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Schulze C, Schunck M, Zdzieblik D, Oesser S. Impact of Specific Bioactive Collagen Peptides on Joint Discomforts in the Lower Extremity during Daily Activities: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:687. [PMID: 38928934 PMCID: PMC11203623 DOI: 10.3390/ijerph21060687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024]
Abstract
The intake of specific collagen peptides (SCPs) has been shown to decrease activity-related knee pain in young, physically active adults. This trial investigated the effect of a 12-week SCP supplementation in a wider age range of healthy men and women over 18 years with functional knee and hip pain during daily activities. A total of 182 participants were randomly assigned to receive either 5 g of specific collagen peptides (CP-G) or a placebo (P-G). Pain at rest and during various daily activities were assessed at baseline and after 12 weeks by a physician and participants using a 10-point numeric rating scale (NRS). The intake of 5 g SCP over 12 weeks significantly reduced pain at rest (p = 0.018) and during walking (p = 0.032) according to the physician's evaluation. Participants in the CP-G also reported significantly less pain when climbing stairs (p = 0.040) and when kneeling down (p < 0.001) compared to the P-G. Additionally, after 12 weeks, restrictions when squatting were significantly lower in the CP-G compared with the P-G (p = 0.014). The daily intake of 5 g of SCP seems to benefit healthy adults with hip and knee joint discomforts by reducing pain during daily activities.
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Affiliation(s)
- Claas Schulze
- Practice of Surgery Bad Schwartau, Am Kurpark 1, 23611 Bad Schwartau, Germany
| | - Michael Schunck
- CRI, Collagen Research Institute, Schauenburgerstr 116, 24118 Kiel, Germany; (M.S.); (S.O.)
| | - Denise Zdzieblik
- CRI, Collagen Research Institute, Schauenburgerstr 116, 24118 Kiel, Germany; (M.S.); (S.O.)
| | - Steffen Oesser
- CRI, Collagen Research Institute, Schauenburgerstr 116, 24118 Kiel, Germany; (M.S.); (S.O.)
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Parente A, Medetti M, Basile G, Parente F. One-Stage Tricompartmental Hypoallergenic UKA for Tricompartmental Osteoarthritis: A Case Report. Healthcare (Basel) 2023; 11:2999. [PMID: 37998491 PMCID: PMC10671051 DOI: 10.3390/healthcare11222999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
Osteoarthritis (OA) is a degenerative and progressive joint disease. When all three compartments are involved, end-stage OA is treated with a total knee arthroplasty (TKA). Unicompartmental knee arthroplasty (UKA) is a primary treatment for isolated osteoarthritis. UKA has a quicker recovery time than TKA, as well as less morbidity and more tissue sparing. At the time of surgery, 17% of patients have a tricompartmental disease and most patients with a Kellegren-Lawrence grade >3 have an intact anterior cruciate ligament (ACL). Conventional TKA sacrifices the ACL. Patients with concurrent medial and lateral osteoarthritis and a functional ACL may receive a primary bi-unicondylar arthroplasty. Combined partial knee arthroplasty (CPKA) is an established practice either in bicompartmental femoro-tibial OA or in OA progression after UKA, with the addition of another UKA. A conversion of a lateral UKA to a tricompartmental joint replacement has been reported in the literature. In our case report, we describe a one-stage hypoallergenic tricompartmental UKA, with improved clinical score and no sign of early failure at the last follow-up.
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Affiliation(s)
- Andrea Parente
- Hip and Knee Replacement Department, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy; (A.P.)
| | - Marta Medetti
- Hip and Knee Replacement Department, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy; (A.P.)
| | - Giuseppe Basile
- Legal Medicine Unit, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy;
| | - Franco Parente
- Hip and Knee Replacement Department, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy; (A.P.)
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Li M, Tian F, Guo J, Li X, Ma L, Jiang M, Zhao J. Therapeutic potential of Coptis chinensis for arthritis with underlying mechanisms. Front Pharmacol 2023; 14:1243820. [PMID: 37637408 PMCID: PMC10450980 DOI: 10.3389/fphar.2023.1243820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
Arthritis is a common degenerative disease of joints, which has become a public health problem affecting human health, but its pathogenesis is complex and cannot be eradicated. Coptis chinensis (CC) has a variety of active ingredients, is a natural antibacterial and anti-inflammatory drug. In which, berberine is its main effective ingredient, and has good therapeutic effects on rheumatoid arthritis (RA), osteoarthritis (OA), gouty arthritis (GA). RA, OA and GA are the three most common types of arthritis, but the relevant pathogenesis is not clear. Therefore, molecular mechanism and prevention and treatment of arthritis are the key issues to be paid attention to in clinical practice. In general, berberine, palmatine, coptisine, jatrorrhizine, magnoflorine and jatrorrhizine hydrochloride in CC play the role in treating arthritis by regulating Wnt1/β-catenin and PI3K/AKT/mTOR signaling pathways. In this review, active ingredients, targets and mechanism of CC in the treatment of arthritis were expounded, and we have further explained the potential role of AHR, CAV1, CRP, CXCL2, IRF1, SPP1, and IL-17 signaling pathway in the treatment of arthritis, and to provide a new idea for the clinical treatment of arthritis by CC.
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Affiliation(s)
- Mengyuan Li
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, China
| | - Fei Tian
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, China
- National Key Laboratory of Chinese Medicine Modernization, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jinling Guo
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, China
| | - Xiankuan Li
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lin Ma
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Miaomiao Jiang
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, China
- National Key Laboratory of Chinese Medicine Modernization, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing Zhao
- Haihe Laboratory of Modern Chinese Medicine, Tianjin, China
- Department of Geriatric, Fourth Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Charnwichai P, Tammachote R, Tammachote N, Chaichana T, Kitkumthorn N. Histological features of knee osteoarthritis treated with triamcinolone acetonide and hyaluronic acid. Biomed Rep 2023; 18:40. [PMID: 37228485 PMCID: PMC10203754 DOI: 10.3892/br.2023.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
Osteoarthritis (OA) is one of the most common degenerative joint diseases leading to disability in the end stage. Although intra-articular triamcinolone acetonide (TA) is one of the OA treatments that have been widely used, the side effects of such corticosteroids are still controversial. Intra-articular hyaluronic acid (HA) injection is another therapeutic option for patients with OA who do not want to use corticosteroids because of their side effects. However, the difference between the histological features associated with TA and HA in the treatment of OA remains unclear. Thus, the present study aimed to compare the histological effects of TA and HA on the cartilage of patients with knee OA. In the current study, 31 patients diagnosed with grade 3-4 knee OA on the Kellgren-Lawrence radiographic grading scale were separated into three groups: TA (n=12); HA (n=7) and untreated group (n=12). Histological examination of the whole articular cartilages of the patients was performed with hematoxylin and eosin and Alcian staining, as well as using a TUNEL assay. Clinical data such as cartilage thickness, structural and component deterioration, proteoglycan levels, apoptosis and empty lacunae were compared between the three groups. The results showed a high level of deterioration in both TA and HA groups but not in the untreated group, although the thickness of cartilage in the HA group was lower compared with that in the TA and untreated groups. The proteoglycan levels in the TA group were lower compared with those in the HA group. Moreover, the number of empty lacunae in the HA group was higher compared with that in the TA group, while no difference in apoptosis was found between TA and HA groups. A significant difference was not found in the histological staining between TA and HA groups. On the other hand, a significant difference was found in cartilage deterioration between the medial and lateral sides in these groups. TA and HA groups showed comparable histological results. TA injection is cheaper and easier but has more adverse effects for patients with knee OA than HA injection. Therefore, orthopaedists should select TA or HA based on the economic and specific needs of patients.
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Affiliation(s)
- Pattaranatcha Charnwichai
- Program in Biotechnology, Faculty of Science, Chulalongkorn University, Pathumwan 10330, Thailand
- Department of Botany, Faculty of Science, Chulalongkorn University, Pathumwan 10330, Thailand
| | - Rachaneekorn Tammachote
- Department of Botany, Faculty of Science, Chulalongkorn University, Pathumwan 10330, Thailand
| | - Nattapol Tammachote
- Department of Orthopedics, Faculty of Medicine, Thammasat University Hospital, Khlong Nueng, Pathumthani 10120, Thailand
| | - Thiamjit Chaichana
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok 10330, Thailand
| | - Nakarin Kitkumthorn
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok 10400, Thailand
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Koland M, Narayanan Vadakkepushpakath A, John A, Tharamelveliyil Rajendran A, Raghunath I. Thermosensitive In Situ Gels for Joint Disorders: Pharmaceutical Considerations in Intra-Articular Delivery. Gels 2022; 8:723. [PMID: 36354630 PMCID: PMC9689403 DOI: 10.3390/gels8110723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 09/17/2023] Open
Abstract
The intra-articular administration of conventional drug solutions or dispersions in joint diseases such as osteoarthritis has a relatively short retention time and, therefore, limited therapeutic effect. Thermosensitive polymer solutions that exhibit a sol-gel phase transition near body temperature after injection can prolong drug retention by providing a depot from which the drug release is sustained while relieving inflammation and preventing degradation of the joint complex. Thermosensitive hydrogels have in recent times garnered considerable attention in the intra-articular therapeutics of joint diseases such as osteoarthritis. Among the stimuli-responsive gelling systems, most research has focused on thermosensitive hydrogels. These gels are preferred over other stimuli-sensitive hydrogels since they have well-controlled in situ gelling properties and are also easier to load with drugs. Temperature-sensitive polymers, such as block copolymers or poloxamers, are frequently used to modify their gelation properties, usually in combination with other polymers. They are compatible with most drugs but may pose formulation challenges in terms of their low-response time, highly fragile nature, and low biocompatibility. The stability and biodegradability of implant hydrogels can control the drug release rate and treatment efficacy. This review stresses the application of thermosensitive gels in joint disorders and summarizes recent developments for intra-articular application, including the incorporation of nanoparticles. The hydrogel composition, drug release mechanisms, and the challenges involved in their formulation and storage are also discussed.
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Affiliation(s)
- Marina Koland
- Department of Pharmaceutics, NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Nitte (Deemed to be University), Mangalore 575018, India
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Kyyak S, Blatt S, Wiesmann N, Smeets R, Kaemmerer PW. Hyaluronic Acid with Bone Substitutes Enhance Angiogenesis In Vivo. MATERIALS 2022; 15:ma15113839. [PMID: 35683136 PMCID: PMC9181602 DOI: 10.3390/ma15113839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022]
Abstract
Introduction: The effective induction of angiogenesis is directly related to the success of bone-substitute materials (BSM) for maxillofacial osseous regeneration. Therefore, the addition of pro-angiogenic properties to a commercially available bovine bone-substitute material in combination with hyaluronic acid (BSM+) was compared to the same bone-substitute material without hyaluronic acid (BSM) in an in-vivo model. Materials and Methods: BSM+ and BSM were incubated for six days on the chorioallantoic membrane (CAM) of fertilized chicken eggs. Microscopically, the number of vessels and branching points, the vessel area and vessel length were evaluated. Subsequently, the total vessel area and brightness integration were assessed after immunohistochemical staining (H&E, alphaSMA). Results: In the BSM+ group, a significantly higher number of vessels (p < 0.001), branching points (p = 0.001), total vessel area (p < 0.001) as well as vessel length (p = 0.001) were found in comparison to the BSM group without hyaluronic acid. Immunohistochemically, a significantly increased total vessel area (p < 0.001 for H&E, p = 0.037 for alphaSMA) and brightness integration (p = 0.047) for BSM+ in comparison to the native material were seen. Conclusions: The combination of a xenogenic bone-substitute material with hyaluronic acid significantly induced angiogenesis in vivo. This might lead to a faster integration and an improved healing in clinical situations.
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Affiliation(s)
- Solomiya Kyyak
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (S.K.); (S.B.); (N.W.)
| | - Sebastian Blatt
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (S.K.); (S.B.); (N.W.)
| | - Nadine Wiesmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (S.K.); (S.B.); (N.W.)
- Department of Otorhinolaryngology, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Ralf Smeets
- Division “Regenerative Orofacial Medicine”, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Peer W. Kaemmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (S.K.); (S.B.); (N.W.)
- Correspondence:
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SOUSA EDUARDOBRANCODE, HAMDAN PAULOCÉSAR, MENEGASSI ZARTURJOSÉBARCELOS, ALCHAAR ADRIENIANTUNESDOAMARAL, TIEPPO ANTONIOMARTINS, SOUZA CAIOGONÇALVESDE, PINHEIRO CARLOSBRUNOREIS, ALMEIDA JÚNIOR CYROSCALADE, ROCHA EDUARDODEMELOCARVALHO, CUNHA FABIANOGONÇALVES, PACHECO IVAN, REZENDE MARCIAUCHÔADE, SOUZA MÁRCIOPASSINIGONÇALVESDE, BRITTO DA SILVA MARCOS, CAMPOS GUSTAVOCONSTANTINODE. BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE HIP (COBRAVI-Q). ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e250414. [DOI: 10.1590/1413-785220223005e250414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022]
Abstract
ABSTRACT Objective: The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of specialists in the field. Methods: A multidisciplinary panel was formed with 15 specialists (sports medicine, orthopedists, physiatrists and rheumatologists), based on clinical and academic experience in the use of viscosupplementation of the hip. 12 statements were prepared, discussed and voted. Each panelist gave a value between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several aspects of viscosupplementation of the hip, with emphasis on the following statements: best indication is for mild to moderate hip arthrosis; it may be indicated in severe osteoarthritis; results may vary according to the characteristics of the viscosupplement used; Viscosupplementation should not be performed as an isolated procedure, but in conjunction with other rehabilitation and pharmacological measures; best injection technique should be based on anatomical references coupled with imaging guidance; it is a cost-effective procedure. Conclusion: Viscosupplementation is a safe and effective therapy for hip osteoarthritis, even in severe cases. Guided injection is recommended. Level of Evidence V, Expert Opinion.
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Liepe K. Radiosynovectomy of large joint arthritis. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
INTRODUCTION Hip osteoarthritis is a prevalent condition responsible for important pain and disability. Most available guidelines for nonsurgical management of hip osteoarthritis recommend a combination of nonpharmacological and pharmacological treatment modalities. Intraarticular corticosteroid injections have been used for decades, although evidence is quite scarce, and many controversies remain. METHODS This article reviews the available literature from Medline and Embase and discusses the evidence for intraarticular corticosteroid injections in hip osteoarthritis, where only 5 randomized controlled trials were found in the literature. These are analyzed in this article, which also aims to explain the main characteristics and features of glucocorticoids, along with their contraindications and potential adverse effects. RESULTS Available randomized controlled trials show that intraarticular corticosteroid injections provide pain relief and functional improvement in hip osteoarthritis. This efficacy has not been shown with intraarticular hyaluronic acid injections. CONCLUSION This review shows that intraarticular corticosteroid injections are efficacious in hip osteoarthritis and that this benefit can last up to 12 weeks.
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Affiliation(s)
- Magda Choueiri
- Department of Rheumatology, Henri Mondor
University Hospital, Créteil, France,Paris XII University, UPEC, Créteil,
France,Magda Choueiri, Department of Rheumatology,
Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny,
Créteil 94010, France.
| | - Xavier Chevalier
- Department of Rheumatology, Henri Mondor
University Hospital, Créteil, France,Paris XII University, UPEC, Créteil,
France
| | - Florent Eymard
- Department of Rheumatology, Henri Mondor
University Hospital, Créteil, France,Paris XII University, UPEC, Créteil,
France
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Abstract
Knee osteoarthritis is a degenerative arthritis that mainly affects older adults. Over time, osteoarthritis can result in significant and sustained discomfort, pain, and disability. Current treatment focuses on the alleviation of pain and functional impairment. While arthroplasty is the definitive management option, it subjects patients to surgical complications, and the possibility of surgical revisions. In addition, many patients are not surgical candidates. Instead, pharmacological therapy is recommended first-line for most patients. On top of pharmacological therapy, there are a range of non-operative procedural options available. However, leading professional guidelines vary in their recommendations for these agents. Therefore, we present a review of recent randomized controlled trials and meta-analyses on injectable corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP), mesenchymal stem cell injections, and ozone therapy. The preliminary data reveal the strongest evidence in favour of corticosteroid injections, although there are promising findings regarding the long-term efficacy of HA and PRP.
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Perineural Local Anesthetic Treatments for Osteoarthritic Pain. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2021; 7:262-282. [DOI: 10.1007/s40883-021-00223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Do We Need to Wait 3 Months After Corticosteroid Injections to Reduce the Risk of Infection After Total Knee Arthroplasty? J Am Acad Orthop Surg 2021; 29:e714-e721. [PMID: 33229905 DOI: 10.5435/jaaos-d-20-00850] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/23/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Corticosteroid injections administered within 3 months before total knee arthroplasty (TKA) have been linked to increased risk of postoperative infection. However, it would be beneficial to further delineate the timing of injections to determine whether a narrower window exists for safe administration of corticosteroid injections. The purposes of our study were to (1) determine whether there were a different time frame between corticosteroid injection and primary TKA that increased infection risk and (2) determine risk factors associated with infection after TKA. METHODS TKA patients were identified from a national database from 2007 to 2017 and stratified based on their history of corticosteroid injections within the 6-month preoperative period. Patients who received injections were stratified into biweekly cohorts by the timing of their most recent injection. The 1-year rate of postoperative infection treated by surgical débridement was compared between injection and noninjection cohorts. Univariate logistic regressions of risk factors and a multivariate analysis for patient comorbidities and injection cohorts associated with increased infection risk were conducted. RESULTS In the 76,090 TKA patients identified, corticosteroid injection within 2 weeks before TKA increased the risk of postoperative infection (P = 0.02) and injections within 2 to 4 weeks trended toward increased infection in univariate regression. No significant differences were observed in any other injection time frames. In the multivariate analysis, injections within 2 weeks before TKA were identified as an independent risk factor (odds ratio: 2.89; P = 0.04) for postoperative infection. Additional risk factors included chronic obstructive pulmonary disease, coronary artery disease, diabetes, ischemic heart disease, obesity, rheumatoid arthritis, and tobacco, whereas female sex and patient aged older than 65 were protective. DISCUSSION Our results suggest that TKA performed within four weeks of a corticosteroid injection may be associated with a higher risk of postoperative infection; however, delaying surgery more than four weeks may not provide additional infection risk reduction. Further prospective randomized studies are needed to determine the optimal timing of TKA after corticosteroid injections. LEVEL OF EVIDENCE Level III.
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Brondeel C, Pauwelyn G, de Bakker E, Saunders J, Samoy Y, Spaas JH. Review: Mesenchymal Stem Cell Therapy in Canine Osteoarthritis Research: "Experientia Docet" (Experience Will Teach Us). Front Vet Sci 2021; 8:668881. [PMID: 34095280 PMCID: PMC8169969 DOI: 10.3389/fvets.2021.668881] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) is currently an incurable and progressive condition in dogs causing chronic joint pain and possibly increasing disability. Due to the poor healing capacity of cartilage lesions that occur with OA, development of effective therapeutics is difficult. For this reason, current OA therapy is mostly limited to the management of pain and inflammation, but not directed ad disease modification. In the search for a safe and effective OA treatment, mesenchymal stem cells (MSCs) have been of great interest since these cells might be able to restore cartilage defects. The designs of OA studies on MSC usage, however, are not always consistent and complete, which limits a clear evaluation of MSC efficacy. The general study results show a tendency to improve lameness, joint pain and range of motion in dogs suffering from naturally-occurring OA. Assessment of the cartilage surface demonstrated the ability of MSCs to promote cartilage-like tissue formation in artificially created cartilage defects. Immunomodulatory capacities of MSCs also seem to play an important role in reducing pain and inflammation in dogs. It should be mentioned, however, that in the current studies in literature there are specific design limitations and further research is warranted to confirm these findings.
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Affiliation(s)
- Carlien Brondeel
- Department of Medical Imaging and Orthopedics of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Glenn Pauwelyn
- Global Stem Cell Technology NV, Part of Boehringer-Ingelheim, Evergem, Belgium
| | - Evelien de Bakker
- Department of Medical Imaging and Orthopedics of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Jimmy Saunders
- Department of Medical Imaging and Orthopedics of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Yves Samoy
- Department of Medical Imaging and Orthopedics of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Jan H Spaas
- Department of Medical Imaging and Orthopedics of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Global Stem Cell Technology NV, Part of Boehringer-Ingelheim, Evergem, Belgium
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da Costa SR, da Mota e Albuquerque RF, Helito CP, Camanho GL. The role of viscosupplementation in patellar chondropathy. Ther Adv Musculoskelet Dis 2021; 13:1759720X211015005. [PMID: 34035839 PMCID: PMC8127754 DOI: 10.1177/1759720x211015005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/13/2021] [Indexed: 12/26/2022] Open
Abstract
Patellar chondropathy has a high incidence in the general population, being more common in patients younger than 50 years, female and recreational athletes, and overweight and obese patients. The most common complaints are pain, limited mobility, crepitus, difficulty climbing and descending stairs, and joint instability, usually showing unsatisfactory results with anti-inflammatory, physiotherapy, rehabilitation, and many other conservative treatment methods. The presumed hyaluronic acid (HA) disease-modifying activity may include effects on cartilage degradation, endogenous HA synthesis, synoviocyte and chondrocyte function, and other cellular inflammatory processes. Currently, HA is widely used as a safe and effective conservative treatment for osteoarthritis in the knee and other joints. HA improves the physiological environment in an osteoarthritic joint and the shock absorption and lubrication properties of the osteoarthritic synovial fluid, thus restoring the protective viscoelasticity of the synovial HA, reducing the pain, and improving the mobility. The complete mechanism of HA in the joint is not fully understood, but a wide range of actions in the joint is recognized. Its anti-inflammatory, analgesic, and chondroprotective action is related to the modulation of the intra- and extracellular inflammation cascade. HA has been shown to be safe and effective in the treatment of pain related to patellar chondropathy.
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Affiliation(s)
- Sergio Ricardo da Costa
- PhD Program for Musculoskeletal System Sciences, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 333 Ovídio Pires de Campos St., Cerqueira César, São Paulo, SP 05403-010, Brazil
| | - Roberto Freire da Mota e Albuquerque
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camilo Partezani Helito
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gilberto Luis Camanho
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Bacterial Biopolymer: Its Role in Pathogenesis to Effective Biomaterials. Polymers (Basel) 2021; 13:polym13081242. [PMID: 33921239 PMCID: PMC8069653 DOI: 10.3390/polym13081242] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/17/2022] Open
Abstract
Bacteria are considered as the major cell factories, which can effectively convert nitrogen and carbon sources to a wide variety of extracellular and intracellular biopolymers like polyamides, polysaccharides, polyphosphates, polyesters, proteinaceous compounds, and extracellular DNA. Bacterial biopolymers find applications in pathogenicity, and their diverse materialistic and chemical properties make them suitable to be used in medicinal industries. When these biopolymer compounds are obtained from pathogenic bacteria, they serve as important virulence factors, but when they are produced by non-pathogenic bacteria, they act as food components or biomaterials. There have been interdisciplinary studies going on to focus on the molecular mechanism of synthesis of bacterial biopolymers and identification of new targets for antimicrobial drugs, utilizing synthetic biology for designing and production of innovative biomaterials. This review sheds light on the mechanism of synthesis of bacterial biopolymers and its necessary modifications to be used as cell based micro-factories for the production of tailor-made biomaterials for high-end applications and their role in pathogenesis.
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Larghi MM, Grassi M, Placenza E, Faugno L, Cerveri P, Manzotti A. Septic arthritis following joint injections: a 17 years retrospective study in an Academic General Hospital. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021308. [PMID: 35075093 PMCID: PMC8823561 DOI: 10.23750/abm.v92i6.10425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/27/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Septic arthritis following intra-articular infiltrations is an uncommon devastating complication correlated to high costs for the health service and often to poor outcomes. The purpose of this study is to assess a 17-years experience in a single academic multispecialist hospital managing this uncommon complication in Orthopaedic practice. METHODS Patients with diagnosis of septic arthritis following joint injections treated in our hospital from January 2002 to December 2019 were included in the study. Clinical and demographic data, pathogens, injected agent, conservative/surgical treatments were reviewed. Patient were classified according to the ore operative Charlson Comorbidity Index (CCI) and the Cierny-Mader Classification(CMC). Furthermore follow-up outcome and time occurred to infection eradication were registered. RESULTS We included in the study 11 patients with a median age of 74 years old (IQR= 61.5 - 79). The median CCI was 3 (IQR= 2 - 5) and the majority of patients belong to CMC = B class. Septic arthritis occurred mainly following corticosteroids injections and more frequently involving knees. The pathogen more often isolated was Staphylococcus aureus. Five (45%) patients referred an history of multiple intrarticular injections. 7 patients (64%) had a complete resolution following an arthroscopic debridement, 4 (36%) patients underwent to a 2-stage replacement and one of them hesitated in an arthrodesis because of a recurrent periprothesic joint infection and extensor apparatus insufficiency. CONCLUSION The authors observed a potential increased risk of septic arthritis following joint injection in patients with history of multiple injections and poor health/immunological conditions. They recommend an early arthroscopic debridement as the treatment of choice especially in septic knees performed in a multispecialist dedicated center.
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Affiliation(s)
- Marco Mattia Larghi
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano, Milan Italy
| | - Miriam Grassi
- Orthopaedic and Trauma Department, “Luigi Sacco” Hospital, ASST FBF-Sacco, Milan, Italy
| | - Emanuele Placenza
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano, Milan Italy
| | - Luca Faugno
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano, Milan Italy
| | - Pietro Cerveri
- Department of Electronics, Information and Bioengeenering, Politecnico di Milano, Milan, Italy
| | - Alfonso Manzotti
- Orthopaedic and Trauma Department, “Luigi Sacco” Hospital, ASST FBF-Sacco, Milan, Italy
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Shanthanna H, Busse J, Wang L, Kaushal A, Harsha P, Suzumura EA, Bhardwaj V, Zhou E, Couban R, Paul J, Bhandari M, Thabane L. Addition of corticosteroids to local anaesthetics for chronic non-cancer pain injections: a systematic review and meta-analysis of randomised controlled trials. Br J Anaesth 2020; 125:779-801. [PMID: 32798067 DOI: 10.1016/j.bja.2020.06.062] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite common use, the benefit of adding steroids to local anaesthetics (SLA) for chronic non-cancer pain (CNCP) injections is uncertain. We performed a systematic review and meta-analysis of English-language RCTs to assess the benefit and safety of adding steroids to local anaesthetics (LA) for CNCP. METHODS We searched MEDLINE, EMBASE, and CENTRAL databases from inception to May 2019. Trial selection and data extraction were performed in duplicate. Outcomes were guided by the Initiative in Methods, Measurements, and Pain Assessment in Clinical Trials (IMMPACT) statement with pain improvement as the primary outcome and pooled using random effects model and reported as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CIs). RESULTS Among 5097 abstracts, 73 trials were eligible. Although SLA increased the rate of success (42 trials, 3592 patients; RR=1.14; 95% CI, 1.03-1.25; number needed to treat [NNT], 13), the effect size decreased by nearly 50% (NNT, 22) with the removal of two intrathecal injection studies. The differences in pain scores with SLA were not clinically meaningful (54 trials, 4416 patients, MD=0.44 units; 95% CI, 0.24-0.65). No differences were observed in other outcomes or adverse events. No subgroup effects were detected based on clinical categories. Meta-regression showed no significant association with steroid dose or length of follow-up and pain relief. CONCLUSIONS Addition of cortico steroids to local anaesthetic has only small benefits and a potential for harm. Injection of local anaesthetic alone could be therapeutic, beyond being diagnostic. A shared decision based on patient preferences should be considered. If used, one must avoid high doses and series of steroid injections. CLINICAL TRIAL REGISTRATION PROSPERO #: CRD42015020614.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.
| | - Jason Busse
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Li Wang
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Alka Kaushal
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Prathiba Harsha
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Erica A Suzumura
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Varun Bhardwaj
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Edward Zhou
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Long-Term Effectiveness of Polymerized-Type I Collagen Intra-Articular Injections in Patients with Symptomatic Knee Osteoarthritis: Clinical and Radiographic Evaluation in a Cohort Study. Adv Orthop 2020; 2020:9398274. [PMID: 32802520 PMCID: PMC7416232 DOI: 10.1155/2020/9398274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/09/2020] [Indexed: 01/07/2023] Open
Abstract
Objective Polymerized-type I collagen (polymerized-collagen) is a downregulator of inflammation and a tissue regenerator. The aim was to evaluate the effect of intra-articular injections (IAIs) of polymerized-collagen among patients with symptomatic knee osteoarthritis (OA) in delaying or preventing joint replacement surgery. Patients and Methods. This was a cohort study of 309 patients with knee OA. Patients with mild-to-moderate disease were treated weekly with IAIs of 2 mL of polymerized-collagen for six weeks (n = 309). Follow-up was for 6–60 months. The primary endpoints included the following determinations: (1) therapeutic effect; (2) survival from total knee replacement surgery (TKR); (3) Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and pain (visual analogue scale, VAS). Clinical improvement was defined as a decrease in pain exceeding 20 mm on the VAS and the achievement of at least 20% improvement from baseline with respect to the WOMAC score. Radiographic analysis was performed at baseline and 60 months. The joint space width in the medial, lateral, and patellofemoral compartments was calculated. Results Patients who received IAIs of polymerized-collagen had a statistically significant improvement in the primary criteria (p < 0.05). Kaplan–Meier survival analysis of the therapeutic effect demonstrated 98.8% survival at 60 months with TKR as the endpoint. There was no significant reduction in joint space in any compartment based on the analyzed radiographs. No serious adverse events were recorded. Conclusion Polymerized-collagen increased the time to TKR by at least 60 months, modifying the disease course, improving functional disability, and decreasing pain.
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Does Epidural Bupivacaine with or Without Steroids Provide Long-Term Relief? A Systematic Review and Meta-analysis. Curr Pain Headache Rep 2020; 24:26. [DOI: 10.1007/s11916-020-00859-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Xu J, Qu Y, Li H, Zhu A, Jiang T, Chong Z, Wang B, Shen P, Xie Z. Effect of Intra-articular Ketorolac Versus Corticosteroid Injection for Knee Osteoarthritis: A Retrospective Comparative Study. Orthop J Sports Med 2020; 8:2325967120911126. [PMID: 32313809 PMCID: PMC7153200 DOI: 10.1177/2325967120911126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/12/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Intra-articular corticosteroid injections have been widely used and are considered a mainstay in the nonoperative treatment of symptomatic knee osteoarthritis (OA). However, their increased use can have negative implications, including chondral toxicity and a high risk of infections. As a result, nonsteroidal anti-inflammatory drugs have been considered as an alternative. PURPOSE To determine the pain relief and safety of ketorolac versus a corticosteroid to supplement an intra-articular sodium hyaluronate injection for the treatment of symptomatic knee OA. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 84 patients with unilateral symptomatic knee OA receiving 5 weekly injections were enrolled in this retrospective study. Group A (n = 42) received 3 weekly intra-articular corticosteroid injections (0.5% lidocaine, 25 mg of triamcinolone acetonide, and 25 mg of sodium hyaluronate, followed by 2 weekly injections of 0.5% lidocaine and 25 mg of sodium hyaluronate), while group B (n = 42) received 5 weekly ketorolac injections (0.5% lidocaine, 10 mg of ketorolac, and 25 mg of sodium hyaluronate). The following parameters were used to evaluate pain relief and safety: visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and side effects before the injection and at 1, 2, and 5 weeks after treatment commencement as well as 3 months after the last injection. RESULTS Patients from both groups had a significant improvement in VAS and WOMAC scores from the first injection to final follow-up at 3 months. In the first week, the VAS score was lower in group A (P = .041), but no significant between-group differences were found for either the VAS or the WOMAC score at the other time points. Of the 42 patients in group A, 34 (81.0%) and 25 (59.5%) achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. In group B, 32 (76.2%) and 24 (57.1%) patients achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. At final follow-up, no significant difference was found in the successful treatment rate between the groups (P = .825). CONCLUSION The current study demonstrated that intra-articular ketorolac and corticosteroid injections produce the same pain relief and functional improvement.
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Affiliation(s)
- Jianda Xu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, Changzhou, China
| | - Yuxing Qu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, Changzhou, China
| | - Huan Li
- Department of Arthroplasty, First People's Hospital of Changzhou, Changzhou, China
| | - Aixiang Zhu
- Department of Orthopaedics, Affiliated Suqian Hospital, Xuzhou Medical University, Suqian, China
| | - Tao Jiang
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, Changzhou, China
| | - Zheng Chong
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, Changzhou, China
| | - Bin Wang
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, Changzhou, China
| | - Pengfei Shen
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, Changzhou, China
| | - Zikang Xie
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Nanjing University of Traditional Chinese Medicine, Changzhou, China
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Haslam A, Livingston C, Prasad V. Medical Reversals in Family Practice: A Review. CURRENT THERAPEUTIC RESEARCH 2020; 92:100579. [PMID: 32180846 PMCID: PMC7063107 DOI: 10.1016/j.curtheres.2020.100579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/14/2020] [Indexed: 11/25/2022]
Abstract
Background Primary care physicians are challenged by the need to stay abreast of current research on a wide variety of topics in an environment of time constraints, evolving literature, and misinformation on health topics that are sometimes promulgated to the public. Objective We sought to identify and discuss common clinical situations encountered in primary care for which medical reversals have occurred. Methods We recently identified almost 400 medical practices that were used in clinical care before they were tested in well-done randomized controlled trials and subsequently were found to be ineffective or harmful. Results We review several of these practices commonly used in family medicine, which include arthroscopy for osteoarthritis of the knee, opioids for common causes of pain, and aspirin and continuous positive airway pressure for the prevention of cardiovascular disease. Conclusions Although these practices were implemented because of sound biologic plausibility or encouraging observational data, well done randomized controlled trials have failed to show evidence of effectiveness. These examples raise caution in introducing new clinical interventions into widespread clinical practice without sufficient high-quality evidence demonstrating efficacy.
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Affiliation(s)
- Alyson Haslam
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Vinay Prasad
- Division of Hematology Oncology, Knight Cancer Institute, and Center for Health Care Ethics, Oregon Health & Science University, Portland, Oregon
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Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies. Pain Res Manag 2020; 2020:3873098. [PMID: 32148599 PMCID: PMC7049418 DOI: 10.1155/2020/3873098] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 12/13/2022]
Abstract
Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.
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Urits I, Hasegawa M, Orhurhu V, Peck J, Kelly AC, Kaye RJ, Orhurhu MS, Brinkman J, Giacomazzi S, Foster L, Manchikanti L, Kaye AD, Viswanath O. Minimally Invasive Treatment of Chronic Ankle Instability: a Comprehensive Review. Curr Pain Headache Rep 2020; 24:8. [PMID: 32020393 DOI: 10.1007/s11916-020-0840-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Chronic ankle pain is a prevalent and significant cause of chronic pain. While the definition of chronic ankle pain is heterogeneous and poorly defined in the literature, systematic reviews and meta-analyses have estimated this condition to be a prevalent and debilitating source of chronic pain. The most identifiable and prominent cause of chronic ankle pain is chronic ankle instability (CAI), a condition defined by instability of the ankle-joint complex. It is a common consequence of lateral ankle sprains or ligamentous injuries and can be described as a failure of the lateral ankle joint complex after an acute, or recurring, ankle injury. The objective of this manuscript is to provide a comprehensive review of CAI diagnosis and our current understanding of minimally invasive treatment options. RECENT FINDINGS First-line treatment is conservative management, some of which includes neuromuscular rehabilitation, balance training, nonsteroidal anti-inflammatory drugs (NSAIDs), manual mobilization, ice therapy, and compression. While conservative management is effective, additional treatments for those who fail conservative management, or who seek alternative options also have been explored. Recent advances and modern techniques have expanded available treatment options, many of which are becoming less invasive, and have shown improving functionality, recovery, and patient satisfaction. Minimally invasive treatments highlighted in this review include: arthroscopic surgery, steroid injections, plasma-rich plasma injections, hyaluronic acid (HA) injections, medicinal signaling cell injections, radiofrequency therapies, and shockwave therapies. This review will discuss some of these current treatments for minimally invasive treatment of CAI, as well as suggest novel treatments for clinical trials and further investigation.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Morgan Hasegawa
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Vwaire Orhurhu
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jacquelin Peck
- Mount Sinai Medical Center of Florida, Department of Anesthesiology, Miami Beach, FL, USA
| | - Angele C Kelly
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC, USA
| | - Mariam Salisu Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Brinkman
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Stephen Giacomazzi
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Lukas Foster
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
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He T, Zhang C, Vedadghavami A, Mehta S, Clark HA, Porter RM, Bajpayee AG. Multi-arm Avidin nano-construct for intra-cartilage delivery of small molecule drugs. J Control Release 2019; 318:109-123. [PMID: 31843642 DOI: 10.1016/j.jconrel.2019.12.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 01/15/2023]
Abstract
Targeted drug delivery to joint tissues like cartilage remains a challenge that has prevented clinical translation of promising osteoarthritis (OA) drugs. Local intra-articular (IA) injections of drugs suffer from rapid clearance from the joint space and slow diffusive transport through the dense, avascular cartilage matrix comprised of negatively charged glycosaminoglycans (GAGs). Here we apply drug carriers that leverage electrostatic interactions with the tissue's high negative fixed charge density (FCD) for delivering small molecule drugs to cartilage cell and matrix sites. We demonstrate that a multi-arm cationic nano-construct of Avidin (mAv) with 28 sites for covalent drug conjugation can rapidly penetrate through the full thickness of cartilage in high concentration and have long intra-cartilage residence time in both healthy and arthritic cartilage via weak-reversible binding with negatively charged aggrecans. mAv's intra-cartilage mean uptake was found to be 112× and 33× the equilibration bath concentration in healthy and arthritic (50% GAG depleted) cartilage, respectively. mAv was conjugated with Dexamethasone (mAv-Dex), a broad-spectrum glucocorticoid, using a combination of hydrolysable ester linkers derived from succinic anhydride (SA), 3,3-dimethylglutaric anhydride (GA) and phthalic anhydride (PA) in 2:1:1 M ratio that enabled 50% drug release within 38.5 h followed by sustained release in therapeutic doses over 2 weeks. A single 10 μM low dose of controlled release mAv-Dex (2:1:1) effectively suppressed IL-1α-induced GAG loss, cell death and inflammatory response significantly better than unmodified Dex over 2 weeks in cartilage explant culture models of OA. With this multi-arm design, <1 μM Avidin was needed - a concentration which has been shown to be safe, preventing further GAG loss and cytotoxicity. A charge-based cartilage homing drug delivery platform like this can elicit disease modifying effects as well as facilitate long-term symptomatic pain and inflammation relief by enhancing tissue specificity and prolonging intra-cartilage residence time of OA drugs. This nano-construct thus has high translational potential for enabling intra-cartilage delivery of a broad array of small molecule OA drugs and their combinations to chondrocytes, enabling OA treatment with a single injection of low drug doses and eliminating toxicity issues associated with multiple high dose injections.
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Affiliation(s)
- Tengfei He
- Departments of Bioengineering, Northeastern University, Boston, MA 02115, USA.
| | - Chenzhen Zhang
- Departments of Bioengineering, Northeastern University, Boston, MA 02115, USA.
| | - Armin Vedadghavami
- Departments of Bioengineering, Northeastern University, Boston, MA 02115, USA.
| | - Shikhar Mehta
- Departments of Bioengineering, Northeastern University, Boston, MA 02115, USA.
| | - Heather A Clark
- Departments of Bioengineering, Northeastern University, Boston, MA 02115, USA; Chemistry and Chemical Biology, Northeastern University, Boston, MA 02115, USA.
| | - Ryan M Porter
- Departments of Internal Medicine and Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
| | - Ambika G Bajpayee
- Departments of Bioengineering, Northeastern University, Boston, MA 02115, USA; Mechanical Engineering, Northeastern University, Boston, MA 02115, USA.
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Guermech I, Lassoued MA, Abdelhamid A, Sfar S. Development and Assessment of Lipidic Nanoemulsions Containing Sodium Hyaluronate and Indomethacin. AAPS PharmSciTech 2019; 20:330. [PMID: 31677079 DOI: 10.1208/s12249-019-1543-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/18/2019] [Indexed: 11/30/2022] Open
Abstract
The present work attempts to develop and optimize the formula of a lipidic nanoemulsion (NE) containing sodium hyaluronate (HNa) and indomethacin (Ind) as HNa-Ind for enhanced transdermal antiarthritic activity. NEs were prepared by the spontaneous emulsification method and characterized by Fourier-transform infrared (FTIR) spectroscopy. The composition of the optimal formulation was statistically optimized using Box-Behnken experimental design method with three independent factors and was characterized for particle size, polydispersity index, and percent transmittance. The selected formula was tested for its in vitro antioxidant activity and in vivo anti-inflammatory activity. The optimized HNa-Ind NE formula was characterized and displayed a particle size of 12.87 ± 0.032 nm, polydispersity index of 0.606 ± 0.082, and 99.4 ± 0.1 percentage of transmittance. FTIR showed no interaction between HNa and Ind as a physical mixture. In addition, the optimized HNa-Ind NE was able to preserve the antioxidant ability of the two drugs, as evidenced through a 2,2-diphenyl-1-picrylhydrazyl (DPPH) inhibition assay used to assess free radical scavenging ability. The cell viability was increased while the free radical scavenging activity was decreased (94.28% inhibition at higher concentrations compared with vitamin C as a reference with an inhibition of 100%). Moreover, the pharmacological anti-inflammatory potential of the optimized HNa-Ind NE formulation was assessed using an in vivo model. Compared with reference drugs (ibuprofen gel 5%), the remarkable activity of the optimized formulation was established using xylene-induced ear edema in mice model, in which the inflamed region reduced by 92.5% upon treatment. The optimized HNa-Ind NE formulation showed considerably higher skin permeation and drug deposition capability compared with the HNa-Ind solution. HNa-Ind NE was demonstrated to be a successful carrier with enhanced antioxidant and anti-inflammatory potential while showing better skin penetration, thus being a promising vehicle for transdermal drug delivery.
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Zhang Y, Zhou D, Chen J, Zhang X, Li X, Zhao W, Xu T. Biomaterials Based on Marine Resources for 3D Bioprinting Applications. Mar Drugs 2019; 17:E555. [PMID: 31569366 PMCID: PMC6835706 DOI: 10.3390/md17100555] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022] Open
Abstract
Three-dimensional (3D) bioprinting has become a flexible tool in regenerative medicine with potential for various applications. Further development of the new 3D bioprinting field lies in suitable bioink materials with satisfied printability, mechanical integrity, and biocompatibility. Natural polymers from marine resources have been attracting increasing attention in recent years, as they are biologically active and abundant when comparing to polymers from other resources. This review focuses on research and applications of marine biomaterials for 3D bioprinting. Special attention is paid to the mechanisms, material requirements, and applications of commonly used 3D bioprinting technologies based on marine-derived resources. Commonly used marine materials for 3D bioprinting including alginate, carrageenan, chitosan, hyaluronic acid, collagen, and gelatin are also discussed, especially in regards to their advantages and applications.
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Affiliation(s)
- Yi Zhang
- Department of Precision Medicine and Healthcare, Tsinghua-Berkeley Shenzhen Institute, Shenzhen 518055, China.
| | - Dezhi Zhou
- Department of Mechanical Engineering, Biomanufacturing Center, Tsinghua University, Beijing 100084, China.
| | - Jianwei Chen
- Department of Precision Medicine and Healthcare, Tsinghua-Berkeley Shenzhen Institute, Shenzhen 518055, China.
| | - Xiuxiu Zhang
- Department of Precision Medicine and Healthcare, Tsinghua-Berkeley Shenzhen Institute, Shenzhen 518055, China.
| | - Xinda Li
- Department of Mechanical Engineering, Biomanufacturing Center, Tsinghua University, Beijing 100084, China.
| | - Wenxiang Zhao
- Department of Mechanical Engineering, Biomanufacturing Center, Tsinghua University, Beijing 100084, China.
| | - Tao Xu
- Department of Precision Medicine and Healthcare, Tsinghua-Berkeley Shenzhen Institute, Shenzhen 518055, China.
- Department of Mechanical Engineering, Biomanufacturing Center, Tsinghua University, Beijing 100084, China.
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Yu Y, Lin H, Wu Z, Xu P, Lei Z. Perioperative combined administration of tranexamic acid and dexamethasone in total knee arthroplasty-benefit versus harm? Medicine (Baltimore) 2019; 98:e15852. [PMID: 31441836 PMCID: PMC6716714 DOI: 10.1097/md.0000000000015852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the benefits and harm of combined administration of tranexamic acid (TXA) and dexamethasone (Dexa) in total knee arthroplasty (TKA). METHODS A total of 88 consecutive patients undergoing TKA for knee osteoarthritis were stratified in 2 groups. All surgeries were performed under general anesthesia. Brief, patients in the TXA + Dexa group (n = 45) received 10 mg Dexa just after the anesthesia, and repeated at 24 hours after the surgery; and patients in the TXA group (n = 43) received 2 ml of normal saline solution at the same time. The measured outcomes were the C-reactive protein (CRP) and interleukin-6 (IL-6) from preoperatively to postoperatively, and postoperative nausea and vomiting (PONV), fatigue, range of motion (ROM), length of stay (LOS), and the analgesic and antiemetic rescue consumption RESULTS:: The level of CRP and IL-6 in the TXA + Dexa group were lower than that in the TXA group at 24 hours (P < .001, P < .001), 48 hours (P < .001, P < .001), and 72 hours (P < .001, P < .001) after the surgery. The pain scores in the TXA + Dexa group were lower during walking at 24 hours (P < .001), 48 hours (P < .001), and 72 hours (P < .001) and at rest at 24 hours (P = .022) after the surgery. Patients in the TXA + Dexa group had a lower nausea score, the incidence of PONV, fatigue, and the analgesic and antiemetic rescue consumption, and had a greater ROM than that in the TXA group. No significant differences were found in LOS and complications. CONCLUSION The combined administration of TXA + Dexa significantly reduced the level of postoperative CRP and IL-6, relieve postoperative pain, ameliorate the incidence of POVN, provide additional analgesic and antiemetic effects, reduce postoperative fatigue, and improve ROM, without increasing the risk of complications in primary TKA.
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Turhan Y, Arıcan M, Karaduman ZO, Turhal O, Gamsızkan M, Aydın D, Kılıç B, Özkan K. Chondroprotective effect of Nigella sativa oil in the early stages of osteoarthritis: an experimental study in rabbits. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2019; 19:362-369. [PMID: 31475944 PMCID: PMC6737550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Nigella sativa oil possesses a well-known ability to protect certain organs from oxidative, neoplastic, and inflammatory damage. This study investigated the potential chondroprotective effects of intraarticular injections of Nigella sativa oil in a rabbit osteoarthritis model. METHODS Osteoarthritis models were created by performing anterior cruciate ligament transections in 20 New Zealand rabbits. Rabbits were randomly divided into two groups of 10 and given intraarticular injections in their right knees weekly for 5 weeks, beginning in the third week post-operation. Injections given to the first group contained whole Nigella sativa oil, whereas the second group was injected with a saline solution. Knee joints were harvested 8 weeks after surgery. Knee joint surfaces were examined macroscopically, and medial femoral condyle sections were examined microscopically. RESULTS There was a statistically significant difference in the macroscopic grading results of the groups, with the Nigella sativa group having better results (p=0.001). The Nigella sativa group also received significantly better total Osteoarthritis Research Society International (OARSI) scores (p=0.035). CONCLUSIONS Intraarticular administration of Nigella sativa oil has the potential to protect cartilage from degeneration in the early stages of osteoarthritis.
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Affiliation(s)
- Yalçın Turhan
- Orthopedics and Traumatology Department, Duzce University Medical Faculty, Duzce, Turkey,Corresponding author: Yalçın Turhan, Assistant Professor, Orthopedics and Traumatology Department, Duzce University Medical Faculty, Duzce, Turkey. Medical Faculty of Duzce University, Department of Orthopaedics and Traumatology, Konuralp street, Center, 81000, Duzce, Turkey E-mail:
| | - Mehmet Arıcan
- Orthopedics and Traumatology Department, Duzce University Medical Faculty, Duzce, Turkey
| | - Zekeriya O. Karaduman
- Orthopedics and Traumatology Department, Duzce University Medical Faculty, Duzce, Turkey
| | - Ozan Turhal
- Orthopedics and Traumatology Department, Duzce University Medical Faculty, Duzce, Turkey
| | - Mehmet Gamsızkan
- Pathology Department, Duzce University Medical Faculty, Duzce, Turkey
| | - Davut Aydın
- Orthopedics and Traumatology Department, Hendek State Hospital, Sakarya, Turkey
| | | | - Korhan Özkan
- Orthopedics and Traumatology Department, Medeniyet University Medical Faculty, Istanbul, Turkey
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Abstract
Osteoarthritis is a common condition that affects many individuals resulting in pain, reduced mobility, and decreased function. Corticosteroids have been a mainstay of osteoarthritis treatment. Studies have shown that they provide short-term pain improvement and can be used for osteoarthritis flares. Hyaluronic acid injections have extensively been studied in knee osteoarthritis but to a lesser degree in other joints. Despite some debate between societies, a large number of recent studies have shown hyaluronic acid to be a viable treatment option showing longer-term improvement in both pain and function.
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Affiliation(s)
- Nina A Yaftali
- Primary Care Sports Medicine, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison, 3rd Floor, Chicago, IL 60612, USA
| | - Kathleen Weber
- Department of Orthopaedics, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison, 3rd Floor, Chicago, IL 60612, USA.
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Lee E, Choi JH, Jeong HJ, Hwang SG, Lee S, Oh JW. Hematologic and serologic status of military working dogs given standard diet containing natural botanical supplements. Toxicol Rep 2018; 5:343-347. [PMID: 29854603 PMCID: PMC5978014 DOI: 10.1016/j.toxrep.2018.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 02/07/2023] Open
Abstract
The experiments with military working dogs (MWDs) as a special case were carried out. Osteoarthritis is a common inflammatory disease in MWDs. We evaluated a mixture of natural botanicals as a dietary supplement. This supplementation had positive effects on hematological and serological values. Results provided support for the development of a feed supplement for MWDs.
The health of military working dogs (MWDs) deployed with Korean troops is of prime importance. The aim of our study was to investigate the hematologic and serologic status of Korean MWDs given natural botanical supplements. To do this, 11 natural botanicals were selected based on relevant references and combined to supplement MWDs. Throughout the 16-week experimental periods, there was no significant difference in body weights of individual dogs. The Hemoglobin (HGB), hematocrit (HCT), Mean Corpuscular Volume (MCV), and Mean Corpuscular Hemoglobin (MCH) values were slightly higher in the group given the supplement. On the other hand, the Mean Corpuscular Hemoglobin Concentration (MCHC) values were slightly lower. Changes in platelet, lymphocyte, and basophil counts were observed in the supplemented group. The median serum IL-6 level did not differ significantly between the supplemented and control groups. However, the mean serum C-reactive protein (CRP) value increased significantly from the start of supplementation to 8 weeks, and then decreased at 16 weeks. Taken together, our result suggests that the health condition of most MWDs supplemented with natural botanicals was gradually improved. Thus, this study may provide support for the development of a feed supplement for MWDs using natural botanicals.
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Affiliation(s)
- Eunchae Lee
- Department of Animal Bioscience and Technology, College of Animal Bioscience and Technology, Konkuk University, Seoul 05029, Republic of Korea
| | - Jun-Ha Choi
- Department of Animal Biotechnology, College of Animal Bioscience and Technology, Konkuk University, Seoul 05029, Republic of Korea
| | - Ha-Jeong Jeong
- Department of Companion Animal Science, Seojeong College, 1046-56, Hwahap-ro, Yangju-si, Gyeonggi-do, Republic of Korea
| | - Sung-Gu Hwang
- Korea Customs Service, Customs Border Control Training Institute 208, Yeongjonghaeanbuk-ro 1204, Incheon-si, Gyeonggi-do, Republic of Korea
| | - Sangrak Lee
- Department of Animal Bioscience and Technology, College of Animal Bioscience and Technology, Konkuk University, Seoul 05029, Republic of Korea
| | - Jae-Wook Oh
- Department of Animal Biotechnology, College of Animal Bioscience and Technology, Konkuk University, Seoul 05029, Republic of Korea
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Farpour HR, Fereydooni F. Comparative effectiveness of intra-articular prolotherapy versus peri-articular prolotherapy on pain reduction and improving function in patients with knee osteoarthritis: A randomized clinical trial. Electron Physician 2017; 9:5663-5669. [PMID: 29403602 PMCID: PMC5783111 DOI: 10.19082/5663] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/10/2017] [Indexed: 01/22/2023] Open
Abstract
Background Osteoarthritis is a common degenerative disease. Prolotherapy is an alternative therapy used in multiple musculoskeletal disorders. Objective To compare the effectiveness of intra-articular dextrose injection versus peri-articular prolotherapy in patients with knee osteoarthritis (KOA). Methods Fifty-two adults with painful primary knee osteoarthritis for at least three months were randomized to intra- and peri-articular injection groups. Prolotherapy was done twice with two week intervals. The outcome measures included the Oxford Knee Scale (OKS), Western Ontario McMaster University Osteoarthritis Index (WOMAC), and Visual Analogue Scale (VAS), which were obtained from patients before the first injection at the base line and after the second injection at the fourth and eighth weeks. Results There were no statistically significant differences between demographic characteristics; before the injection, pain intensity, OKS, and WOMAC scores were approximately equal between the two groups. After dextrose prolotherapy, VAS, OKS, and WOMAC scores improved from baseline through the fourth and eighth weeks in both groups without any superiority between the two methods of injections (p<0.001). Conclusion Dextrose prolotherapy either intra- or peri-articular injection resulted in significant improvement, so it could be an inexpensive and effective management of knee osteoarthritis. Trial registration The study protocol was registered as a clinical trial under registration ID of IRCT2016091229795N1 at the Iranian Registry of Clinical Trials (http://www.irct.ir). Funding The authors received no financial support for the research, authorship, or publication of this article.
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Affiliation(s)
- Hamid Reza Farpour
- M.D. Physiatrist, Assistant Professor, Bone and Joint Diseases Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Farzane Fereydooni
- M.D. Physical medicine and Rehabilitation Resident, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Shiraz University of Medical Science, Shiraz, Iran
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Bisicchia S, Tudisco C. Hyaluronic acid vs corticosteroids in symptomatic knee osteoarthritis: a mini-review of the literature. ACTA ACUST UNITED AC 2017; 14:182-185. [PMID: 29263730 DOI: 10.11138/ccmbm/2017.14.1.182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction Although intra-articular injections of hyaluronic acid (HA) are common non-operative measures used in clinical practice in the management of symptomatic osteoarthritis, there is a great controversy on their efficacy and safety compared to corticosteroids (CSs). Efficacy Conflicting results have been reported in clinical trials and meta-analysis due to methodological differences in study design, along with collection, analysis, and interpretation of data. Even if some studies reported small or no differences of HA compared with CSs (or inferred that HA is not more effective than saline as a placebo), in general CSs have shown to be superior in the short term (especially on pain control), while better results have been reported with HA at subsequent evaluations, but with only a moderate effect after 26 weeks. Safety Mild or moderate adverse events have generally been reported after HA injections, the most common being injection site pain. HA is generally considered safe compared to CSs or saline. Furthermore, HA has shown to be safe also after a previous course of injections. Conclusions Conflicting results have been reported on the efficacy and safety of HA. Guidelines are controversial and in most of the cases "uncertain" recommendations are provided due to inconclusive evidence in literature. However, HA does not seem to have significantly higher side effects when compared to saline or CSs injections, and provides better medium-term control of symptoms in patients with mild to moderate knee osteoarthritis.
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Affiliation(s)
- Salvatore Bisicchia
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Cosimo Tudisco
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
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Ze R, Wang S, Xie M, Zhang B, Tang X, Li J. Roxatidine Attenuates Degradation of Extracellular Matrix. Biomed Pharmacother 2017; 95:1156-1160. [PMID: 28926925 DOI: 10.1016/j.biopha.2017.08.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022] Open
Abstract
Degradation of extracellular matrix such as type II collagen and aggrecan induced by proinflammatory cytokines has been considered as an important hallmark of Osteoarthritis (OA). Roxatidine is a licensed specific competitive H (2) -receptor antagonist used for the treatment of gastric and duodenal ulcers. The pharmacological function of roxatidine on Osteoarthritis (OA) remains unknown. In the current study, we report that roxatidine attenuated TNF-α- induced degradation of type II collagen by suppressing the expression of MMP-3 and MMP-13 in human chondrosarcoma cell line SW1353 cells. In addition, roxatidine ameliorated TNF-α- induced reduction of aggrecan by inhibiting the expression of ADAMTS-4 and ADAMTS-5. Notably, results indicate that roxatidine ameliorated TNF-α- induced the phosphorylations of IKK, IκBα, and NF-κB p65 as well as nuclear translocation of NF-κB p65 and the transcriptional activity of NF-κB, suggesting that roxatidine abolished the activation of NF-κB signaling pathway. Our findings implicate that roxatidine might be considered as an anti-osteoarthritic agent.
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Affiliation(s)
- Renhao Ze
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Science and Technology of Huazhong University, Wuhan 430022, China
| | - Shangyu Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Science and Technology of Huazhong University, Wuhan 430022, China
| | - Mao Xie
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Science and Technology of Huazhong University, Wuhan 430022, China
| | - Bo Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Science and Technology of Huazhong University, Wuhan 430022, China
| | - Xin Tang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Science and Technology of Huazhong University, Wuhan 430022, China
| | - Jin Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Science and Technology of Huazhong University, Wuhan 430022, China.
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Euppayo T, Punyapornwithaya V, Chomdej S, Ongchai S, Nganvongpanit K. Effects of hyaluronic acid combined with anti-inflammatory drugs compared with hyaluronic acid alone, in clinical trials and experiments in osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord 2017; 18:387. [PMID: 28877688 PMCID: PMC5585914 DOI: 10.1186/s12891-017-1743-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/28/2017] [Indexed: 12/24/2022] Open
Abstract
Background The objectives are to compare the efficacy of intra-articular hyaluronic acid (IA-HA) alone and in combination with anti-inflammatory drugs (IA-HA + AI), corticosteroids (CS) or non-steroidal anti-inflammatory drugs (NSAIDs) in clinical trials and in vivo and in vitro studies of osteoarthritis (OA). Methods Data in the BIOSIS, CINAHL, Cochrane Library, EMBASE and Medline databases were collected and analyzed. Random effects models were used to compute the effect size (ES) of the mean difference in pain reduction scores from baseline and the relative risk (RR) of adverse events. The ES of histological scores in vivo and cartilage metabolism in vitro were also calculated. We conducted sensitivity analysis of blinding and intention-to-treat (ITT), compared IA-HA combined with CS vs. IA-HA alone in trials, and compared the effects of HA + AI vs. AI alone in vitro, including anabolic and catabolic gene expression. Results Thirteen out of 382 papers were included for data analysis. In clinical trials, the ES of pain reduction scores within the 1st month was −4.24 (−6.19, −2.29); 2nd–12th month, −1.39 (−1.95, −0.82); and within one year, −1.63 (−2.19, −1.08), favoring IA-HA + AI (P < 0.001). The ES of RR was 1.08 (0.59, 1.98), and histological scores was 1.38 (−0.55, 3.31). The ES of anabolic gene expression was 1.22 (0.18, 2.25), favoring HA alone (P < 0.05); catabolic gene expression was 0.74 (−0.44, 1.53), favoring HA alone; and glycosaminoglycans remaining was −2.45 (−5.94, 1.03). Conclusions IA-HA + AI had greater efficacy for pain relief than IA-HA alone within a one-year period. However, HA + AI down-regulated the ACAN gene when compared with HA alone in vitro.
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Affiliation(s)
- Thippaporn Euppayo
- Animal Bone and Joint Research Laboratory, Department of Veterinary Biosciences and Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand
| | - Veerasak Punyapornwithaya
- Department of Food Animal Clinic, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriwadee Chomdej
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriwan Ongchai
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Korakot Nganvongpanit
- Animal Bone and Joint Research Laboratory, Department of Veterinary Biosciences and Public Health, Faculty of Veterinary Medicine, Chiang Mai University, Chiang Mai, 50100, Thailand. .,Excellence Center in Veterinary Bioscience, Chiang Mai University, Chiang Mai, 50200, Thailand.
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BUYUK ABDULFETTAH, KILINC ERAY, CAMURCU ISMETYALKIN, CAMUR SAVAS, UCPUNAR HANIFI, KARA ADNAN. COMPARED EFFICACY OF INTRA-ARTICULAR INJECTION OF METHYLPREDNISOLONE AND TRIAMCINOLONE. ACTA ORTOPEDICA BRASILEIRA 2017; 25:206-208. [PMID: 29081706 PMCID: PMC5608740 DOI: 10.1590/1413-785220172505172581] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To compare the effect of two different corticosteroid types in bilateral and symmetrical knee osteoarthritis (OA). Methods: One hundred and twenty-six patients received injections of methylprednisolone acetate (MP) in one knee and triamcinolone hexacetonide (TH) in the contralateral knee. Patients were evaluated before injection and 2, 4, 8, 12, and 24 weeks after. Results: Mean patient age was 68.5±9 years. Mean BMI was 26.3±2.6 kg/m2. At first admission, mean VAS score was 7.7±1.3 for the right side and 7.5±1.5 for the left side, and mean WOMAC score was 67.6±14.4. After bilateral intra-articular injection, VAS scores for both knees and WOMAC scores decreased significantly when initial scores were compared with 2, 4, 8, 12, and 24 weeks after injection (p<0.05). A statistically significant change was seen over time when VAS and WOMAC scores for 2, 4, 8, 12, and 24 weeks post-injection were compared to each other (p<0.05). No significant difference was seen between knee sides (p>0.05). Conclusion: MP and TH have similar efficacy in relieving pain and improving function. The efficacy of intra-articular corticosteroid injection peaks 2 weeks after injection and the effect continues until the 24th week. Level of Evidence II, Comparative Prospective Study.
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Affiliation(s)
| | | | | | - SAVAS CAMUR
- Umraniye Training and Research Hospital, Turkey
| | - HANIFI UCPUNAR
- Baltalimani Bone Diseases Research and Training Hospital, Turkey
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Boutefnouchet T, Puranik G, Holmes E, Bell KM. Hylan GF-20 Viscosupplementation in the Treatment of Symptomatic Osteoarthritis of the Knee: Clinical Effect Survivorship at 5 Years. Knee Surg Relat Res 2017; 29:129-136. [PMID: 28545178 PMCID: PMC5450575 DOI: 10.5792/ksrr.16.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/13/2017] [Accepted: 04/23/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis. Materials and Methods A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results. Results Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint. Conclusions This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.
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Affiliation(s)
- Tarek Boutefnouchet
- Department of Trauma Orthopaedics, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Guru Puranik
- Department of Trauma Orthopaedics, Alexandra Hospital, Redditch, UK
| | - Esther Holmes
- Department of Trauma Orthopaedics, Alexandra Hospital, Redditch, UK
| | - Karl M Bell
- Department of Trauma Orthopaedics, Alexandra Hospital, Redditch, UK
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Bernardoni ED, Frank RM, Gomoll AH. Looking Back: Safety of Current Treatments. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bar-Or D, Rael LT, Brody EN. Use of Saline as a Placebo in Intra-articular Injections in Osteoarthritis: Potential Contributions to Nociceptive Pain Relief. Open Rheumatol J 2017; 11:16-22. [PMID: 28400868 PMCID: PMC5366377 DOI: 10.2174/1874312901711010016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/06/2017] [Accepted: 01/08/2017] [Indexed: 11/23/2022] Open
Abstract
Background: Osteoarthritis of the knee (OAK) is a severe debilitating condition characterized by joint pain, stiffness, and resultant limited mobility. In recent years, intra-articular (IA) injections have been used to relieve symptoms and have succeeded to varying degrees either with sodium hyaluronate preparations or with a biologic. Objective: The objective of this review is to evaluate multiple studies that demonstrate some relief from the symptoms of OAK in the saline arm of various clinical trials. Method: A thorough literature search (PubMed) was performed assessing the pain efficacy of various compounds compared to saline injections in clinical trials. A total of 73 studies were identified in the literature search including a total of 5,816 patients. These clinical trials all involved the IA injection of a viscosupplement (hyaluronate, platelet rich plasma (PRP), etc.) or a biologic (the low molecular weight fraction (< 5kDa) of human serum albumin (LMWF-5A)). For all of these studies, the control arm was injection of sterile physiological saline that approximates the salt concentration and total solute concentration of blood and most tissues. Results: Based on our review of the current literature, the tested compounds performed with mixed results when compared to saline injections. Moreover, OAK is a variable disease, with severity measured on the Kellgren and Lawrence (KL) scale where various hyaluronate preparations have a therapeutic effect mostly on KL 2-3 patients while a biologic works best on KL 3-4 patients. Conclusion: Since the effect of saline injection is always greater than no treatment, the evaluations of these treatments can be confounded in clinical trials. Therefore, the question of whether there are known therapeutic effects of saline injections might explain these results.
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Affiliation(s)
- David Bar-Or
- Swedish Medical Center, Trauma Research, Englewood, CO 80133, USA; St. Anthony Hospital, Lakewood, CO 80228, USA; The Medical Center of Plano, Plano, TX 75075, USA; Penrose Hospital, Colorado Springs, CO 80907, USA; Ampio Pharmaceuticals Inc., Englewood, CO 80112, USA
| | - Leonard T Rael
- Swedish Medical Center, Trauma Research, Englewood, CO 80133, USA; St. Anthony Hospital, Lakewood, CO 80228, USA; The Medical Center of Plano, Plano, TX 75075, USA; Penrose Hospital, Colorado Springs, CO 80907, USA; Ampio Pharmaceuticals Inc., Englewood, CO 80112, USA
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Kim SR, Ho MJ, Kim SH, Cho HR, Kim HS, Choi YS, Choi YW, Kang MJ. Increased localized delivery of piroxicam by cationic nanoparticles after intra-articular injection. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:3779-3787. [PMID: 27895468 PMCID: PMC5117887 DOI: 10.2147/dddt.s118145] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Piroxicam (PRX), a potent nonsteroidal anti-inflammatory drug, is prescribed to relieve postoperative and/or chronic joint pain. However, its oral administration often results in serious gastrointestinal adverse effects including duodenal ulceration. Thus, a novel cationic nanoparticle (NP) was explored to minimize the systemic exposure and increase the retention time of PRX in the joint after intra-articular (IA) injection, by forming micrometer-sized electrostatic clusters with endogenous hyaluronic acid (HA) in the synovial cavity. PRX-loaded NPs consisting of poly(lactic-co-glycolic acid), Eudragit RL, and polyvinyl alcohol were constructed with the following characteristics: particle size of 220 nm, zeta potential of 11.5 mV in phosphate-buffered saline, and loading amount of 4.0% (w/w) of PRX. In optical and hyperspectral observations, the cationic NPs formed more than 50 μm-sized aggregates with HA, which was larger than the intercellular gaps between synoviocytes. In an in vivo pharmacokinetic study in rats, area under the plasma concentration-time curve (AUC0-24 h) and maximum plasma concentration (Cmax) of PRX after IA injection of the cationic NPs were <70% (P<0.05) and 60% (P<0.05), respectively, compared to those obtained from drug solution. Moreover, the drug concentration in joint tissue 24 h after dosing with the cationic NPs was 3.2-fold (P<0.05) and 1.8-fold (P<0.05) higher than that from drug solution and neutrally charged NPs, respectively. Therefore, we recommend the IA cationic NP therapy as an effective alternative to traditional oral therapy with PRX, as it increases drug retention selectively in the joint.
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Affiliation(s)
- Sung Rae Kim
- Division of Pharmaceutical Sciences, College of Pharmacy, Chung-Ang University, Seoul
| | - Myoung Jin Ho
- College of Pharmacy, Dankook University, Cheonan, Chungnam, South Korea
| | - Sang Hyun Kim
- Division of Pharmaceutical Sciences, College of Pharmacy, Chung-Ang University, Seoul
| | - Ha Ra Cho
- College of Pharmacy, Dankook University, Cheonan, Chungnam, South Korea
| | - Han Sol Kim
- College of Pharmacy, Dankook University, Cheonan, Chungnam, South Korea
| | - Yong Seok Choi
- College of Pharmacy, Dankook University, Cheonan, Chungnam, South Korea
| | - Young Wook Choi
- Division of Pharmaceutical Sciences, College of Pharmacy, Chung-Ang University, Seoul
| | - Myung Joo Kang
- College of Pharmacy, Dankook University, Cheonan, Chungnam, South Korea
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Liopo A, Su R, Tsyboulski DA, Oraevsky AA. Optical clearing of skin enhanced with hyaluronic acid for increased contrast of optoacoustic imaging. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:081208. [PMID: 27232721 PMCID: PMC4882400 DOI: 10.1117/1.jbo.21.8.081208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/18/2016] [Indexed: 05/06/2023]
Abstract
Enhanced delivery of optical clearing agents (OCA) through skin may improve sensitivity of optical and optoacoustic (OA) methods of imaging, sensing, and monitoring. This report describes a two-step method for enhancement of light penetration through skin. Here, we demonstrate that topical application of hyaluronic acid (HA) improves skin penetration of hydrophilic and lipophilic OCA and thus enhances their performance. We examined the OC effect of 100% polyethylene and polypropylene glycols (PPGs) and their mixture after pretreatment by HA, and demonstrated significant increase in efficiency of light penetration through skin. Increased light transmission resulted in a significant increase of OA image contrast in vitro. Topical pretreatment of skin for about 30 min with 0.5% HA in aqueous solution offers effective delivery of low molecular weight OCA such as a mixture of PPG-425 and polyethylene glycol (PEG)-400. The developed approach of pretreatment by HA prior to application of clearing agents (PEG and PPG) resulted in a ∼ 47-fold increase in transmission of red and near-infrared light and significantly enhanced contrast of OA images.
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Affiliation(s)
- Anton Liopo
- TomoWave Laboratories, 6550 Mapleridge Street Suite 124, Houston, Texas 77081, United States
| | - Richard Su
- TomoWave Laboratories, 6550 Mapleridge Street Suite 124, Houston, Texas 77081, United States
- University of Houston, Department of Biomedical Engineering, 3600 Calhoun Road, Houston, Texas 77004, United States
| | - Dmitri A. Tsyboulski
- TomoWave Laboratories, 6550 Mapleridge Street Suite 124, Houston, Texas 77081, United States
| | - Alexander A. Oraevsky
- TomoWave Laboratories, 6550 Mapleridge Street Suite 124, Houston, Texas 77081, United States
- University of Houston, Department of Biomedical Engineering, 3600 Calhoun Road, Houston, Texas 77004, United States
- Address all correspondence to: Alexander A. Oraevsky, E-mail:
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Does Injection of Corticosteroid After Arthrocentesis Improve Outcomes of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. J Oral Maxillofac Surg 2016; 74:2151-2158. [PMID: 27376184 DOI: 10.1016/j.joms.2016.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/16/2016] [Accepted: 05/29/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study is to answer the following clinical question: Among patients with temporomandibular joint (TMJ) osteoarthritis (OA), do those undergoing arthrocentesis and corticosteroid (CS) injection, when compared with those undergoing arthrocentesis alone, have better outcomes in terms of range of motion and clinical symptoms? MATERIALS AND METHODS A randomized clinical trial in adult patients with TMJ OA referred to our clinic between May 2012 and September 2013 was implemented. The sample was composed of 24 consecutive patients with TMJ OA treated randomly with either arthrocentesis alone (control group) or arthrocentesis plus CS injection (CS group). The outcome variables were visual analog scale evaluations (ie, masticatory efficiency, joint sounds, and pain complaints), maximal interincisal opening, and mandibular motions. The outcome variables were recorded at baseline and at 12 months postoperatively. The Mann-Whitney U test was used for intergroup comparison. The paired t test and Wilcoxon signed rank test were used for intragroup comparisons. RESULTS The sample was composed of 32 joints in 24 patients with TMJ OA (15 joints in 12 patients with a mean age of 35.08 ± 14.84 years comprising the control group and 17 joints in 12 adult patients with a mean age of 32.58 ± 9.58 years comprising the CS group). Pain complaints and joint sounds showed statistically significant decreases (P < .01) in both groups, whereas painless interincisal opening showed a statistically significant increase (P < .001) in only the CS group. After estimation of differences between the follow-up and baseline outcomes, the mean change in the primary outcome variables showed no statistically significant differences between the 2 groups (P > .05). CONCLUSIONS These findings suggest that arthrocentesis plus intra-articular CS injection produced no better outcomes in terms of range of motion and clinical symptoms in patients with TMJ OA, as compared with those undergoing arthrocentesis alone.
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Ahire JJ, Dicks LMT. Antimicrobial Hyaluronic Acid-Cefoxitin Sodium Thin Films Produced by Electrospraying. Curr Microbiol 2016; 73:236-41. [PMID: 27146506 DOI: 10.1007/s00284-016-1057-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
The healing properties of hyaluronic acid (HA) in the recovery of wounds are well known. Cefoxitin (Cef), a cephalosporin antibiotic, is generally used to prevent and treat postoperative infections. In this study, we describe the incorporation of Cef in HA thin films (Cef-HAF) by using electrospraying. Scanning electron microscopy images showed that HA-containing thin films (HAF) were composed of numerous nanoparticles (255 ± 177 nm in diameter) with irregular surfaces, connected to each other with nanofibers of 50 ± 11 nm in diameter. Cef-HAF contained fewer, but larger, particles (551 ± 293 nm) with smooth surfaces and were interconnected with nanofibers of 61 ± 13 nm in diameter. Differences in surface morphology between HAF and Cef-HAF were confirmed by atomic force microscopy. Fourier transform infrared and X-ray diffraction analyses revealed that Cef was not modified when incorporated into Cef-HAF and remained active against Klebsiella pneumoniae Xen 39, Staphylococcus aureus Xen 36 and Listeria monocytogenes EDGe. Nanofiber scaffolds of HA-containing Cef may be used in dressings to control postoperative infections.
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Affiliation(s)
- Jayesh J Ahire
- Department of Microbiology, University of Stellenbosch, Matieland, Stellenbosch, 7602, South Africa
| | - Leon M T Dicks
- Department of Microbiology, University of Stellenbosch, Matieland, Stellenbosch, 7602, South Africa.
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Richards MM, Maxwell JS, Weng L, Angelos MG, Golzarian J. Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine. PHYSICIAN SPORTSMED 2016; 44:101-8. [PMID: 26985986 PMCID: PMC4932822 DOI: 10.1080/00913847.2016.1168272] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Knee osteoarthritis (OA) is a debilitating condition that may ultimately require total knee arthroplasty (TKA). Non-operative treatments are bracing, oral analgesics, physical therapy, and intra-articular knee injection (IAKI). The objective of this paper is to provide a systematic literature review regarding intra-articular treatment of knee OA and insight into promising new products of regenerative medicine that may eventually have a substantial effect on treatment. METHODS A literature search was executed using Medline, Cochrane, and Embase with keywords "knee osteoarthritis" and "injection." Specifically, 45 articles that discussed intra-articular knee injection using corticosteroids, hyaluronic acid, analgesics, local anesthetics, and newer products of regenerative medicine, such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSC), were analyzed. Of these, eleven were level 1, three were level 2, twelve were level 3, two were level 4, and seventeen were level 5 evidence. Papers included animal models. RESULTS Local anesthetics have potential side effects and may only be effective for a few hours. Morphine and ketorolac may provide significant pain relief for 24 hours. Corticosteroids may give patients weeks to months of effective analgesia, but complications may occur, such as systemic hyperglycemia, septic arthritis, and joint degradation . Hyaluronic acid is a natural component of synovial fluid, but efficacy with respect to analgesia is controversial. Platelet-rich plasma formulations, autologous conditioned serum, autologous protein solution, and mesenchymal stem cell injections contain anti-inflammatory molecules and have been proposed to attenuate joint destruction or potentially remodel the joint. CONCLUSIONS Currently, knee OA treatment does not address the progressively inflammatory environment of the joint. More investigation is needed regarding products of regenerative medicine, but they may ultimately have profound implications in the way knee OA is managed.
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Affiliation(s)
- Masters M. Richards
- University of Minnesota-School of Medicine, Department of Vascular and Interventional Radiology 420 Delaware St. SE, Minneapolis, MN 55455, Ph. (612)626-5388
| | - Joshua Shane Maxwell
- University of Minnesota-School of Medicine, Department of Family Medicine and Community Health, 420 Delaware St. SE, MMC 381, Minneapolis, MN 55455, Ph. (612)625-0646
| | - Lihui Weng
- University of Minnesota-School of Medicine, Department of Vascular and Interventional Radiology 420 Delaware St. SE, Minneapolis, MN 55455, Ph. (612)626-5388
| | - Mathew G. Angelos
- University of Minnesota-School of Medicine, Department of Hematology, Oncology, and Transplantation, 401 East River Parkway, Suite 131, MMC 194, Minneapolis, Minnesota 55455, Ph. (612)625-3654
| | - Jafar Golzarian
- University of Minnesota-School of Medicine, Department of Vascular and Interventional Radiology 420 Delaware St. SE, Minneapolis, MN 55455, Ph. (612)626-5388
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The timing of elective shoulder surgery after shoulder injection affects postoperative infection risk in Medicare patients. J Shoulder Elbow Surg 2016; 25:390-7. [PMID: 26651428 DOI: 10.1016/j.jse.2015.08.039] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/09/2015] [Accepted: 08/25/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The goal of this study was to employ a national database to evaluate the association of preoperative injection before shoulder arthroscopy and arthroplasty with the incidence of postoperative infection. METHODS A national database of Medicare patients was queried for patients who underwent shoulder arthroscopy or arthroplasty after ipsilateral shoulder injection. Three arthroscopy cohorts were created: arthroscopy within 3 months of injection (n = 3625), arthroscopy between 3 and 12 months after injection (n = 7069), and matched control arthroscopy without prior injection (n = 186,678). Three arthroplasty cohorts were created: arthroplasty within 3 months of injection (n = 636), arthroplasty between 3 and 12 months after injection (n = 1573), and matched control arthroplasty (n = 6211). Infection rates within 3 and 6 months postoperatively were assessed. RESULTS The incidence of infection after arthroscopy at 3 months (0.7%; odds ratio [OR], 2.2; P < .0001) and 6 months (1.1%; OR, 1.6; P = .003) was significantly higher in patients who underwent injection within 3 months before arthroscopy compared with controls. The incidence of infection after arthroplasty at 3 months (3.0%; OR, 2.0; P = .007) and 6 months (4.6%; OR, 2.0; P = .001) was significantly higher in patients who underwent injection within 3 months before arthroplasty compared with controls. CONCLUSIONS There was a significant increase in postoperative infection in Medicare patients who underwent injection within 3 months before shoulder arthroscopy and arthroplasty. This association was not noted when shoulder arthroscopy or arthroplasty occurred >3 months after injection.
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Conrozier T, Patarin J, Mathieu P, Rinaudo M. Steroids, lidocain and ioxaglic acid modify the viscosity of hyaluronic acid: in vitro study and clinical implications. SPRINGERPLUS 2016; 5:170. [PMID: 27026867 PMCID: PMC4766165 DOI: 10.1186/s40064-016-1762-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/12/2016] [Indexed: 01/18/2023]
Abstract
Background Viscosupplementaion by intra-articular injection of hyaluronic acid (HA) is a therapeutic modality for treating osteoarthritis of the knee, of the hip and less frequently of other joints. During viscosupplementation, it is usual to inject other drugs, without knowing whether this association may have a deleterious effect thereon. The rheological properties of a viscosupplement are highly dependent on the product [molecular weight × concentration] of HA. Therefore, any reduction of its viscoelastic properties is related either to a decrease of its concentration or/and of its molecular weight. The presence of other molecules can create favorable or unfavorable molecular interactions with HA. The objective of the study was to investigate the effect of products, that are commonly associated with HA (corticosteroids, lidocain, iodinated contrast media), on the rheological behavior of HA, then to try drawing practical conclusions. Methods The rheological behavior of both a linear and a cross-linked HA, was studied before and after mixing with different volumes (ratio 1:0.5–1:4) of the following compounds: phosphate buffered saline (PBS, as a control), cortivazol, triamcinolone hexacetonide, lidocain chlorhydrate and meglumine ioxaglate. The flow curve of the different samples was obtained using a measuring method based on a constant shear rate. Results Whatever the dilution and the added molecule were, viscosity of the cross-linked viscosupplement remained much higher than that of the linear one. Addition of PBS at a ratio 1:1 caused a dramatic decrease (up to 97.5 %) of HA viscosity. Cortivazol and lidocain had a similar effect than PBS on linear HA. Both were much deleterious on cross-linked HA viscosity. Among corticosteroids, triamcinolone decreased much less HA viscosity than cortivazol. The effect of meglumine ioxaglate was dose-dependent. Up to a ratio 1:1 viscosity of the linear HA remained above the dilution effect. On the cross-linked HA, the deleterious effect of the contrast agent was evident as soon as a ratio 1:1 and became very marked at 1:2. Conclusion HA viscosity varies widely in presence of other molecules. These changes are due to both dilution and molecular interactions. This study suggests that addition of other molecules with HA can lead to a major decrease of its viscosity. However, provided to respect a maximum ratio of 1:1, the contrast medium and triamcinolone seem to have no major deleterious effect on the viscosity level, especially on crosslinked HA. The study also suggests a deleterious effect of lidocain on the cross-linked HA. These in vitro data suggest that drugs associations must be avoided when they are not essential. However, clinical trials are needed to determine whether these rheological changes may have a significant impact on the clinical outcome.
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Affiliation(s)
- Thierry Conrozier
- Service de rhumatologie, Hôpital Nord Franche-Comté, 14 rue de Mulhouse, 90000 Belfort, France
| | - Jeremy Patarin
- Rhéonova, Domaine Universitaire, 363, rue de la chimie, 38400 Saint Martin d'Hères, France
| | - Pierre Mathieu
- Laboratoire de Rhumatologie Appliquée, 19 place Tolozan, 69001 Lyon, France
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Shanthanna H, Busse JW, Thabane L, Paul J, Couban R, Choudhary H, Kaushal A, Suzumura E, Kim I, Harsha P. Local anesthetic injections with or without steroid for chronic non-cancer pain: a protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2016; 5:18. [PMID: 26831725 PMCID: PMC4736179 DOI: 10.1186/s13643-016-0190-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 01/15/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Steroids are often combined with local anesthetic (LA) and injected to reduce pain associated with various chronic non-cancer pain (CNCP) complaints. The biological rationale behind injection of a steroid solution is unclear, and it is uncertain whether the addition of steroids offers any additional benefits over injection of LA alone. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using steroids and LA vs. LA alone in the treatment of CNCP. METHODS An experienced librarian will perform a comprehensive search of EMBASE, MEDLINE, and the Cochrane Central Registry of Controlled Trials (CENTRAL) databases with search terms for clinical indications, LA, and steroid agents. We will review bibliographies of all relevant published reviews in the last 5 years for additional studies. Eligible trials will be published in English and randomly allocate patients with CNCP to treatment with steroid and LA injection therapy or injection with LA alone. We will use the guidelines published by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to inform the outcomes that we collect and present. Teams of reviewers will independently and in duplicate assess trial eligibility, abstract data, and assess risk of bias among eligible trials. We will prioritize intention to treat analysis and, when possible, pool outcomes across trials using random effects models. We will report our findings as risk differences, weighted mean differences, or standardized mean differences for individual outcomes. Further, to ensure interpretability of our results, we will present risk differences and measures of relative effect for pain reduction based on anchor-based minimally important clinical differences. We will conduct a priori defined subgroup analyses and use the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to evaluate the certainty of the evidence on an outcome-by-outcome basis. DISCUSSION Our review will evaluate both the effectiveness and the adverse events associated with steroid plus LA vs. LA alone for CNCP, evaluate the quality of the evidence using the GRADE approach, and prioritize patient-important outcomes guided by IMMPACT recommendations. Our results will facilitate evidence-based management of patients with chronic non-cancer pain and identify key areas for future research. TRIAL REGISTRATION PROSPERO CRD42015020614.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada.
| | - Jason W Busse
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - Lehana Thabane
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
| | - James Paul
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada.
| | - Rachel Couban
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada. .,The Michael G. DeGroote Institute for Pain Research and Care, Hamilton, Canada.
| | - Harman Choudhary
- Department of Orthopedics, McMaster University, Hamilton, Canada.
| | - Alka Kaushal
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Erica Suzumura
- Research Institute - Hospital do Coração (HCor), São Paulo, Brazil.
| | - Isabel Kim
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Hamilton, Canada.
| | - Prathiba Harsha
- Department of Anesthesia, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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Oelschlaeger C, Bossler F, Willenbacher N. Synthesis, Structural and Micromechanical Properties of 3D Hyaluronic Acid-Based Cryogel Scaffolds. Biomacromolecules 2016; 17:580-9. [DOI: 10.1021/acs.biomac.5b01529] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- C. Oelschlaeger
- Karlsruhe Institute of Technology (KIT), Institute for Mechanical Process Engineering and Mechanics, 76131 Karlsruhe, Germany
| | - F. Bossler
- Karlsruhe Institute of Technology (KIT), Institute for Mechanical Process Engineering and Mechanics, 76131 Karlsruhe, Germany
| | - N. Willenbacher
- Karlsruhe Institute of Technology (KIT), Institute for Mechanical Process Engineering and Mechanics, 76131 Karlsruhe, Germany
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Ahire JJ, Robertson D, Neveling DP, van Reenen AJ, Dicks LMT. Hyaluronic acid-coated poly(d,l-lactide) (PDLLA) nanofibers prepared by electrospinning and coating. RSC Adv 2016. [DOI: 10.1039/c6ra01996j] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Process of preparation of HA/PDLLA nanohybrids.
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Affiliation(s)
- J. J. Ahire
- Department of Microbiology
- University of Stellenbosch
- Stellenbosch
- South Africa
| | - D. Robertson
- Department of Chemistry and Polymer Science
- University of Stellenbosch
- Stellenbosch
- South Africa
| | - D. P. Neveling
- Department of Microbiology
- University of Stellenbosch
- Stellenbosch
- South Africa
| | - A. J. van Reenen
- Department of Chemistry and Polymer Science
- University of Stellenbosch
- Stellenbosch
- South Africa
| | - L. M. T. Dicks
- Department of Microbiology
- University of Stellenbosch
- Stellenbosch
- South Africa
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Yadav P, Yadav H, Shah VG, Shah G, Dhaka G. Biomedical Biopolymers, their Origin and Evolution in Biomedical Sciences: A Systematic Review. J Clin Diagn Res 2015; 9:ZE21-5. [PMID: 26501034 DOI: 10.7860/jcdr/2015/13907.6565] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 07/05/2015] [Indexed: 01/07/2023]
Abstract
Biopolymers provide a plethora of applications in the pharmaceutical and medical applications. A material that can be used for biomedical applications like wound healing, drug delivery and tissue engineering should possess certain properties like biocompatibility, biodegradation to non-toxic products, low antigenicity, high bio-activity, processability to complicated shapes with appropriate porosity, ability to support cell growth and proliferation and appropriate mechanical properties, as well as maintaining mechanical strength. This paper reviews biodegradable biopolymers focusing on their potential in biomedical applications. Biopolymers most commonly used and most abundantly available have been described with focus on the properties relevant to biomedical importance.
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Affiliation(s)
- Preeti Yadav
- Senior Lecturer, Department of Prosthodontics, Crown and Bridge and Implantology, NIMS Dental College , Jaipur, Rajasthan, India
| | - Harsh Yadav
- Private Practioner, Oral & Maxillofacial Surgery, Gurgaon, Haryana, India
| | - Veena Gowri Shah
- Reader, Department of Prosthodontics, Crown and Bridge and Implantology, NIMS Dental College , Jaipur, Rajasthan, India
| | - Gaurav Shah
- Reader, Department of Oral & Maxillofacial Surgery, NIMS Dental College , Jaipur, Rajasthan, India
| | - Gaurav Dhaka
- Private Practitioner, Meerut, Uttar Pradesh, India
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The efficacy of steroid injection in total knee or hip arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:2306-2314. [PMID: 24841939 DOI: 10.1007/s00167-014-3049-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A systematic review and meta-analysis based on randomized controlled trials (RCTs) was conducted to evaluate the efficacy and safety of steroid injection in total knee or hip arthroplasty (TKA/THA). METHODS A systematical electronic search identified the relevant RCTs in the databases of PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials. Two reviewers independently completed data collection and assessment of methodological quality. Meta-analysis was performed for the outcomes of visual analogue pain score, range of motion (ROM), postoperative nausea and vomiting (PONV), morphine consumption, length of stay and complications. RESULTS A total of 863 participants were enrolled. Patients who received steroid injection had a significant reduction in the incidence of PONV and improvement in short-term pain score, and ROM (p < 0.05). Regarding morphine consumption and hospitalization time, the steroid group showed a significant reduction in TKA but no statistically significant difference in THA. In addition, there were no significant differences in complications (n.s.). CONCLUSIONS The current evidence suggests that steroid injection in TKA/THA provides short-term advantages in pain relief and antiemetic effects. The optimal dose and long-term effects of steroid injection still require numerous studies. LEVEL OF EVIDENCE II.
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