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Author(s):  
Jordi Puigdellívol Grifell ◽  
Juan Pérez Estévez ◽  
Enrique Herrera Otto ◽  
Jordi Marcos ◽  
Mindaugas Gudelis

Objective: To evaluate the effectiveness and safety of a novel intra-articular formulation of hyaluronic acid (HA) to treat athletes with articular lesions. Methods: Multicenter, prospective, interventional, observational study analyzing the clinical evolution of athletes who received 2 or 3 intra-articular injections of HA. The study was scheduled in Visit 1 (week 0), Visit 2 (week 1), Visit 3 (week 2), Visit 4 (week 3), and Visit 5 (end of follow up, week 24). The change in Visual Analog Scale (VAS) of pain and in Knee Injury and Osteoarthritis Outcome Score (KOOS) and the rate of return to physical activity were evaluated upon treatment initiation for up to 24 weeks. The incidence of adverse events was recorded throughout the study. Results: Sixty patients were recruited: 28 (46.7%) in the 2-injection group and 32 (53.3%) in the 3-injection group. Mean VAS gradually decreased across the visits, with statistically significant reductions in both groups from Visit 2 to Visit 3 and to Visit 5 (P < 0.0001). Inter-group differences in the change in VAS from Visit 2 to Visit 5 were statistically comparable (P = 0.8271). At Visit 5, the KOOS of all subscales statistically improved in both treatment groups. At the end of follow-up (Visit 5), 75.9% of patients returned to sport in the overall population. Only one patient reported an adverse event. Conclusion: This novel formulation of HA is effective and safe for at least 24 weeks, resulting in a promising treatment option for athletes with articular lesions.


2021 ◽  
pp. 112070002110603
Author(s):  
Catriona Heaver ◽  
Megan Pinches ◽  
Jan Herman Kuiper ◽  
Geraint Thomas ◽  
Simon Lewthwaite ◽  
...  

Background: Greater trochanteric pain syndrome (GTPS) is a common problem with an incidence of 1.8–5.6 per 1000 population. Physiotherapy, anti-inflammatories, corticosteroid injections and surgery have all been described in the management of GTPS, with limited, temporal success. Extracorporeal shockwave therapy (ESWT) has been proposed as a potential non-invasive management option for this difficult presentation. Method: We ran a prospective, 2-arm, single-blinded, randomised control trial comparing focused shockwave therapy (f-ESWT) to an ultrasound guided corticosteroid injection. Primary outcome measure was the visual analogue pain score. Secondary outcome measures included the Harris Hip Score (HHS) and Trendelenburg test for function; SF-36 for quality of life (QoL); and a Likert scale question for subjective assessment of symptom improvement. Results: 104 patients (10 males and 94 females), of mean age 61.5 years were recruited. 53 were randomised to receive ESWT and 51 to receive an image-guided injection. 11 patients were lost to follow-up. There were no significant differences in baseline scores between groups. At 3 months, pain, function and QoL scores had improved in both groups but were not statistically significant. The Trendelenburg test was significantly improved in the f-ESWT group with 80% patients being negative compared to 20% at baseline ( p < 0.001). At 12 months, across all outcomes, the ESWT group had significantly improved scores compared to the injection group; VAS 37.1 versus 55.0 ( p = 0.007, 95% confidence interval [CI], 6.3–30.8), HHS 69.7 versus 57.5 ( p = 0.002, 95% CI, −20.0 to −4.6) and SF-36 52.4 versus 47.7 ( p = 0.048, 95% CI, −9.31 to −0.04). The improvement in Trendelenburg test was maintained in the ESWT group, but the injection group had reverted to baseline ( p < 0.001). Conclusions: We have shown f-ESWT is an effective treatment for patients with GTPS. We would advocate f-ESWT as an effective non-invasive treatment modality for this challenging patient population. Trial Registration No. ISRCTN8338223


2021 ◽  
Author(s):  
Xiong Chen ◽  
Lizhi ZHOU ◽  
Jingping Mu ◽  
Junti LU ◽  
Jin XIE ◽  
...  

Abstract ImportanceFibromyalgia (FM) is a common clinical chronic disease, mainly manifested as generalized chronic muscle pain and discomfort throughout the body, often accompanied by various emotional disorders such as depression, anxiety, cognitive impairment and sleep disorder, which seriously affects the quality of life of patients. However, there has not been adequately good treatment methods in clinically, so it is urgent to seek a better treatment method. In this study, duloxetine combined with ozone pain point injection was used to treat FM patients, and the clinical efficacy of the patients was observed.ObjectiveTo determine whether duloxetine combined with ozone pain point injection is safe and efficacious in the treatment of Fibromyalgia.MethodsAccording to the final treatment plan selection, the patients diagnosed with FM in the Pain Department of Shiyan Taihe Hospital, were selected from July 2017 to July 2020. After communication and written consent, 66 patients were injected with drugs and ozone pain point. Actually 60 cases finished the study procedure and follow-up. The age ranged from 22 to 57 years, and the course of the disease ranged from 2 to 8 years. In this study, a crossover design was adopted, and random number table method was used to enter the group. The patients were randomly divided into duloxetine group (group D), ozone injection group (group O) and duloxetine-ozone injection group (group D+O), with 20 patients in each group. Each group was given corresponding treatment. VAS, FIQ, PSQI and HAMD scales were used to evaluate and calculate the number of pain points, so as to observe and evaluate the clinical efficacy of patients.ResultsIn terms of pain, there was no significant difference among the groups before treatment. After 2 weeks and 4 weeks of treatment, the VAS scores in each group were significantly lower than before intervention (F=324.365 P < 0.05). The number of pain points in each group was significantly lower than before intervention, and the difference was statistically significant (F=514.046 P &lt; 0.05). It was observed that the analgesic effect of duloxetine combined with ozone pain point injection in the treatment of fibromyalgia was better than that of single therapy. There was no significant difference in quality of life among the groups before treatment. After 2 weeks and 4 weeks of treatment, the FIQ of each group was significantly lower than that before intervention, and the difference was statistically significant (F = 324.365, P<0.05). It was observed that duloxetine combined with ozone pain point injection for fibromyalgia significantly improved the quality of life of patients, especially in terms of improving sleep, compared with treatment alone. At the end of 4 weeks of treatment, HAMD scores for depressive symptoms were significantly lower in all 3 groups than before intervention (F=1079.961, P<0.05), and loxetine combined with ozone pain point injection for fibromyalgia had a more significant antidepressant effect (F=5.089, P <0.05).ConclusionThis study confirmed that duloxetine combined with ozone pain-point injection can effectively relieve pain in patients with FM, significantly improve the accompanying symptoms of sleep disorder and depression, and improve the quality of life of patients, which is worthy of clinical promotion.


Author(s):  
Dongzhi Chen ◽  
Zhao Li ◽  
Rui Liang ◽  
Huifang Liu ◽  
Yuanyuan Wang ◽  
...  

  The rates of invariant natural killer T (iNKT) cells in vivo are very low, and the amounts of cells obtained directly from the body are hard enough to fulfill their potential in clinical application. To overcome this problem, we subcutaneously injected alpha-galactosylceramide (α-GalCer) into DBA/1 mice and thymic single cells were isolated and cultured in vitro. Fluorescence-activated cell sorting was used to detect the iNKT cells and their subsets in the thymus after the injection of α-GalCer by different methods. In addition, in vitro changes of single-cell suspensions and their cytokines in culture supernatants were assessed. Compared with the α-GalCer multiple subcutaneous injection group, the rates of iNKT cells in the α-GalCer single subcutaneous injection group were markedly higher at each time point, while the highest levels of iNKT1 and iNKT2 cells were observed on day 4 and 8, respectively. In α-GalCer single subcutaneous injection for 8 days and thymic mononuclear cell cultured for 14 days group, the expansion rate of iNKT cells was significantly faster than the other groups, while it reached a peak for iNKT1 cells. Interferon-gamma was consistent with the development of iNKT1 cells, however no difference was found between the cultured iNKT cells in vitro and the natural iNKT cells in vivo in terms of cytokine production. Herein, we introduced a method in which antigenic stimulation in vivo and directed induction in vitro yielded high levels of iNKT cells with specific functions.


Eye ◽  
2021 ◽  
Author(s):  
Tae-Hoon Lee ◽  
Jung-Gwon Nam ◽  
Chang Kyu Lee

Abstract Purpose To examine the effects of intrapolyp triamcinolone acetonide (TA) injections on intraocular pressure (IOP) and recurrence of nasal polyps after endoscopic sinus surgery. Patients and methods This was a prospective, randomized, double-blind, placebo-controlled study. Patients were randomized into either the TA injection group (Group I, 20 mg/ml, 2 mL) or the placebo normal saline injection group (group II, 2 mL). There were a total of five study visits: one baseline visit and one at 2, 4, 8, and 12 w after the injection. The primary safe outcome was the change in IOP between two groups at 4 w. The secondary safe outcome was the IOP at each visit and proportion of patients having IOP above 21 mmHg at 4 and 8 w. Changes in the nasal polyp size were measured between two groups at each visit. Results A total of 43 consenting participants completed this study (22 in group I and 21 in group II). The mean IOP elevation in both eyes was not significantly different between the groups (p > 0.05) and was not over 2 mmHg at the 4-w mark. There was also no significant difference in the proportion of patients having IOP above 21 mmHg at 4 and 8 w between the groups (p > 0.05). However, there was a significant difference in the change in polyp size until 8 w between both groups (p < 0.01). Conclusions Intrapolyp TA injection is a safe and effective method for the management of recurrent polyps after endoscopic sinus surgery.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiaodan Lv ◽  
Chunyi Guan ◽  
Ying Li ◽  
Xing Su ◽  
Lu Zhang ◽  
...  

Abstract Background Currently, there is no effective treatment for premature ovarian failure (POF), and stem cell therapy is considered the most promising treatment. Human umbilical cord blood mesenchymal stem cells (hUC-MSCs) have shown good regenerative ability in various diseases, including POF; however, their underlying mechanism and dosage for POF treatment remain unclear. This study aimed to compare the effect of single and multiple injections of hUC-MSCs on ovarian function repair in chemotherapy-induced POF. Methods Female mice were intraperitoneally injected with 30 mg/kg busulfan and 120 mg/kg cyclophosphamide (CTX) to induce POF. In the single hUC-MSC injection group, hUC-MSCs were transplanted into mice D7 after CTX and busulfan administration, while in the multiple injection group, hUC-MSCs were transplanted on D7, D14, and D21 after CTX and busulfan administration. We evaluated the ovarian morphology, fertility, follicle-stimulating hormone and estradiol concentrations, follicle count, POF model, and cell transplantation results. In addition, real-time polymerase chain reaction, immunohistochemistry, and miRNA and mRNA chips were used to evaluate the effect of the cell therapy. Results Ovary size, number of follicle at all developmental stages, and fertility were significantly reduced in the POF group compared with the control. Under hUC-MSC treatment, the ovarian morphology and follicle count were significantly restored, and fertility was significantly increased. By comparing the single and multiple hUC-MSC injection groups, we found that the anti-Müllerian hormone and Ki-67 levels were significantly increased in the multiple hUC-MSC group on D60 after chemotherapy. The expression of stimulating hormone receptors, inhibin α, and inhibin β was significantly restored, and the therapeutic effect was superior to that of the single hUC-MSC injection group. Conclusion These results indicate that hUC-MSCs can restore the structure of injured ovarian tissue and its function in chemotherapy-induced POF mice and ameliorate fertility. Multiple hUC-MSC transplantations have a better effect on the recovery of ovarian function than single hUC-MSC transplantation in POF.


2021 ◽  
pp. 159101992110399
Author(s):  
Federico Bruno ◽  
Nicola Carboni ◽  
Pierpaolo Palumbo ◽  
Francesco Arrigoni ◽  
Marco Varrassi ◽  
...  

Purpose To retrospectively evaluate the clinical and instrumental outcome of different treatment sessions of oxygen–ozone (O2–O3) chemodiscolysis in patients with lumbar disc herniation Methods We evaluated 73 patients partially responders to a single session of oxygen–ozone (O2–O3) chemodiscolysis and submitted to multiple injections sessions. All patients completed a pre- and post-treatment clinical (VAS and modified McNab score) and instrumental MRI follow-up. Imaging evaluation included assessment of intervertebral disc area (IDA). Pre- and post-treatment differences were compared to evaluate differences in variation between groups. Correlation analysis was used to evaluate the relationship between morphological and clinical parameters. Results Based on the type and number of treatments performed, patients were divided into three groups: Group A) patients submitted to an additional periradicular anaesthetic/steroid injection; Group B) patients submitted to an additional session of intradiscal O2–O3 injection; Group C) patients submitted to two further sessions of intradiscal O2–O3 injection. The results showed an improvement of pain scores in all groups, and a smaller disc area change in group B. Comparing the differences between pre- and post-treatment features among the three different groups of patients, we did not find any statistically significant difference. Correlation analysis did not show any statistically significant correlation between the morphological changes of the intervertebral disc and the clinical output scores. Conclusions In our retrospective observation of partially responder patients, multiple intradiscal ozone injections were not associated with a higher disc shrinkage nor superior clinical outcome compared to a single intradiscal O2–O3 application with an additional periradicular injection session.


2021 ◽  
Vol 8 ◽  
Author(s):  
Fei Nie ◽  
Wei Li

Objective: The current review was designed to assess the impact of prior intra-articular injections on the risk of prosthetic joint infection (PJI) in patients undergoing total joint arthroplasty (TJA) with a focus on the timing of injection before surgery.Methods: The databases of PubMed, Embase and Google Scholar were searched up to 15th June 2021. All studies comparing the incidence of PJI with and without prior intra-articular injections were included. Risk ratios (RR) with 95% confidence intervals were calculated for PJI.Results: Nineteen studies were included. Both corticosteroids and hyaluronic acid injections were used before TJA in the included studies. Overall, comparing 127,163 patients with prior intra-articular injections and 394,104 patients without any injections, we noted a statistically significant increased risk of PJI in the injection group (RR 1.24 95% CI: 1.11, 1.38 I2 = 48% p = 0.002). On subgroup analysis, there was a statistically significant increased risk of PJI in the injection group in studies where intra-articular injections were administered &lt;12 months before surgery (RR 1.18 95% CI: 1.10, 1.27 I2 = 7% p &lt; 0.00001). Furthermore, on meta-analysis, we noted non-significant but increased risk of PJI when injections were administered 1 month (RR 1.47 95% CI: 0.88, 2.46 I2 = 77% p = 0.14), 0–3 months (RR 1.22 95% CI: 0.96, 1.56 I2 = 84% p = 0.11), and 3–6 months (RR 1.16 95% CI: 0.99, 1.35 I2 = 49% p = 0.06) before surgery.Conclusion: Our results indicate that patients with prior intra-articular injections have a small but statistically significant increased risk of PJI after TJA. Considering that PJI is a catastrophic complication with huge financial burden, morbidity and mortality; the clinical significance of this small risk cannot be dismissed. The question of the timing of injections and the risk of PJI still remains and can have a significant impact on the decision making.Systematic Review Registration: PROSPERO: CRD42021258297.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Xin Jin ◽  
Lei Fan ◽  
Yongling Yao

This study was to explore the value of magnetic resonance imaging (MRI) technology processed by convolutional neural network (CNN) optimization algorithms in the clinical research of patients with chronic pain caused by myofascial trigger points (MTrPs). Firstly, referring to the traditional iterative algorithm, this study iterated the convolution network and data consistency layer as a whole for several times, which increased the fitting ability of the data consistency layer and network. When it was applied to magnetic resonance examination, it could be concluded that the effect of its reconstruction method was better than the traditional convolution neural network without the data consistency layer. The image edge was clear, and the restoration effect of details was better. 100 patients with chronic neck pain caused by MTrP were collected and divided into an ultrasound treatment group and a local anesthetic drug injection group, with 50 cases in each group. In addition, 50 healthy volunteers were selected. After clinical treatment, the results showed that, after 3 weeks of treatment, the visual analog score (VAS) and the pain rating index (PRI) of the injection group were 3.16 ± 1.14 points and 4.92 ± 1.26 points, respectively; the present pain intensity (PPI) score was 2.06 ± 0.85 points, and the number of pain days per month was 7.73 ± 1.15. After 1 month of treatment, the VSA and PRI of the injection group were 1.24 ± 0.89 and 1.31 ± 0.97, respectively; the PPI score was 1.34 ± 0.65, and the number of pain days per month was 5.34 ± 0.98. In addition, there were 38 cases reaching the level of clinical cure, accounting for 76%. Therefore, all indicators in the injection group were better than those in the ultrasound treatment group, and the differences were statistically significant ( P < 0.05 ). The results of MRI examination showed that compared with the healthy control group, patients with chronic pain caused by the myofascial trigger point had reduced axial kurtosis (AK), mean kurtosis (MK), and radial kurtosis (RK) in multiple brain areas such as the right parahippocampal gyrus and the right medial prefrontal cortex. In short, chronic pain caused by the trigger point of the myofascial membrane would affect the microstructure of the gray matter of the patient’s brain. In clinical treatment, the efficacy of local anesthetic injection was better than ultrasound therapy.


2021 ◽  
Vol 24 (3) ◽  
pp. 147-155
Author(s):  
Jeung Yeol Jeong ◽  
Eun Kyung Khil ◽  
Tae Soung Kim ◽  
Young Woo Kim

Background: This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections for treatment of full-thickness rotator cuff tear (RCT).Methods: Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 were enrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HA injection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery using the American Shoulder and Elbow Surgeons score, visual analog scale pain, functional scores (pain visual analog scale, function visual analog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity.Results: Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05). However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than in group I (0%) (p=0.021).Conclusions: Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuff repair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thickness RCT.


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