosslinking to form a hydrogel, to create a very high surface area alginate hydrogel scaffold loaded with high hydrophobic drug contents (here, >8 wt% ibuprofen) without the need for any pore-forming additives. The impregnated scaffolds significantly accelerated burn wound healing while also promoting regeneration of the native skin morphology. We anticipate this approach can be leveraged to load clinically-relevant and highly bioavailable dosages of hydrophobic drugs in hydrogels for a broad range of potential applications.
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Affiliation(s)
- Kelli-Anne Johnson
- Department of Chemical Engineering, McMaster University, 1280 Main St. W., Hamilton, ON, Canada
| | - Nicola Muzzin
- Department of Chemical Engineering, McMaster University, 1280 Main St. W., Hamilton, ON, Canada
| | - Samaneh Toufanian
- Department of Chemical Engineering, McMaster University, 1280 Main St. W., Hamilton, ON, Canada
| | - Rebecca A Slick
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael W Lawlor
- Department of Pathology and Laboratory Medicine and Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Paul Moquin
- Ceapro, Inc., 7824-51 Avenue NW, Edmonton, AB, Canada
| | - David Latulippe
- Department of Chemical Engineering, McMaster University, 1280 Main St. W., Hamilton, ON, Canada
| | - Todd Hoare
- Department of Chemical Engineering, McMaster University, 1280 Main St. W., Hamilton, ON, Canada.
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Tucker WA, Birt MC, Heddings AA, Horton GA. The Effect of Postoperative Nonsteroidal Anti-inflammatory Drugs on Nonunion Rates in Long Bone Fractures. Orthopedics 2020; 43:221-227. [PMID: 32379334 DOI: 10.3928/01477447-20200428-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/03/2020] [Indexed: 02/03/2023]
Abstract
The association of nonsteroidal anti-inflammatory drugs (NSAIDs) with non-union in long bone fractures has been controversial. The purpose of this study was to evaluate whether NSAID exposure results in increased risk of non-union in operatively treated long bone fractures. The authors used International Classification of Diseases and Current Procedural Terminology codes to identify patients under a single-payer private insurance with operatively treated humeral shaft, tibial shaft, and subtrochanteric femur fractures from a large database. Patients were divided into cohorts based on NSAID use in the immediate postoperative period, and nonunion rates were compared. A cost analysis and a multivariate analysis were performed. Between 2007 and 2016, a total of 5310 tibial shaft, 3947 humeral shaft, and 8432 subtrochanteric femur fractures underwent operative fixation. Patients used NSAIDs in the first 90 days postoperatively in 900 tibial shaft, 694 humeral shaft, and 967 subtrochanteric femur fractures. In these patients, nonunion rates were 18.8%, 17.4%, and 10.4%, respectively. When no NSAIDs were used, the rates were 11.4%, 10.1%, and 4.6% for each fracture type, respectively (P<.05). Among patients taking NSAIDs, subtrochanteric femur fractures had a 2.4 times higher risk of nonunion and humeral shaft and tibial shaft fractures both had a 1.7 times higher risk of nonunion (P<.05). Multivariate analysis showed NSAID use to be an independent risk factor in all 3 types. Cost analysis showed a great increase in economic burden (P<.05). This study indicated that NSAID exposure was associated with fracture nonunion. [Orthopedics. 2020;43(4):221-227.].
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Rapid exposure of macrophages to drugs resolves four classes of effects on the leading edge sensory pseudopod: Non-perturbing, adaptive, disruptive, and activating. PLoS One 2020; 15:e0233012. [PMID: 32469878 PMCID: PMC7259666 DOI: 10.1371/journal.pone.0233012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
Leukocyte migration is controlled by a membrane-based chemosensory pathway on the leading edge pseudopod that guides cell movement up attractant gradients during the innate immune and inflammatory responses. This study employed single cell and population imaging to investigate drug-induced perturbations of leading edge pseudopod morphology in cultured, polarized RAW macrophages. The drugs tested included representative therapeutics (acetylsalicylic acid, diclofenac, ibuprofen, acetaminophen) as well as control drugs (PDGF, Gö6976, wortmannin). Notably, slow addition of any of the four therapeutics to cultured macrophages, mimicking the slowly increasing plasma concentration reported for standard oral dosage in patients, yielded no detectable change in pseudopod morphology. This finding is consistent with the well established clinical safety of these drugs. However, rapid drug addition to cultured macrophages revealed four distinct classes of effects on the leading edge pseudopod: (i) non-perturbing drug exposures yielded no detectable change in pseudopod morphology (acetylsalicylic acid, diclofenac); (ii) adaptive exposures yielded temporary collapse of the extended pseudopod and its signature PI(3,4,5)P3 lipid signal followed by slow recovery of extended pseudopod morphology (ibuprofen, acetaminophen); (iii) disruptive exposures yielded long-term pseudopod collapse (Gö6976, wortmannin); and (iv) activating exposures yielded pseudopod expansion (PDGF). The novel observation of adaptive exposures leads us to hypothesize that rapid addition of an adaptive drug overwhelms an intrinsic or extrinsic adaptation system yielding temporary collapse followed by adaptive recovery, while slow addition enables gradual adaptation to counteract the drug perturbation in real time. Overall, the results illustrate an approach that may help identify therapeutic drugs that temporarily inhibit the leading edge pseudopod during extreme inflammation events, and toxic drugs that yield long term inhibition of the pseudopod with negative consequences for innate immunity. Future studies are needed to elucidate the mechanisms of drug-induced pseudopod collapse, as well as the mechanisms of adaptation and recovery following some inhibitory drug exposures.
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Rothe R, Schulze S, Neuber C, Hauser S, Rammelt S, Pietzsch J. Adjuvant drug-assisted bone healing: Part I – Modulation of inflammation. Clin Hemorheol Microcirc 2020; 73:381-408. [DOI: 10.3233/ch-199102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca Rothe
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Sabine Schulze
- University Center of Orthopaedics & Traumatology (OUC), University Hospital Carl Gustav Carus, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Christin Neuber
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Sandra Hauser
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
| | - Stefan Rammelt
- University Center of Orthopaedics & Traumatology (OUC), University Hospital Carl Gustav Carus, Dresden, Germany
- Center for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Center for Regenerative Therapies Dresden (CRTD), Dresden, Germany
| | - Jens Pietzsch
- Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Institute of Radiopharmaceutical Cancer Research, Department of Radiopharmaceutical and Chemical Biology, Dresden, Germany
- Technische Universität Dresden, School of Science, Faculty of Chemistry and Food Chemistry, Dresden, Germany
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28
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Xie Y, Pan M, Gao Y, Zhang L, Ge W, Tang P. Dose-dependent roles of aspirin and other non-steroidal anti-inflammatory drugs in abnormal bone remodeling and skeletal regeneration. Cell Biosci 2019; 9:103. [PMID: 31890152 PMCID: PMC6929289 DOI: 10.1186/s13578-019-0369-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023] Open
Abstract
The failure of remodeling process that constantly regenerates effete, aged bone is highly associated with bone nonunion and degenerative bone diseases. Numerous studies have demonstrated that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) activate cytokines and mediators on osteoclasts, osteoblasts and their constituent progenitor cells located around the remodeling area. These cells contribute to a complex metabolic scenario, resulting in degradative or synthetic functions for bone mineral tissues. The spatiotemporal effects of aspirin and NSAIDs in the bone remodeling are controversial according the specific therapeutic doses used for different clinical conditions. Herein, we review in vitro, in vivo, and clinical studies on the dose-dependent roles of aspirin and NSAIDs in bone remodeling. Our results show that low-dose aspirin (< 100 μg/mL), which is widely recommended for prevention of thrombosis, is very likely to be benefit for maintaining bone mass and qualities by activation of osteoblastic bone formation and inhibition of osteoclast activities via cyclooxygenase-independent manner. While, the roles of high-dose aspirin (150-300 μg/mL) and other NSAIDs in bone self-regeneration and fracture-healing process are difficult to elucidate owing to their dual effects on osteoclast activity and bone formation of osteoblast. In conclusion, this study highlighted the potential clinical applications of low-dose aspirin in abnormal bone remodeling as well as the risks of high-dose aspirin and other NSAIDs for relieving pain and anti-inflammation in fractures and orthopedic operations.
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Affiliation(s)
- Yong Xie
- 1Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853 China
| | - Meng Pan
- 2State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 China
| | - Yanpan Gao
- 2State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 China
| | - Licheng Zhang
- 1Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853 China
| | - Wei Ge
- 2State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 China
| | - Peifu Tang
- 1Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853 China
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29
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Eroglu I, Gultekinoglu M, Bayram C, Erikci A, Ciftci SY, Ayse Aksoy E, Ulubayram K. Gel network comprising UV crosslinked PLGA-b-PEG-MA nanoparticles for ibuprofen topical delivery. Pharm Dev Technol 2019; 24:1144-1154. [PMID: 31298072 DOI: 10.1080/10837450.2019.1643880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Ibuprofen is a non-steroidal anti-inflammatory drug for the treatment of Rheumatoid Arthritis and osteoarthritis. In this study, we prepared topical gel network for enhancement of ibuprofen penetration, maintenance of controlled release and increased patient compliance. Nanoparticles containing ibuprofen were prepared by means of emulsion formation/solvent diffusion method using synthesized copolymer. Nanoparticles were then conjugated with aminoethylmethacrylate, resulting in ibuprofen-loaded nanoparticles in PLGA-b-PEG-MA structure. Ibuprofen-loaded gel networks were developed by crosslinking nanoparticles via UV exposure. Suitability for topical application has been assessed through characterization of particle size, zeta potential, morphology, encapsulation efficiency, in vitro release, cytotoxicity and enhancement of in vitro wound healing. The mean diameter of nanoparticles was measured as 230 ± 20 nm. Gel network formulations with higher particle size (2800 ± 350 nm) and zeta potential (39.8 ± 9.2 mV), depending on conjugation of methacrylate within copolymeric structure, and having encapsulation efficacy of 73.6 ± 2.8% were prepared. The in vitro release of ibuprofen was sustained for more than 7 hours. Gel network improved collagen synthesis, type I collagen mRNA expression and fibrosis in dose dependent manner. Based on this, we can conclude that PLGA-b-PEG gel network might be a promising systems for the local delivery of ibuprofen in RA patients.
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Affiliation(s)
- Ipek Eroglu
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | - Merve Gultekinoglu
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey.,Bioengineering Division, Institute for Graduate Studies in Science & Engineering, Hacettepe University , Ankara , Turkey
| | - Cem Bayram
- Advanced Technologies Application and Research Center, Hacettepe University , Ankara , Turkey
| | - Acelya Erikci
- Department of Biochemistry, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | | | - Eda Ayse Aksoy
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey
| | - Kezban Ulubayram
- Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Hacettepe University , Ankara , Turkey.,Bioengineering Division, Institute for Graduate Studies in Science & Engineering, Hacettepe University , Ankara , Turkey
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30
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Lim JWA, Liow MH, Tan AHC. Post-operative non-steroidal anti-inflammatory drugs do not affect clinical outcomes of rotator cuff repair. J Orthop 2019; 17:113-115. [PMID: 31879487 DOI: 10.1016/j.jor.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/04/2019] [Indexed: 01/08/2023] Open
Abstract
Background The administration of non-steroidal anti-inflammatory drugs (NSAIDs) to patients is thought to impair rotator cuff healing and clinical outcomes. Methods 36 patients who underwent rotator cuff repair were divided into 3 groups based on their post-operative analgesia regimes. Results At 4.4 years postoperative, there was significant improvement in SST and UCLA scores (p < 0.001). There were no significant differences in post-operative clinical outcome scores between the groups (p > 0.05). Administration of NSAIDs and duration of their use did not influence outcomes of rotator cuff repair (p = 0.151). Conclusion NSAIDs has no significant influence on clinical outcomes of rotator cuff repair.
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Affiliation(s)
- Joel Wei-An Lim
- Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169865, Singapore
| | - Ming Han Liow
- Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169865, Singapore
| | - Andrew Hwee Chye Tan
- Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169865, Singapore
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31
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Qazi TH, Duda GN, Ort MJ, Perka C, Geissler S, Winkler T. Cell therapy to improve regeneration of skeletal muscle injuries. J Cachexia Sarcopenia Muscle 2019; 10:501-516. [PMID: 30843380 PMCID: PMC6596399 DOI: 10.1002/jcsm.12416] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/27/2019] [Indexed: 12/14/2022] Open
Abstract
Diseases that jeopardize the musculoskeletal system and cause chronic impairment are prevalent throughout the Western world. In Germany alone, ~1.8 million patients suffer from these diseases annually, and medical expenses have been reported to reach 34.2bn Euros. Although musculoskeletal disorders are seldom fatal, they compromise quality of life and diminish functional capacity. For example, musculoskeletal disorders incur an annual loss of over 0.8 million workforce years to the German economy. Among these diseases, traumatic skeletal muscle injuries are especially problematic because they can occur owing to a variety of causes and are very challenging to treat. In contrast to chronic muscle diseases such as dystrophy, sarcopenia, or cachexia, traumatic muscle injuries inflict damage to localized muscle groups. Although minor muscle trauma heals without severe consequences, no reliable clinical strategy exists to prevent excessive fibrosis or fatty degeneration, both of which occur after severe traumatic injury and contribute to muscle degeneration and dysfunction. Of the many proposed strategies, cell-based approaches have shown the most promising results in numerous pre-clinical studies and have demonstrated success in the handful of clinical trials performed so far. A number of myogenic and non-myogenic cell types benefit muscle healing, either by directly participating in new tissue formation or by stimulating the endogenous processes of muscle repair. These cell types operate via distinct modes of action, and they demonstrate varying levels of feasibility for muscle regeneration depending, to an extent, on the muscle injury model used. While in some models the injury naturally resolves over time, other models have been developed to recapitulate the peculiarities of real-life injuries and therefore mimic the structural and functional impairment observed in humans. Existing limitations of cell therapy approaches include issues related to autologous harvesting, expansion and sorting protocols, optimal dosage, and viability after transplantation. Several clinical trials have been performed to treat skeletal muscle injuries using myogenic progenitor cells or multipotent stromal cells, with promising outcomes. Recent improvements in our understanding of cell behaviour and the mechanistic basis for their modes of action have led to a new paradigm in cell therapies where physical, chemical, and signalling cues presented through biomaterials can instruct cells and enhance their regenerative capacity. Altogether, these studies and experiences provide a positive outlook on future opportunities towards innovative cell-based solutions for treating traumatic muscle injuries-a so far unmet clinical need.
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Affiliation(s)
- Taimoor H Qazi
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Melanie J Ort
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sven Geissler
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Winkler
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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32
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Constantinescu DS, Campbell MP, Moatshe G, Vap AR. Effects of Perioperative Nonsteroidal Anti-inflammatory Drug Administration on Soft Tissue Healing: A Systematic Review of Clinical Outcomes After Sports Medicine Orthopaedic Surgery Procedures. Orthop J Sports Med 2019; 7:2325967119838873. [PMID: 31019986 PMCID: PMC6469280 DOI: 10.1177/2325967119838873] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: The effects of perioperative nonsteroidal anti-inflammatory drugs (NSAIDs) on
soft tissue healing in humans have yet to be established. Purpose: To systematically review the literature addressing the effects of
perioperative NSAID administration on soft tissue healing and clinical
patient outcomes. Study Design: Systematic review; Level of evidence, 3. Methods: This review study was conducted in accordance with the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) statement. A
review of the literature regarding the existing evidence for clinical
effects of NSAID use on soft tissue healing was performed through use of the
Cochrane Database of Systematic Reviews, the Cochrane Central Register of
Controlled Trials, PubMed (1980 to present), and MEDLINE. Inclusion criteria
for articles were as follows: outcome studies after soft tissue (ligament,
meniscus, tendon, muscle) healing after surgical procedure with
perioperative NSAID administration, at least 1 year of follow-up, English
language, and human participants. Results: A total of 466 studies were initially retrieved, with 4 studies satisfying
all inclusion criteria. Among the surgical procedures reported, 93% of the
patients (4144/4451) underwent anterior cruciate ligament (ACL)
reconstruction, 3% (120/4451) underwent rotator cuff repair, 3% (155/4451)
underwent Bankart shoulder repair, and 1% (32/4451) underwent meniscal
repair. The reported surgical failure rate among patients administered
NSAIDs was 3.6% (157/4360). The reported surgical failure rate among control
participants not given NSAIDs was 3.7% (147/3996). NSAID use showed no
statistically significant effect on need for reoperation in meniscal repair
(P = .99), ACL reconstruction (P =
.8), and Bankart repair (P = .8) compared with no NSAID
administration. Celecoxib administration had a significantly higher rate of
retear (37%) after rotator cuff repair compared with ibuprofen (7%)
(P = .009). Conclusion: Insufficient data are available to definitively state the effects of
perioperative NSAIDs on soft tissue healing. Use of NSAIDs should be
considered on a case-by-case basis and may not affect healing rates
following either meniscal, ACL, rotator cuff, or Bankart repair. However,
celecoxib (a selective COX-2 inhibitor) may inhibit tendon-to-bone healing
in rotator cuff repair. Further research through clinical trials is required
to fully determine whether NSAIDs have an adverse effect on soft tissue
healing.
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Affiliation(s)
- David S Constantinescu
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael P Campbell
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Alexander R Vap
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Yu X, Qi Y, Zhao T, Fang J, Liu X, Xu T, Yang Q, Dai X. NGF increases FGF2 expression and promotes endothelial cell migration and tube formation through PI3K/Akt and ERK/MAPK pathways in human chondrocytes. Osteoarthritis Cartilage 2019; 27:526-534. [PMID: 30562625 DOI: 10.1016/j.joca.2018.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/22/2018] [Accepted: 12/05/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Vascular invasion is observed at the osteochondral junction in osteoarthritis (OA). Nerve growth factor (NGF) as an angiogenic factor is expressed in OA. This study is to investigate the effects of NGF on angiogenesis in vitro in human chondrocytes. DESIGN Articular cartilages of knee joints were harvested from healthy and OA patients. Expressions of NGF and tropomyosin-related kinase A (TrkA) were detected by western blot, Safranin-O and fast green staining and immunohistochemistry in cartilage. Expression of fibroblast growth factor 2 (FGF2) was detected by western blot in cultured chondrocytes. Chondrocytes were transfected by lentiviral vectors to knock down TrkA. Migration and tube formation of human microvascular endothelial cell (HMVEC) were assessed by using transwell co-culture with chondrocyte after treatment of NGF. RESULTS We confirmed expressions of NGF and TrkA were significantly up-regulated in OA. NGF induced expression of FGF2 in a time- and dose-dependent manner. Angiogenic activities of endothelial cells were greatly enhanced after co-cultured with NGF pre-treated chondrocytes, while knock-down of TrkA significantly abolished the above effects. We further found that NGF-induced expression of FGF2 promoted angiogenic activities of endothelial cells through PI3K/Akt and ERK/MAPK signaling pathways. CONCLUSIONS NGF promotes expression of FGF2 in vitro via PI3K/Akt and ERK/MAPK signaling pathways in human chondrocytes and it increases angiogenesis, which is mediated by TrkA. NGF could be responsible for vascular up-growth from subchondral bone in OA.
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Affiliation(s)
- X Yu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou 310009, PR China; Orthopaedics Research Institute, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, PR China; Department of Orthopaedic Surgery, Hangzhou Mingzhou Hospital (International Medical Center, Second Affiliated Hospital, Zhejiang University), Shixin Road 590#, Hangzhou 311215, PR China
| | - Y Qi
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou 310009, PR China; Orthopaedics Research Institute, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, PR China
| | - T Zhao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou 310009, PR China; Orthopaedics Research Institute, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, PR China
| | - J Fang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou 310009, PR China; Orthopaedics Research Institute, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, PR China; Department of Orthopaedic Surgery, Hangzhou Mingzhou Hospital (International Medical Center, Second Affiliated Hospital, Zhejiang University), Shixin Road 590#, Hangzhou 311215, PR China
| | - X Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou 310009, PR China; Orthopaedics Research Institute, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, PR China
| | - T Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou 310009, PR China; Orthopaedics Research Institute, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, PR China
| | - Q Yang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou 310009, PR China; Orthopaedics Research Institute, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, PR China
| | - X Dai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou 310009, PR China; Orthopaedics Research Institute, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, PR China.
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34
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Mannava S, Whitney KE, Kennedy MI, King J, Dornan GJ, Klett K, Chahla J, Evans TA, Huard J, LaPrade RF. The Influence of Naproxen on Biological Factors in Leukocyte-Rich Platelet-Rich Plasma: A Prospective Comparative Study. Arthroscopy 2019; 35:201-210. [PMID: 30472018 DOI: 10.1016/j.arthro.2018.07.030] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify and compare normative catabolic and anabolic factor concentrations in leukocyte-rich platelet-rich plasma (LR-PRP) at various time points, including baseline, 1 week after initiating naproxen use, and after a 1-week washout period. METHODS Asymptomatic healthy donors aged between 18 and 70 years were recruited (average age, 36.6 years; range, 25-64 years). Subjects were excluded from the study if they were actively taking any prescribed medications or nonsteroidal anti-inflammatory drugs (NSAIDs) or if they had any of the following at present or previously: blood or immunosuppression disorders, cancer, osteonecrosis, rheumatoid arthritis, avascular necrosis, NSAID intolerance, gastrointestinal or peptic ulcer disease, or kidney dysfunction. The anabolic factors vascular endothelial growth factor, fibroblast growth factor 2, platelet-derived growth factor AB (PDGF-AB), and platelet-derived growth factor AA (PDGF-AA) and the catabolic factors interleukin (IL) 1β, IL-6, IL-8, and tumor necrosis factor α in LR-PRP were measured. Peripheral blood was drawn at 3 time points: baseline, after 1 week of naproxen use, and after a 1-week washout period. RESULTS The angiogenic factors PDGF-AA (44% decrease in median) and PDGF-AB (47% decrease) significantly declined from baseline (P < .05) after 1 week of naproxen use. There was a significant recovery (P < .05) of PDGF-AA (94% increase) and PDGF-AB (153% increase) levels after the 1-week washout period, with a return to baseline levels. The catabolic factor IL-6 also had a significant decline from baseline (77% decrease in median, P < .05) after 1 week of naproxen use. After a 1-week washout period, the IL-6 level was similar to the baseline level (130% increase, P < .05). CONCLUSIONS Naproxen use diminished several biological factors in LR-PRP; however, a 1-week washout period was sufficient for the recovery of PDGF-AA, PDGF-AB, and IL-6 to return to baseline levels. Tumor necrosis factor α, IL-1β, IL-8, vascular endothelial growth factor, and fibroblast growth factor 2 did not show differences between the 3 time points of data collection. Discontinuing NSAIDs for a minimum of 1 week before LR-PRP treatment may improve certain biological factor levels. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Sandeep Mannava
- Center of Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A
| | | | | | - Jill King
- The Steadman Clinic, Vail, Colorado, U.S.A
| | | | | | | | - Thos A Evans
- Center of Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A
| | - Johnny Huard
- Center of Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A
| | - Robert F LaPrade
- Center of Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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Juráňová J, Aury-Landas J, Boumediene K, Baugé C, Biedermann D, Ulrichová J, Franková J. Modulation of Skin Inflammatory Response by Active Components of Silymarin. Molecules 2018; 24:molecules24010123. [PMID: 30598040 PMCID: PMC6337225 DOI: 10.3390/molecules24010123] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 12/21/2022] Open
Abstract
In this study, we compared selected silymarin components, such as quercetin (QE), 2,3-dehydrosilybin (DHS) and silybin (SB), with the anti-inflammatory drug indomethacin (IND) in terms of their wound healing potential. In view of the fact that pathological cutaneous wound healing is associated with persistent inflammation, we studied their anti-inflammatory activity against inflammation induced by bacterial lipopolysaccharide (LPS). We investigated the regulation of crucial pro-inflammatory transcription factors—nuclear factor kappa-B (NF-κB) and activator protein 1 (AP-1)—as well as the expression of downstream inflammatory targets by Western blotting, real-time PCR (RT-PCR), electrophoretic mobility shift assay (EMSA), and/or enzyme-linked immunosorbent assay (ELISA) in vitro using primary normal human dermal fibroblasts (NHDF). We demonstrated the greater ability of DHS to modulate the pro-inflammatory cytokines production via the NF-κB and AP-1 signaling pathways when compared to other tested substances. The prolonged exposure of LPS-challenged human dermal fibroblasts to DHS had both beneficial and detrimental consequences. DHS diminished interleukin-6 (IL-6) and interleukin-8 (IL-8) secretion but induced the significant upregulation of IL-8 mRNA associated with NF-κB and AP-1 activation. The observed conflicting results may compromise the main expected benefit, which is the acceleration of the healing of the wound via a diminished inflammation.
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Affiliation(s)
- Jana Juráňová
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 3, 775 15 Olomouc, Czech Republic.
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 5, 779 00 Olomouc, Czech Republic.
| | | | - Karim Boumediene
- EA7451 BioConnecT, Normandie University, UNICAEN, 14000 Caen, France.
| | - Catherine Baugé
- EA7451 BioConnecT, Normandie University, UNICAEN, 14000 Caen, France.
| | - David Biedermann
- Institute of Microbiology of the Czech Academy of Sciences, Laboratory of Biotransformation, Vídeňská 1083, 14220 Praha 4, Czech Republic.
| | - Jitka Ulrichová
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 3, 775 15 Olomouc, Czech Republic.
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 5, 779 00 Olomouc, Czech Republic.
| | - Jana Franková
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 3, 775 15 Olomouc, Czech Republic.
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Hněvotínská 5, 779 00 Olomouc, Czech Republic.
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Liao YP, Du WM, Hu Y, Li FS, Ma Y, Wang H, Zhu JH, Zhou Y, Li Q, Su YX, He BC. CREB/Wnt10b mediates the effect of COX-2 on promoting BMP9-induced osteogenic differentiation via reducing adipogenic differentiation in mesenchymal stem cells. J Cell Biochem 2018; 120:9572-9587. [PMID: 30525243 DOI: 10.1002/jcb.28234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 11/15/2018] [Indexed: 01/10/2023]
Abstract
Bone morphogenetic protein 9 (BMP9) is one of the most potent osteogenic factors, which may be a potential candidate for bone tissue engineering. However, the osteogenic capacity of BMP9 still need to be further enhanced. In this study, we determined the effect of Wnt10b on BMP9-induced osteogenic differentiation in mesenchymal stem cell (MSCs) and the possible mechanism underlying this process. We introduced the polymerase chain reaction (PCR), Western blot analysis, histochemical stain, ectopic bone formation, and microcomputed tomography analysis to evaluate the effect of Wnt10b on BMP9-induced osteogenic differentiation. Meanwhile, PCR, Western blot analysis, chromatin immunoprecipitation, and immunoprecipitation were used to analyze the possible relationship between BMP9 and Wnt10b. We found that BMP9 upregulates Wnt10b in C3H10T1/2 cells. Wnt10b increases the osteogenic markers and bone formation induced by BMP9 in C3H10T1/2 cells, and silencing Wnt10b decreases these effects of BMP9. Meanwhile, Wnt10b enhances the level of phosphorylated Smad1/5/8 (p-Smad1/5/8) induced by BMP9, which can be reduced by silencing Wnt10b. On the contrary, Wnt10b inhibits adipogenic markers induced by BMP9, which can be decreased by silencing Wnt10b. Further analysis indicated that BMP9 upregulates cyclooxygenase-2 (COX-2) and phosphorylation of cAMP-responsive element binding (p-CREB) simultaneously. COX-2 potentiates the effect of BMP9 on increasing p-CREB and Wnt10b, while silencing COX-2 decreases these effects. p-CREB interacts with p-Smad1/5/8 to bind the promoter of Wnt10b in C3H10T1/2 cells. Our findings suggested that Wnt10b can promote BMP9-induced osteogenic differentiation in MSCs, which may be mediated through enhancing BMP/Smad signal and reducing adipogenic differentiation; BMP9 may upregulate Wnt10b via the COX-2/p-CREB-dependent manner.
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Affiliation(s)
- Yun-Peng Liao
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Wei-Min Du
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ying Hu
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Fu-Shu Li
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yan Ma
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Han Wang
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Jia-Hui Zhu
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ya Zhou
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qin Li
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yu-Xi Su
- Department of Orthopedic, Children Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Bai-Cheng He
- Department of Pharmacology, School of Pharmacy, Chongqing Medical University, Chongqing, People's Republic of China.,Key Laboratory of Biochemistry and Molecular Pharmacology of Chongqing, Chongqing Medical University, Chongqing, People's Republic of China
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Séon-Lutz M, Couffin AC, Vignoud S, Schlatter G, Hébraud A. Electrospinning in water and in situ crosslinking of hyaluronic acid / cyclodextrin nanofibers: Towards wound dressing with controlled drug release. Carbohydr Polym 2018; 207:276-287. [PMID: 30600010 DOI: 10.1016/j.carbpol.2018.11.085] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022]
Abstract
Hyaluronic acid (HA) is widely investigated due to its high potential for wound dressing applications. The fabrication of biomimetic HA-based scaffolds by electrospinning is thus extensively studied. However, HA is often dissolved in toxic organic solvents to allow the efficient production of electrospun nanofibers. Indeed, although HA is soluble in water, its ionic nature leading to long-range electrostatic interactions and the presence of counter ions induce a dramatic increase of the viscosity of aqueous HA solutions without insuring enough chain entanglements necessary for a stable and efficient electrospinning. In this study, biocompatible insoluble HA-based nanofibers were fabricated by electrospinning in pure water. To this end, poly(vinyl alcohol) (PVA) was added as a carrier polymer and it was found that the addition of hydroxypropyl-βcyclodextrin (HPβCD) stabilized the process of electrospinning and led to the efficient formation of uniform nanofibrous scaffolds. An in situ crosslinking process of the scaffolds is also proposed, insuring a whole fabrication process without any toxicity. Furthermore, the beneficial presence of HPβCD in the HA-based scaffolds paves the way for wound dressing applications with controlled drug encapsulation-release properties. As a proof of concept, naproxen (NAP), a non-steroidal anti-inflammatory drug was chosen as a model drug. NAP was impregnated into the scaffolds either in aqueous solution or under supercritical CO2. The resulting functional scaffolds showed a regular drug release profile along several days without losing the fibrous structure. This study proposes a simple approach to form stable HA-based nanofibrous scaffolds embedding HPβCD using water as the only solvent, enabling the development of safe functional wound dressings.
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Affiliation(s)
- Morgane Séon-Lutz
- CEA-LETI, Microtechnologies for Biology and Healthcare Division, 17 rue des Martyrs, 38054 Grenoble Cedex 09, France; ICPEES, Institut de Chimie et Procédé pour l'Energie l'Environnement et la Santé, CNRS UMR 7515, ECPM-Université de Strasbourg, 25 rue Becquerel, 67087 Strasbourg Cedex 2, France
| | - Anne-Claude Couffin
- CEA-LETI, Microtechnologies for Biology and Healthcare Division, 17 rue des Martyrs, 38054 Grenoble Cedex 09, France; Université Grenoble Alpes, 38000 Grenoble, France
| | - Séverine Vignoud
- CEA-LETI, Microtechnologies for Biology and Healthcare Division, 17 rue des Martyrs, 38054 Grenoble Cedex 09, France; Université Grenoble Alpes, 38000 Grenoble, France
| | - Guy Schlatter
- ICPEES, Institut de Chimie et Procédé pour l'Energie l'Environnement et la Santé, CNRS UMR 7515, ECPM-Université de Strasbourg, 25 rue Becquerel, 67087 Strasbourg Cedex 2, France
| | - Anne Hébraud
- ICPEES, Institut de Chimie et Procédé pour l'Energie l'Environnement et la Santé, CNRS UMR 7515, ECPM-Université de Strasbourg, 25 rue Becquerel, 67087 Strasbourg Cedex 2, France.
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Ge H, Liu C, Shrestha A, Wu P, Cheng B. Do Nonsteroidal Anti-Inflammatory Drugs Affect Tissue Healing After Arthroscopic Anterior Cruciate Ligament Reconstruction? Med Sci Monit 2018; 24:6038-6043. [PMID: 30160247 PMCID: PMC6128182 DOI: 10.12659/msm.910942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Experimental studies have reported nonsteroidal anti-inflammatory drugs (NSAIDs) could impair tendon healing. The purpose of this study was to investigate whether NSAIDs could affect recovery of knee joint function in patients after anterior cruciate ligament (ACL) reconstruction. Material/Methods We enrolled 40 patients treated with celecoxib and 40 patients treated with tramadol, who underwent ACL reconstruction from January 2011 to December 2017. Visual analogue scale (VAS) and functional outcomes were collected and evaluated. The follow-up period was 12 months. Results In both groups, all patients obtained pain release after surgery, compared with that before surgery. But no significant differences were observed between the 2 groups in VAS scores. We also did not find any differences between the 2 groups at 1 year of follow-up, in terms of anterior drawer test, Lachman test, side-to-side laxity assessed by KT-2000, IKDC score, Lysholm score, and Tegner scale. However, the celecoxib group showed a reduced incidence of nausea compared to the tramadol group (P=0.048). Conclusions The use of NSAIDs after ACL reconstruction is relatively safe and could decrease adverse side effects which were caused by opioid drugs.
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Affiliation(s)
- Heng'an Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Tongji University School of Medicine, Shanghai, China (mainland)
| | - Centao Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Suzhou University School of Medicine, Suzhou, Jiangsu, China (mainland)
| | - Amrit Shrestha
- Shiva Jyoti Hospital and Research Center PVT. Ltd., Kathmandu, Nepal
| | - Peng Wu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Biao Cheng
- Department of Orthopeadics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Kaplan K, Hanney WJ, Cheatham SW, Masaracchio M, Liu X, Kolber MJ. Rotator Cuff Tendinopathy: An Evidence-Based Overview for the Sports Medicine Professional. Strength Cond J 2018. [DOI: 10.1519/ssc.0000000000000364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Borgeat A, Ofner C, Saporito A, Farshad M, Aguirre J. The effect of nonsteroidal anti-inflammatory drugs on bone healing in humans: A qualitative, systematic review. J Clin Anesth 2018; 49:92-100. [PMID: 29913395 DOI: 10.1016/j.jclinane.2018.06.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/29/2018] [Accepted: 06/08/2018] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in postoperative pain management. While an increasing number of in vitro and animal studies point toward an inhibitory effect of NSAIDs on bone healing process, the few existing retro- and prospective clinical studies present conflicting data. DESIGN The aim of this qualitative, systematic review was to investigate the impact of perioperative use of NSAIDs in humans on postoperative fracture/spinal fusion healing compared to other used analgesics measured as fracture nonunion with radiological control. PATIENTS/INTERVENTIONS We performed a systematic literature search of the last 38 years using PubMed Embase and the Cochrane Controlled Trials Register including retro- and prospective clinical, human trials assessing the effect of NSAIDs on postoperative fracture/spinal fusion healing when used for perioperative pain management with a radiological follow up to assess eventual nonunion. Due to different study designs, drugs, dosages/exposition times and different methods to assess fracture nonunion, these studies were not pooled for a meta-analysis. A descriptive summary of all studies, level of evidence, study quality and study bias assessment using different scores were used. MAIN RESULTS Three prospective randomized controlled studies and thirteen retrospective cohort human studies were identified for a total of 12'895 patients. The overall study quality was low according to Jadad and Oxford Levels of Evidence scores. CONCLUSIONS Published results of human trials did not show strong evidence that NDAIDs for pain therapy after fracture osteosynthesis or spinal fusion lead to an increased nonunion rate. Reviewed studies present such conflicting data, that no clinical recommendation can be made regarding the appropriate use of NSAIDs in this context. Considering laboratory data of animal, human tissue research and recommendation of clinical reviews, a short perioperative exposition to NSAIDs is most likely not deleterious. However, randomized, controlled studies are warranted to support or refute this hypothesis.
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Affiliation(s)
- Alain Borgeat
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland.
| | - Christian Ofner
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
| | - Andrea Saporito
- Service of Anaesthesiology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | - Mazda Farshad
- Spine Surgery, Balgrist University Hospital Zurich, Switzerland
| | - José Aguirre
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
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Herskin MS, Nielsen BH. Welfare Effects of the Use of a Combination of Local Anesthesia and NSAID for Disbudding Analgesia in Dairy Calves-Reviewed Across Different Welfare Concerns. Front Vet Sci 2018; 5:117. [PMID: 29922684 PMCID: PMC5996095 DOI: 10.3389/fvets.2018.00117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/16/2018] [Indexed: 11/13/2022] Open
Abstract
Across the international dairy industry, the vast majority of dairy herds have dehorned cows. Farmers choose to dehorn calves for different reasons such as easier handling of non-horned cattle and reduced risk of injuries in animals and staff. This review focuses on disbudding by use of hot-iron cautery as is practiced by dairy farmers in calves <3 months of age. We examine welfare effects of the use of NSAIDs in combination with a local anesthetic including indicators relevant for the three major welfare concerns-affective states, basic health, and functioning as well as the possibility to behave naturally. Across indicators of animal welfare, the majority of available evidence suggest that the use of NSAIDs in combination with a local anesthetic is advantageous in terms of animal welfare, and no studies suggest that NSAIDs are a disadvantage to animal welfare. However, irrespective of the welfare concern, use of NSAIDs combined with a local anesthetic does not fully eliminate the welfare challenges from disbudding. Further research is needed in order to fully understand the effects of this medication protocol on calf welfare, including knowledge about the duration of healing and the presence of long-term pain. At present, this lack of knowledge challenges the precise formulation of adequate pain management-in terms of medication protocol, duration, dosage, and type of administration.
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Osteoimmunology: Effects of Standard Orthopaedic Interventions on Inflammatory Response and Early Fracture Healing. J Am Acad Orthop Surg 2018; 26:343-352. [PMID: 29659378 DOI: 10.5435/jaaos-d-16-00646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Achieving fracture union is highly dependent on the initial inflammatory phase of fracture healing, which is influenced by both the local and systemic inflammatory environments. The rapidly emerging field of osteoimmunology involves the study of the interactions between the immune system and the skeletal system. Recent research has advanced the current state of knowledge regarding the effects of the surrounding soft-tissue injury, fracture hematoma, and the method of fracture fixation on the inflammatory phase of fracture healing. Acute systemic inflammation, as seen in patients with polytrauma, and chronic systemic inflammation, as seen in patients with diabetes or rheumatoid arthritis, affects the inflammatory phase of fracture healing. The use of NSAIDs can influence early fracture healing. Understanding the effects of standard orthopaedic interventions on the local and systemic inflammatory responses and early fracture healing is important for optimizing fracture union.
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Abstract
Soft tissue trauma of skeletal muscle is one of the most common side effects in surgery. Muscle injuries are not only caused by accident-related injuries but can also be of an iatrogenic nature as they occur during surgical interventions when the anatomical region of interest is exposed. If the extent of trauma surpasses the intrinsic regenerative capacities, signs of fatty degeneration and formation of fibrotic scar tissue can occur, and, consequentially, muscle function deteriorates or is diminished. Despite research efforts to investigate the physiological healing cascade following trauma, our understanding of the early onset of healing and how it potentially determines success or failure is still only fragmentary. This review focuses on the initial physiological pathways following skeletal muscle trauma in comparison to bone and tendon trauma and what conclusions can be drawn from new scientific insights for the development of novel therapeutic strategies. Strategies to support regeneration of muscle tissue after injury are scarce, even though muscle trauma has a high incidence. Based on tissue specific differences, possible clinical treatment options such as local immune-modulatory and cell therapeutic approaches are suggested that aim to support the endogenous regenerative potential of injured muscle tissues.
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Oh JH, Seo HJ, Lee YH, Choi HY, Joung HY, Kim SH. Do Selective COX-2 Inhibitors Affect Pain Control and Healing After Arthroscopic Rotator Cuff Repair? A Preliminary Study. Am J Sports Med 2018; 46:679-686. [PMID: 29253346 DOI: 10.1177/0363546517744219] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Selective cyclooxygenase (COX)-2 inhibitors are commonly used analgesics that provide similar analgesia as that of other analgesics but with fewer adverse effects. However, few prospective studies have performed comparative analyses in this regard. PURPOSE To evaluate the efficacy of a selective COX-2 inhibitor in early postoperative pain control, satisfaction with pain management, and incidence of systemic adverse effects in patients undergoing arthroscopic rotator cuff repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This study included 180 patients who underwent arthroscopic rotator cuff repair between September 2011 and August 2012. The patients were randomly assigned to receive celecoxib, ibuprofen, or tramadol (n = 60 each). Visual analog scale (VAS) scores for pain intensity and satisfaction with medication, incidence of adverse effects, and use of rescue medication were recorded and compared between the 3 groups at 3 days and 2 weeks after surgery. Magnetic resonance and ultrasonography images of 82 patients were retrospectively reviewed at least 24 months after surgery, along with the range of motion and pain VAS and functional scores. RESULTS There were no significant differences among the 3 groups in terms of pain intensity, incidence of adverse effects, or dosage of rescue medication at 3 days or 2 weeks after surgery. Pain VAS and functional scores at the final follow-up were also comparable among the 3 groups. However, the retear rate in the celecoxib group (11/30 [37%]) was significantly higher than those in the ibuprofen (2/27 [7%]) and tramadol (1/25 [4%]) groups ( P = .009). CONCLUSION Despite having similar postoperative analgesic effects as other nonsteroidal anti-inflammatory drugs and opioids, selective COX-2 inhibitors should not be used for postoperative analgesia because they might negatively affect tendon-to-bone healing after surgical repair. Registration: NCT02850211 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyuk Jun Seo
- Department of Orthopaedic Surgery, Daegu Chamtntn Hospital, Daegu, Republic of Korea
| | - Ye-Hyun Lee
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Republic of Korea
| | - Hye-Yeon Choi
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Republic of Korea
| | - Ho Yun Joung
- Department of Orthopaedic Surgery, Wonkwang University School of Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Sae Hoon Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Ateschrang A, Körner D, Joisten K, Ahrend MD, Schröter S, Stöckle U, Riedmann S. Incidence and risk factors for postoperative Achilles tendon calcifications after percutaneous repair. Arch Orthop Trauma Surg 2018; 138:203-210. [PMID: 29094200 DOI: 10.1007/s00402-017-2829-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Numerous publications are dealing with acute Achilles tendon rupture. To our knowledge, no systematic trial has been published analyzing the incidence, risk factors and the potential clinical impact of postoperative tendon calcifications (PTC) after percutaneous Achilles tendon repair. Therefore, the aim of this study was to analyze these relevant aspects. MATERIALS AND METHODS Between March 2003 and November 2010, a total of 126 patients with an acute, complete Achilles tendon rupture were treated with a percutaneous technique according to Ma and Griffith at a single university-based trauma department. The follow-up included a detailed clinical and sonographic examination. To assess the functional outcome and possible impact of PTC after percutaneous Achilles tendon repair, the Thermann and AOFAS scores were used. 81 patients (65 men and 16 women) with a median age of 46 years (range 24-76) were available for a follow-up examination. The median time of follow-up was 64 months (range 15-110 months). RESULTS PTC occurred in nine out of 81 patients (11.1%). All patients with PTC were male with a median age of 52 years (range 26-76 years). In the group of patients with PTC, the median overall Thermann score was 94 (range 68-100) and the median overall AOFAS score was 97 (range 85-100). In the group of patients without PTC, the median overall Thermann score was 88.5 (range 60-100) and the median overall AOFAS score was 97 (range 85-100). No significant differences were detected between the group of patients with PTC and the group of patients without PTC and the clinical outcome according to the Thermann (p = 0.21) and the AOFAS scores (p = 0.37). None of the patients with PTC sustained a re-rupture. The overall re-rupture rate was 4.9%. PTC was no risk factor for wound and neurological complications. CONCLUSION The incidence of PTC after percutaneous Achilles tendon repair was 11.1%. Male gender and advanced age seem to be risk factors for PTC. In this study, PTC had no negative impact on the postoperative clinical outcome.
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Affiliation(s)
- Atesch Ateschrang
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Daniel Körner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany.
| | - Konrad Joisten
- Department of Oral and Maxillofacial Surgery, Marien Hospital, Stuttgart, Germany
| | - Marc-Daniel Ahrend
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Steffen Schröter
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Ulrich Stöckle
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany
| | - Stephan Riedmann
- Orthopedic Clinic Paulinenhilfe, Diakonie Clinic, Stuttgart, Germany
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Abstract
Progress in surgical acute pain management has allowed most foot and ankle surgery to be performed in ambulatory outpatient surgical centers. Multimodal analgesia focuses on improving postoperative pain by combining pharmacologic and other modalities, addressing multiple pain mechanisms and receptor pathways while reducing adverse effects through lower doses of oral medications. Local anesthesia techniques provide excellent pain relief with few adverse events. Multimodal analgesia in foot and ankle surgery provides superior pain relief, and reduced opioid dependence and opioid-related side effects, improving patient satisfaction, safety, and timely return to function.
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Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedics, The University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Nathan G Orgain
- Department of Anesthesiology, The University of Utah, SOM 3C444, 30 North 1900 East, Salt Lake City, UT 84132, USA
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Huang Y, Chiu F, Webb CA, Weyker PD. Review of the evidence: best analgesic regimen for shoulder surgery. Pain Manag 2017; 7:405-418. [PMID: 28936915 DOI: 10.2217/pmt-2017-0013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Multimodal pain management has been advocated in patients experiencing acute pain after surgical procedures due to tissue damage and the subsequent inflammatory response. For patients undergoing shoulder surgeries, studies have definitively shown that interscalene blocks (ISBs) via single-injection or continuous infusion can reduce the total opioid consumption and can lower pain scores after surgery. In some cases, ISBs can be used as the sole anesthetic during shoulder surgeries and spare patients of receiving general anesthesia. However, clinicians should be fully aware of potential pulmonary complications of ISBs and weigh the risk-benefit ratio in patients with limited pulmonary reserve.
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Affiliation(s)
- Yolanda Huang
- Department of Anesthesiology, Division of Orthopedic & Regional Anesthesia, Columbia University Medical Center
| | - Felicia Chiu
- Department of Anesthesiology, Division of Orthopedic & Regional Anesthesia, Columbia University Medical Center
| | - Christopher Aj Webb
- The Permanente Medical Group, Kaiser Permanente Northern California.,Adjunct Assistant Clinical Professor. Department of Anesthesia & Perioperative Care. University of California San Francisco School of Medicine
| | - Paul David Weyker
- Department of Anesthesiology, Divisions of Critical Care, Liver Transplant Anesthesia, Pain Medicine & Regional Anesthesia, Columbia University Medical Center
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Inderhaug E, Kollevold KH, Kalsvik M, Hegna J, Solheim E. Preoperative NSAIDs, non-acute onset and long-standing symptoms predict inferior outcome at long-term follow-up after rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2017; 25:2067-2072. [PMID: 26520644 DOI: 10.1007/s00167-015-3845-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/22/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate mid- to long-term results after arthroscopic rotator cuff repair and to explore possible predictors of inferior outcome. METHODS Patients treated for full-thickness supraspinatus and/or infraspinatus tears from 2004 to 2008, using a uniform single-row arthroscopic technique, were included in the study. Pre- and post-operative QuickDASH were used as the primary outcome measure, and VAS of pain, function and satisfaction were also collected. An additional questionnaire explored demographic and preoperative factors like onset and duration of symptoms, preoperative treatment and smoking habits. RESULTS One hundred and forty-seven patients (82 %) were available at 6-9 years after surgery. All outcomes improved significantly from the preoperative values. A total of 8 % of patients had undergone additional surgery to the same shoulder during the follow-up period. Long-standing symptoms (>12 months) (P < 0.01), non-acute onset of symptoms (P < 0.01) and preoperative use of NSAIDs (P = 0.01) were correlated with inferior outcome at follow-up. No other factors investigated (i.e. gender, age, smoking and steroid injections) were found to affect the primary outcome (QuickDASH). CONCLUSION The current study is one of few reports of mid- to long-term outcomes after arthroscopic single-row repair of full-thickness rotator cuff tears. Global improvement in symptoms and function was found between the preoperative and the 6-9 years evaluation, and the technique therefore seems like a viable approach for treating tears of the supra- and the infraspinatus tendon. Several predictors of inferior long-term outcome after rotator cuff repair were, however, identified: preoperative use of NSAIDs, long-standing symptoms before surgery and non-acute onset of shoulder symptoms. In light of the current findings, accurate diagnosis and prompt treatment seem important in optimizing outcomes after rotator cuff surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Eivind Inderhaug
- Surgical Department, Haraldsplass Deaconess Hospital, PB 6165, 5152, Bergen, Norway. .,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
| | - Kristin H Kollevold
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Maiken Kalsvik
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | | | - Eirik Solheim
- Surgical Department, Haraldsplass Deaconess Hospital, PB 6165, 5152, Bergen, Norway.,Teres Bergen, Nesttun, Norway.,Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Patient Comprehension and Compliance Survey to Assess Postoperative Pain Regimens in the Orthopaedic Trauma Population. J Orthop Trauma 2017; 31:e190-e194. [PMID: 28538459 DOI: 10.1097/bot.0000000000000822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aims to determine the groups of patients who are at risk for noncompliance and misunderstanding of their pain regimen. DESIGN Survey-based cohort study. SETTING Suburban Level-I trauma center. PATIENTS/PARTICIPANTS A total of 171 patients between the ages of 18-89 years who underwent surgical fixation of fractures involving the pelvis, long bones, or periarticular regions of the knee, ankle, elbow, and wrist. MAIN OUTCOME MEASUREMENTS Patients who cannot accurately reproduce their prescribed pain medication list and patients who modify this pain medication regimen were analyzed by age, employment status, income level, education level, time between surgery and follow-up, and whether pain interfered with activities of daily living. RESULTS Overall, 147 patients completed the survey. Seventy percent (n = 114) of patients could not accurately reproduce their pain medication regimen, regardless of age, employment status, income level, education level, time between surgery and follow-up, and whether pain interfered with activities of daily living. Patients (61.2%; n = 90), regardless of the 6 aforementioned demographic factors, also admitted to modifying their pain medication regimen with non-prescribed medications, with 55.8% (n = 82) of patients adding over-the-counter medications to surgeon-prescribed narcotic medications. CONCLUSIONS Misunderstanding and noncompliance of surgeon-prescribed pain regimens are prevalent across all patient demographics. Knowledge of the potential effects these augmentative medications can have on fracture healing and any drug-drug interactions that may arise is an important aspect of patient postoperative care. Surgeons must be wary of these trends and screen for any unintended side effects a patient's pain regimen may have. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Roemer FW, Miller CG, West CR, Brown MT, Sherlock SP, Kompel AJ, Diaz L, Galante N, Crema MD, Guermazi A. Development of an imaging mitigation strategy for patient enrolment in the tanezumab nerve growth factor inhibitor (NGF-ab) program with a focus on eligibility assessment. Semin Arthritis Rheum 2017. [PMID: 28624172 DOI: 10.1016/j.semarthrit.2017.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Nerve growth factor antibodies (NGF-ab) have shown promising analgesic efficacy. Aim was to describe reader training efforts and present reliability data focusing on radiographic eligibility in the tanezumab program. METHODS A multi-step process was used for reader calibration and reliability testing. First, a reference standard set of cases was created and diagnostic performance was evaluated. A second exercise focused on agreement of ordinal assessment (Kellgren-Lawrence grading) of radiographic osteoarthritis. Subsequently, 11 readers were trained and read a test set of 100 cases focused on eligibility assessments. Additional reliability testing and calibration of five core readers assessing eligibility of 30 cases was performed 3 and 6 months after study start. RESULTS Sensitivity for the reference standard readings ranged from 0.50 to 0.90 and specificity from 0.40 to 0.83. Overall agreement for Kellgren-Lawrence grading ranged from 71.4% to 82.9%. For the 11 reader exercise, in 76% of cases at least 8 of 11 readers agreed on eligibility status. For the reliability testing 3 months after study start, in 80.0% of cases at least 4 of 5 readers agreed on eligibility with a κ = 0.43 (95% CI: 0.32-0.54). For the reliability testing after 6 months, in 83.3% of cases at least 4 of 5 readers agreed on eligibility with a κ = 0.52 (95% CI: 0.41-0.63). CONCLUSIONS After intense efforts spent in the development of an imaging program for an NGF-ab clinical program, the achieved reliability for eligibility assessment is substantial but not perfect. Ongoing efforts of calibration prior to including additional readers to the program and during study conduct between current readers will be needed to ensure agreement on potential adverse events and radiographic disease severity.
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Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
| | | | | | | | | | - Andrew J Kompel
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA
| | - Luis Diaz
- Department of Radiology, Boston Veterans Affairs Healthcare System, Boston, MA
| | | | - Michel D Crema
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA; Department of Radiology, Saint-Antoine Hospital, Paris VI University, Paris, France
| | - Ali Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA
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