Amniotic Tissue Modulation of Knee Pain—A Focus on Osteoarthritis

2018 ◽  
Vol 32 (01) ◽  
pp. 026-036 ◽  
Author(s):  
Charles Hannon ◽  
Adam Yanke ◽  
Jack Farr
Keyword(s):  
Clinical Trials ◽  
Hyaluronic Acid ◽  
Growth Factors ◽  
Stromal Cells ◽  
Level Of Evidence ◽  
Vasoactive Peptides ◽  
Biologic Effects ◽  
Anti Inflammatory ◽  
High Level ◽  
Tissue Product

AbstractThe use of intra-articular therapies as sources of growth factors, anti-inflammatory mediators, and medicinal signaling cells for osteoarthritis (OA) is rapidly evolving. Amnion, chorion, amniotic fluid, and the umbilical cord are distinct placental tissues that have been investigated for use in OA. Amniotic membrane (AM) synthesizes a variety of growth factors, cytokines, and vasoactive peptides that modulate inflammation. In addition, they contain amniotic epithelial cells and amniotic mononuclear undifferentiated stromal cells, which have chondrogenic and osteogenic differentiation capacity. AMs are also rich sources of hyaluronic acid and proteoglycans, which could play a role in the potential therapeutic relief of OA. Currently, there are several commercially available formulations of AM that differ based on content as well as how they were preserved. Understanding the processing of amniotic tissue is important because of their distinct mechanical and biologic effects of preservation on AM grafts. To date, there have been two preclinical and only one clinical study on the use of AM for OA, which show promising results. Many high level of evidence clinical trials are currently underway investigating the use of AM of OA. Future basic science and clinical research is warranted to better understand the anti-inflammatory and chondroregenerative properties of amniotic tissue and to determine clinically what amniotic tissue product is most efficacious for symptomatic OA.

scholarly journals Alternate nostril breathing: a systematic review of clinical trials

2017 ◽  
Vol 5 (8) ◽  
pp. 3273 ◽  
Author(s):  
Shreya Ghiya
Keyword(s):  
Clinical Trials ◽  
Cognitive Functioning ◽  
Scientific Evidence ◽  
Systemic Review ◽  
Memory Retention ◽  
Level Of Evidence ◽  
Safety Issues ◽  
Autonomic Nervous ◽  
High Level ◽  
Clinical Populations

Anulom-vilom Pranayama/ alternate nostril breathing (ANB)/Nadi-suddhi pranayama is one of the common yogic breathing techniques and involves breathing through one nostril at a time while closing the other nostril manually. This study aimed to summarize effects of independent ANB on various physiological parameters, to evaluate safety issues in clinical populations and collect published primary scientific evidence on the benefits of ANB. PubMed/Medline, Cinahl, Web of Science and Google Scholar were searched using the following terms: Alternate nostril breathing, Anulom-vilom/ anuloma-viloma pranayama, Nadi-shodhan/Nadi-shodhana pranayama. Forty-four randomized controlled trials were included in this review paper. These studies evaluated the effects of alternate nostril breathing on parameters of the autonomic nervous system, cardiopulmonary system, cognitive functioning, problem solving and motor memory retention. Of the studies, ten showed a high level of bias; twenty-nine showed a low level of bias and five showed an unknown level of bias as per Cochrane systemic review guidelines. Most of the studies included healthy subjects and age range was eight to seventy years. Alternate nostril breathing has few variations and standardization of the technique is yet to be established. This technique provides high level evidence for positive outcomes for the autonomic nervous and cardiopulmonary systems. There is also high level of evidence regarding improvement in cognitive functioning with regular practice of alternate nostril breathing. More clinical trials are required to evaluate the effects of alternate nostril breathing in clinical populations and to synthesize effective frequency and duration parameters.

Differential characteristics and management of pseudoseptic arthritis following hyaluronic acid injection is a rare complication: a systematic review

2020 ◽  
pp. jisakos-2020-000438
Author(s):  
Phelopater Sedrak ◽  
Philip Hache ◽  
Nolan S Horner ◽  
Olufemi R Ayeni ◽  
Anthony Adili ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Septic Arthritis ◽  
Rare Complication ◽  
Diagnosis And Treatment ◽  
Level Of Evidence ◽  
Reactive Protein ◽  
Pertinent Data ◽  
Anti Inflammatory ◽  
Pseudoseptic Arthritis

ImportanceAcute pseudoseptic arthritis is a rare complication of hyaluronic acid (HA) injections that is not well documented in the literature. Practitioners initially suspect the symptoms of this complication to represent septic arthritis, cautiously prescribing antibiotics. This review identifies that time to presentation of symptoms postinjection, negative cell cultures and lack of crystallisation could be used as differentials to suspect pseudoseptic arthritis and to prescribe anti-inflammatory drugs while closely monitoring change of symptoms.ObjectiveThe purpose of this study was to describe the presentation, diagnosis and treatment of pseudoseptic arthritis.Evidence reviewA systematic review of the literature was conducted for studies reporting the use of HA injections for osteoarthritis resulting in pseudoseptic arthritis using the electronic databases MEDLINE, Embase and PubMed. Pertinent data were abstracted from the search yield. A unique case of a pseudoseptic reaction is also presented.FindingsA total of 11 studies (28 cases), all of level IV and V evidence were included in this review. Reported cases of pseudoseptic arthritis in the literature present with severe joint pain (100%), effusion (100%), inability to weight-bear, functional impairment, and occasionally fever (22.2%). C reactive protein and erythrocyte sedimentation rate are generally elevated (71.4% and 85.7%, respectively), and leucocytosis above 10 000 was less common (50%). All reported cases in the literature identified aseptic growth on arthrocentesis, despite four cases (15.4%) reporting synovial leucocyte counts above 50 000. The presented case is the highest reported leucocyte count at 1 74 960 cells/mm3.Conclusions and relevanceAcute pseudoseptic arthritis is rare, but a number of cases have been reported in the literature. A high degree of suspicion for pseudoseptic arthritis may be maintained in patients who present under 72 hours following HA injection. Initial antibiotic treatment, along with anti-inflammatory medications until cultures are confirmed to be negative at 5 days, is a cautious approach. However, the strength of this conclusion is limited by the few reported cases. Ultimately, this review is intended to inform practitioners of the symptoms, diagnosis and treatment of this complication, such that it could be safely differentiated from septic arthritis.Level of evidenceIV.

scholarly journals Hyaluronic Acid Fillers Enriched with Glycine and Proline in Eyebrow Augmentation Procedure

2021 ◽  
Author(s):  
Antonio Scarano ◽  
Biagio Rapone ◽  
Domenico Amuso ◽  
Francesco Inchingolo ◽  
Felice Lorusso
Keyword(s):  
Hyaluronic Acid ◽  
Full Description ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Aesthetic Result ◽  
Study Results ◽  
High Level ◽  
Based Medicine ◽  
Augmentation Procedure

Abstract Background The eyebrow area is a clinically critical district due to the anatomical complexity and the propensity to aging-related atrophy. Hyaluronic acid fillers have been proposed to recover the dermal volume of the facial and lips regions. Aim The aim of the present investigation was to evaluate hyaluronic acid fillers enriched with glycine and proline for the treatment of eyebrow augmentation. Methods A total of 15 healthy patients were treated with eyebrow augmentation procedure. The distance between mid-bipupil to lateral eyebrow and mid-eyebrow to the medial eyebrow was measured before, immediately after treatment and at follow-up of 6 months. Results The healing period was uneventful, and no evidence of inflammation or swelling associated with the treatment was reported. No macroscopical alteration was reported in the surrounding tissues with no evidences of visible wheals or lumps in the treated sites at the follow-up. Before treatment, the angle was equal to 9.32 ± 0.2°, while after treatment it was 11.21 ± 0.4° (p < 0.01); after three and 6 weeks, it was, respectively, 10.66 ± 0.2° (p<0.05) and 10.02 ± 0.3°(p > 0.05). Conclusions The study results suggest that the hyaluronic acid fillers enriched with glycine and proline treatment resulted as being a useful procedure for augmentation, contour and volume definition and elevation of the eyebrow region with a high-level aesthetic result. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

scholarly journals Experimental justification for clinical application of bone growth stimulators in traumatology and orthopaedics (a review)

2021 ◽  
pp. 5-17
Author(s):  
V.A. Konev ◽  
◽  
D.V. Labutin ◽  
S.A. Bozhkova ◽  
◽  
...  
Keyword(s):  
Clinical Trials ◽  
Growth Factors ◽  
Growth Factor ◽  
Bone Regeneration ◽  
Clinical Application ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Bone Growth ◽  
Growth Stimulation ◽  
Cell Technology

Analysis of scientifi c publications devoted to effi cacy assessment and experimental justifi cation of cell technology and growth factors application for osteogenesis stimulation in clinical practice of traumatologists-orthopaedists.The search was performed for papers published in PubMed and E-library digital databases within the period of 2010-2020. The search filter was set to explore randomised clinical trials. Th e key words were: “platelet growth factor OR vascular endothelial growth factor OR bone morphogenetic proteins OR autologous bone marrow stromal cells AND bone defect AND human”. Works dated 2010-2020 were selected for analysis of experimental studies using the following key word combinations: “mesenchymal stromal cells AND osteogenesis OR bone regeneration”, “growth factors AND mesenchymal stromal cells AND osteogenesis OR bone regeneration”. In addition, essential literatures describing properties of multipotent mesenchymal stromal cells (MSCs) were cited as well as issues in their osteogenic diff erentiation. Despite the great number of experimental works related to cell technology application for bone growth stimulation, a large variety of unresolved issues associated with optimal means to create such cells, their cultivation and combined application with morphogenetic proteins and growth factors remains. Clinical application of rhBMP-2, PDGF has demonstrated effi cacy in complex treatment of patients with bone defects. Th erewith, growth factors may be effi caciously used in diff erent combinations with MSCs. In a number of cases, application of implants enriched with growth factors may become an alternative for autogenic grafts. To the present day, there is crucial defi cit in the number of works presenting results of randomised controlled clinical trials devoted to stimulation of bone tissue repair. The controversial results of the publications analysed may be based on a low number of patients enrolled. With consideration for active development of reparative medicine as a whole, further investigation of possibilities in bone growth stimulation with local application of cell-engineering constructions is considered to be a promising trend for traumatology and orthopaedics.

scholarly journals Use of consensus term and definition for delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage

2019 ◽  
Author(s):  
Matthew J Rowland ◽  
Kyle T.S. Pattinson ◽  
Mervyn D.I. Vergouwen ◽  
Peter J Watkinson
Keyword(s):  
Clinical Trials ◽  
Cerebral Ischemia ◽  
Subarachnoid Haemorrhage ◽  
Cohort Studies ◽  
Cerebral Ischaemia ◽  
Delayed Cerebral Ischemia ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Level Of Evidence ◽  
Delayed Cerebral Ischaemia ◽  
High Level

AbstractBackground and purposeIn 2010, a multidisciplinary research group proposed a consensus term and definition for the complication of delayed cerebral ischaemia (DCI) following aneurysmal subarachnoid haemorrhage (SAH). We assessed the use of this term and its definition as an endpoint in observational studies and clinical trials.MethodsFirstly, we performed a MEDLINE abstract search from Jan 2008 to Dec 2017 for observational cohort studies and clinical trials to investigate the used terminology over the years. Next, we studied trends in citations of the original paper citing the consensus definitions since publication in 2010.ResultsThe number of publications citing the 2010 consensus definitions has steadily increased from 18 in 2011 to 54 in 2017. Between 2010 and 2017, 527 papers were published with delayed cerebral ischemia, or another term to describe the same complication, as an endpoint. However, the term delayed cerebral ischemia was used only in 131/527 (25%) of papers and only 14/81 (17%) of clinical trials/cohort studies published in 2017 cited the consensus definitions when outlining study endpoints.ConclusionsDespite publication of consensus terminology and definitions for DCI in 2010, the majority of cohort studies and clinical trials in patients with SAH are not using these. Researchers and editors should be reminded of the importance of using these consensus terminology and definitions in future studies, which will promote the comparability of results between studies, understand the true impact of an intervention, aggregate results in meta-analyses, and construct guidelines with a high level of evidence.

scholarly journals Two different regenerative injections in patients diagnosed with secondary hip osteoarthritis: A report of two cases

2021 ◽  
Vol 38 (2) ◽  
pp. 204-207
Author(s):  
Ferhat SAY ◽  
İsmail BÜYÜKCERAN ◽  
Sina COŞKUN
Keyword(s):  
Growth Factors ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Hip Osteoarthritis ◽  
Developmental Dysplasia ◽  
Effective Treatment Option ◽  
Autologous Conditioned Serum ◽  
Functional Scores ◽  
Anti Inflammatory ◽  
High Level

Non-surgical treatment options are limited in hip osteoarthritis secondary to developmental dysplasia of the hip (DDH). Treatment of Autologous Conditioned Serum (ACS) is based on the high level of anti-inflammatory cytokine production of leukocytes in peripheral blood. It is an effective treatment option which contains the cytokines and the growth factors. Platelet Rich Plasma (PRP) is a form of treatment that stimulates natural healing steps through growth factors in platelets. In this case report we aimed to present the results of ACS and PRP injection in two patients who developed secondary coxarthrosis after DDH surgery. At the 1-year follow-up examination, patient’s functional scores improved and requirement for non-steroid anti-inflammatory drugs had significantly reduced. Regenerative injections either autologous conditioned serum or platelet rich plasma treatments are safe and effective treatments and can be recommended particularly for cases of secondary hip osteoarthritis associated with DDH.

A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Incidence ◽  
Hip Surgery ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Postoperative Thrombosis ◽  
High Level ◽  
Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

Bridging the Knowledge Gaps in Arrhythmogenic Cardiovascular Conditions: The Critical Role of Registries

2016 ◽  
Vol 10 (2) ◽  
pp. 1 ◽  
Author(s):  
Melody Hermel ◽  
Rebecca Duffy ◽  
Alexander Orfanos ◽  
Isabelle Hack ◽  
Shayna McEnteggart ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Natural History ◽  
Risk Stratification ◽  
Critical Role ◽  
Knowledge Gaps ◽  
Level Of Evidence ◽  
The Future

Cardiac registries have filled many gaps in knowledge related to arrhythmogenic cardiovascular conditions. Despite the less robust level of evidence available in registries when compared with clinical trials, registries have contributed a range of clinically useful information. In this review, the authors discuss the role that registries have played – related to diagnosis, natural history, risk stratification, treatment, and genetics of arrhythmogenic cardiovascular conditions – in closing knowledge gaps, and their role in the future.

The Efficacy of Anti-inflammatory Agents in the Prevention of Atrial Fibrillation Recurrences

2020 ◽  
Vol 28 (1) ◽  
pp. 137-151
Author(s):  
Homa Nomani ◽  
Sara Saei ◽  
Thomas P. Johnston ◽  
Amirhossein Sahebkar ◽  
Amir Hooshang Mohammadpour
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Therapeutic Option ◽  
General Rule ◽  
Promising Candidate ◽  
Term Basis ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Meta Analyses ◽  
Af Recurrence

: Several studies have indicated an association between inflammation and the recurrence of Atrial Fibrillation (AF), especially after ablation, which is a therapeutic option leading to local inflammation. On the other hand, each AF can lead to another AF, as a general rule. Thus, preventing recurrences of AF is extremely important for patient outcomes. In this paper, we attempted to review the effect of medicinal agents with anti-inflammatory properties on the prevention of AF recurrence. There are several randomized controlled trials (RCTs) and meta-analyses on the prevention of AF recurrence using agents with anti-inflammatory properties, which include steroids, colchicine, statins, and n-3 fatty acids (n-3 FA). Clinical trials evaluating the efficacy of anti-inflammatory drugs in preventing the recurrence of AF led to inconsistent results for corticosteroids, statins and n-3 FAs. These results may be related to the fact that inflammation is not the only factor responsible for triggering recurrences of AF. For example, the presence of structural, mechanical and electrical remodeling could potentially be the most important factors that trigger recurrences of AF but these factors have not been addressed in most of the reported studies. Therefore, future clinical trials are needed to compare the efficacy of anti-inflammatory drugs in AF patients with, or without other factors. For colchicine, a potent anti-inflammatory drug, there are limited studies. However, all the studies investigating colchicine in the context of AF were consistent and promising, especially when colchicine was used on a short-term basis following ablation in patients with paroxysmal AF. Therefore, colchicine could be a promising candidate for further clinical studies involving recurrent AF.

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