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  • Treatment of advanced stage gonarthrosis with prolotherapy: case report

    Abstract

    INTRODUCTION: This case report aims to discuss the clinical and radiological outcomes of prolotherapy at a patient whom to total knee prosthesis had been planned but surgery couldn\'t be performed due to co-morbidities.

    CASE PRESENTATION: A 72 year old woman presented with severe pain at her knees for over 5 years. Treatment methods include weight loss, decreasing the weight bearing on the joint, stretching exercises, nonsteroid anti-inflammatory and steroid drugs, and physiotherapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was applied to measure the osteoarthritis level of the patient: Pain level; 25 points, stiffness level; 10 points, Physical function loss; 80 points, and total WOMAC 115 points. At radiological evaluation, the patient was diagnosed as grade IV osteoarthritis due to significant osteophyte presence and complete joint space narrowing. Six sessions of knee prolotherapy protocol was applied to the patient, one session monthly.

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  • Clinical Applications of Platelet-Rich Plasma in Patellar Tendinopathy

    Abstract

    Platelet-rich plasma (PRP), a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), fibroblastic growth factor (FGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers.

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  • Allogenic Mesenchymal Stem Cells as a Treatment for Equine Degenerative Joint Disease: a Pilot Study

    Abstract

    Cell-based therapies, such as treatments with mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) are thought to have beneficial effects on the clinical outcome of orthopedic injuries, but very few animal studies with large sample size are published so far. Therefore, the aim of this study was to assess the safety and report the clinical outcome of allogenic, immature or chondrogenic induced MSCs in combination with PRP for the treatment of degenerative joint disease (DJD) in 165 horses. MSCs and PRP were isolated from a 6-year-old donor horse and transplanted either in their native state or after chondrogenic induction in combination with PRP into degenerated stifle (n=30), fetlock (n=58), pastern (n=34) and coffin (n=43) joints. Safety was assessed by means of clinical evaluation and the outcome was defined as failure to return to work (score 0), rehabilitation (score 1), return to work (score 2) and return to previous level (score 3), shortly (6 weeks) after treatment or at 18 weeks for the patients that returned for long-term follow-up (n=91). No adverse effects were noticed, except for three patients who showed a moderate flare reaction within one week after treatment of the fetlock joint without long-term effects (1.8% of 165 horses). Already after 6 weeks, 45% (native MSCs) and 60% (chondrogenic induced MSCs) of the treated patients returned to work (ï‚® score 2+3) and the beneficial effects of the treatment further increased after 18 weeks (78% for native MSCs and 86% for chondrogenic induced MSCs). With the odds ratio of 1.47 for short-term and 1.24 for long-term, higher average scores (but statistically not significant) could be noticed using chondrogenic induced MSCs as compared to native MSCs. For all three lower limb joints a higher percentage of the treated patients returned to work after chondrogenic induced MSC treatment, whereas the opposite trend could be noticed for stifle joints. Nevertheless, more protracted follow-up data should confirm the sustainability of these joints.

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  • Synergistic anabolic actions of hyaluronic acid and platelet-rich plasma on cartilage regeneration in osteoarthritis therapy

    Abstract

    Osteoarthritis (OA) is a common disease associated with tissue inflammation, physical disability and imbalanced homeostasis in cartilage. For advanced treatments, biological approaches are currently focused on tissue regeneration and anti-inflammation. This study was undertaken to evaluate the therapeutic efficacies of hyaluronic acid (HA) and platelet-rich plasma (PRP) (HA+PRP) on OA. Articular chondrocytes were obtained from five OA patients. The optimal HA and PRP concentrations were evaluated by MTT assay. The expressions of chondrogenic and inflammatory genes were analyzed by RT-PCR. Signaling pathway was examined by immunoblotting and the expressions of OA pathology-related chemokines and cytokines was demonstrated by real-time PCR-based SuperArray. The therapeutic efficacies of HA+PRP were then demonstrated in 3D arthritic neo-cartilage and ACLT-OA model. Here we showed that HA+PRP could greatly retrieve pro-inflammatory cytokines-reduced articular chondrocytes proliferation and chondrogenic phenotypes, the mechanism of which involve the sequential activation of specific receptors CD44 and TGF-βRII, downstream mediators Smad2/3 and Erk1/2, and the chondrogenic transcription factor SOX9. The real-time PCR-based SuperArray results also indicated that OA pathology-related chemokines and cytokines could be efficiently suppressed by HA+PRP. Moreover, the cartilaginous ECM could be retrieved from inflammation-induced degradation by HA+PRP in both 2D monolayer and 3D neo-cartilage model. Finally, the intra-articular injection of HA+PRP could strongly rescue the meniscus tear and cartilage breakdown and then decrease OA-related immune cells. The combination of HA+PRP can synergistically promote cartilage regeneration and inhibit OA inflammation. This study might offer an advanced and alternative OA treatment based on detailed regenerative mechanisms.

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  • Case-control study on therapeutic effects of ozone and triamcinolone acetonide on the treatment of meniscal injury

    Abstract

    OBJECTIVE: To compare the clinical therapeutic effects between ozone and triamcinolone acetonide for the treatment of mild meniscal injury.

    METHODS: From January 2008 to December 2012, 119 patients with meniscal injury diagnosed as type I or II by MRI were divided into three groups. In the triamcinolone acetonide (A) group, there were 38 males and 2 females, with an average age of (25.34 +/- 6.34) years old, ranging from 18 to 48 years old; 36 patients had single knee injuries, 4 patients had double knee injuries and 44 knees with joint effusion. In the ozone (B) group,there were 37 males and 2 females, with an average age of (26.98 +/- 7.20) years old, ranging from 19 to 50 years old; 33 patients had single knee injuries, 6 patiens had double knees injuries and 40 knees with joint effusion. In the combination of ozone and triamcinolone acetonide (C) group, there were 37 males and 3 females,with an average age of (26.44 +/- 6.38) years old, ranging from 18 to 47 years old; 33 patients had single knee injuries, 7 patients had double knees injuries and 39 knees with joint effusion. The patients were treated with injection of 3 mg triamcinolone acetonide alone, 30 ml (30 microg/ml) ozone alone, or both two drugs respectively in knee joint cavity. All the treatment methods were carried out weekly and 4 times injections were required for a treatment course. Knee joint function was evaluated by Lysholm scale and knee joint effusion was examined by MRI before and after treatment.

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  • Successful Treatment of Athletic Pubalgia in a Lacrosse Player with Ultrasound-Guided Needle Tenotomy and Platelet Rich Plasma Injection: A Case Report

    Abstract

    Athletic pubalgia is a syndrome of persistent groin pain due to chronic, repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet rich plasma (PRP) injection. Following injection, the patient returned to pain-free play at his previous level of intensity. This suggests PRP may be a useful treatment for this diagnosis.

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  • Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial

    Abstract

    PURPOSE: To compare the advantages of prolotherapy in the treatment of first carpometacarpal osteoarthritis (OA) with those of corticosteroid local injection in the short and long term.

    METHODS: We performed a randomized controlled trial from March 2010 to March 2011 in an outpatient clinic at a university hospital. Sixty participants (60 hands) with OA of the first carpometacarpal joint were assigned equally to two groups. For the corticosteroid group, after 2 monthly saline placebo injections, a single dose of 40

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  • Using nitric oxide to treat tendinopathy

    Abstract

    Nitric oxide (NO) is a small free radical generated by a family of enzymes, the nitric oxide synthases (NOSs). Following injury to a tendon, NO is induced by all three isoforms of NOS and NOS activity is also upregulated in tendinopathy. In animal models when NOS activity is inhibited by competitive inhibitors of NOS, tendon healing is reduced. When additional NO is added, tendon healing is enhanced. In humans, in three randomised clinical trials, we have shown that NO delivered via a transdermal patch enhances the subjective and objective recovery of patients with tennis elbow, Achilles tendinosis and supraspinatus tendinosis.

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  • Comparison of Postinjection Protocols After Intratendinous Achilles Platelet-rich Plasma Injections: A Cadaveric Study

    Abstract

    The purpose of the present investigation was to evaluate the distribution of intratendinous injected platelet-rich plasma (PRP) after 15 minutes of prone resting versus immediate manipulation simulating weightbearing. Ten cadaveric lower limbs were injected under ultrasound guidance with PRP dyed with India blue ink. The dyed PRP was injected into the mid-portion of the Achilles tendon, after which 5 specimens were placed in the prone position for 15

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  • Comparison of mesenchymal stem cells from bone marrow and adipose tissue for bone regeneration in a critical size defect of the sheep tibia and the influence of platelet-rich plasma.

    Abstract

    Aim of the present study was to compare the osteogenic potential of bone marrow derived mesenchymal stem cells (BMSC) and adipose-tissue derived stem cells (ASC) and to evaluate the influence of platelet-rich plasma (PRP) on the osteogenic capacity of ASC in a large animal model. Ovine BMSC (BMSC-group) and ASC (ASC-group) were seeded on mineralized collagen sponges and implanted into a critical size defect of the sheep tibia (n=5 each). In an additional group, platelet-rich plasma (PRP) was used in combination with ASC (PRP-group). Unloaded mineralized collagen (EMPTY-group) served as control (n=5 each). Radiographic evaluation was performed every 2 weeks, after 26 weeks histological analysis was performed. Radiographic evaluation revealed a significantly higher amount of newly formed bone in the BMSC-group compared to the ASC-group at week 10 and compared to EMPTY-group from week 12 (all p<0.05). A superiority on radiographic level concerning bone formation of the PRP-group versus the empty control group was found (p<0.05), but not for the ASC-group. Histological analysis confirmed radiographic evaluation finding analogous significances. In conclusion, ASC seem to be inferior to BMSC in terms of their osteogenic potential but that can partially be compensated by the addition of PRP.

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  • Platelet-rich plasma affects bacterial growth in vitro

    Abstract

    Background aims

    Platelet-rich plasma (PRP), a blood derivative rich in platelets, is a relatively new technique used in tissue regeneration and engineering. The increased quantity of platelets makes this formulation of considerable value for their role in tissue healing and microbicidal activity. This activity was investigated against five of the most important strains involved in nosocomial infections (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Streptococcus faecalis) to understand the prophylactic role of pure (P)-PRP. Microbicidal proteins released from activated P-PRP platelets were also determined.

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  • Increased growth factors play a role in wound healing promoted by noninvasive oxygen-ozone therapy in diabetic patients with foot ulcers

    Abstract

    Management of diabetic foot ulcers (DFUs) is a great challenge for clinicians. Although the oxygen-ozone treatment improves the diabetic outcome, there are few clinical trials to verify the efficacy and illuminate the underlying mechanisms of oxygen-ozone treatment on DFUs. In the present study, a total of 50 type 2 diabetic patients complicated with DFUs, Wagner stage 2~4, were randomized into control group treated by standard therapy only and ozone group treated by standard therapy plus oxygen-ozone treatment. The therapeutic effects were graded into 4 levels from grade 0 (no change) to grade 3 (wound healing). The wound sizes were measured at baseline and day 20, respectively. Tissue biopsies were performed at baseline and day 11. The expressions of vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and platelet-derived growth factor (PDGF) proteins in the pathologic specimens were determined by immunohistochemical examinations. The effective rate of ozone group was significantly higher than that of control group (92% versus 64%, P < 0.05). The wound size reduction was significantly more in ozone group than in control group (P < 0.001). After treatment, the expressions of VEGF, TGF-β, and PDGF proteins at day 11 were significantly higher in ozone group than in control group. Ozone therapy promotes the wound healing of DFUs via potential induction of VEGF, TGF-β, and PDGF at early stage of the treatment. (Clinical trial registry number is ChiCTR-TRC-14004415).

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  • Bacteriostatic effect of equine pure platelet-rich plasma and other blood products against methicillin-sensitive Staphylococcus aureus

    Summary

    Objectives: 1) To evaluate the bacteriostatic in vitro effect of pure platelet-rich plasma (P-PRP), pure platelet-rich gel (P-PRG), leukocyte-poor gel (LPG), platelet-poor plasma (PPP), and heat inactivated plasma (IP) against methicillin-sensitive Staphylococcus aureus (MSSA) over a period of 24 hours. 2) To determine the degradation of platelet factor-4 (PF-4), transforming growth factor beta 1 (TGF-β1), and platelet-derived growth factor isoform BB (PDGF-BB) in these equine blood components. 3) To establish correlations between platelet and leukocyte counts, PF-4 concentrations, and MSSA growth. Methods: Fourteen horses were used. Blood components were obtained by a manual protocol. Every blood component was mixed with MSSA and M×¼ller-Hinton Broth and cultured at 37 °C for 24 hours. Samples for the determination of bacterial growth (colony-forming units) and PF-4, TGF-β1 and PDGF-BB concentrations were taken at one, four, eight, 12 and 24 hours. Results: The bacterial growth was significantly (p = 0.01) inhibited for P-PRP, P-PRG, LPG and PPP in comparison with IP and, the positive control group during the first 12 hours. The P-PRG had higher and sustained TGF-β1 and PDGF-BB concentrations over time in comparison with the other blood components. Clinical significance: The plasma complement could be one of the most responsible components of the in vitro bacteriostatic effect of P-PRP, P-PRG, LPG and PPP against MSSA. Additionally, P-PRG was the better biomaterial because it had an acceptable bacteriostatic effect and the highest concentration of growth factors.

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  • Comparison of Platelet-Rich Plasma Formulations for Cartilage Healing

    Platelet-rich plasma (PRP) has been advocated as one treatment for cartilage tissue regeneration. To date, several different platelet-rich formulations have been available, but a deep knowledge of their composition and mechanism of action in a specific clinical use is needed. The aim of this study was to investigate the effect of various PRP formulations on human chondrocytes in vitro.

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  • Three-Dimensional Culture Environment Increases the Efficacy of Platelet Rich Plasma Releasate in Prompting Skin Fibroblast Differentiation and Extracellular Matrix Formation

    Abstract

    Platelet rich plasma clot- releasate (PRCR) shows significant influence on tissue regeneration in clinical trials. Although, the mechanism of PRCR effect on fibroblast differentiation has been studied on 2D culture system, a detailed investigation is needed to establish the role of PRCR in cell seeded in 3D scaffolds. Therefore, a study was conducted to evaluate the influence of PRCR in fibroblasts (DFB) differentiation and extracellular matrix formation on both 3D and 2D culture systems. Cell viability was measured using MTT assay and DFB differentiation was evaluated by determining the expression levels of nucleostamin and alpha smooth muscle actin (α-SMA), using indirect immunostaining and Western blotting. The expression levels of extracellular matrix genes (collagen-I, collagen-III, fibronectin and laminin) and focal adhesion formation gene (integrin beta-1) were measured using Real-time PCR. The PRCR at 10% showed significant effect on cells viability compared with 5% and 20% in both culture environments. The decrease in the expression levels of nucleostamin and the increase in α-SMA signify the DFB differentiation to myofibroblast-like cells that was prominently greater in 3D compared to 2D culture. In 3D culture systems, the total collage production, expression levels of the extracellular matrix gene and the focal adhesion gene were increased significantly compared to 2D culture. In conclusion, 3D culture environments enhances the proliferative and differentiation effects of PRCR on DFB, thereby potentially increases the efficacy of DFB for future tissue engineering clinical application.

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  • Comparison of short-term results of intraarticular platelet-rich plasma (PRP) and hyaluronic acid treatments in early-stage gonarthrosis patients

    Abstract

    The present study aimed to compare short-term clinical outcomes between intraarticular platelet-rich plasma (PRP) and hyaluronic acid (HA) treatments in early-stage gonarthrosis patients. Data of gonarthrosis patients, who were stage 1 or stage 2 according to Kellgren-Lawrence classification and underwent intraarticular PRP or HA treatment, were obtained retrospectively. The patients received treatment for three times at one-week intervals (intraarticular PRP or HA). They were evaluated using the Knee Society\'s Knee Scoring System (KSS) and the visual analog scale (VAS) scoring system before treatment and at the second and sixth months of treatment. The study included 132 patients (mean age, 55.06

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  • Platelet-Rich Plasma Injections for the Treatment of Hamstring Injuries A Randomized Controlled Trial

    Abstract

    Background: A hamstring injury is one of the most common types of injury affecting athletes. Despite this, the optimal management of hamstring muscle injuries is not yet defined. The effect of autologous platelet-rich plasma (PRP) therapy on the recovery of hamstring injuries is unclear.

    Purpose: To investigate the effect of a single PRP injection in the treatment of grade 2 hamstring muscle injuries.

    Study Design: Randomized controlled trial; Level of evidence, 2.

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  • Whey protein could help diabetics

    Consuming whey protein - a popular protein among sportsmen who want to build muscle - before a regular breakfast reduces the blood sugar \"spikes\" common after meals rich in carbohydrates.

    It also is believed by Israeli and other researchers in an Israeli-Swedish study to improve the body\'s insulin response. The research was conducted by Prof. Daniela Jakubowicz and Dr. Julio Wainstein at Wolfson Medical Center in Holon, Prof. Oren Froy of the Hebrew University of Jerusalem, Prof. Bo Ahrשn of Lund University and colleagues.

    It was recently published in Diabetologia, the journal of the European Association for the Study of Diabetes.

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  • Clinical Applications of Platelet-Rich Plasma in Patellar Tendinopathy

    Introduction

    Platelet-rich plasma (PRP) is prepared by centrifuging anticoagulated whole blood obtained by phlebotomy.Therefore,it contains a hyperphysiological concentration of autologous platelets, 3-8 times the concentration of platelets in whole blood [1]. However, the exact definition of PRP has not been determined in terms of the concentration of platelet, and most published reports differ on PRP concentrations [2].

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  • Does Platelet-Rich Plasma Freeze-Thawing Influence Growth Factor Release and Their Effects on Chondrocytes and Synoviocytes?

    Introduction

    The use of platelet concentrates is becoming very popular in the field ofmusculoskeletal tissue regeneration.Awidespread interest has been shown for platelet-rich plasma (PRP) as an injective treatment or as a surgical augmentation procedure of several tissues [7]. These molecules bind to the transmembrane receptors of their target cells regulating cell signaling pathways [1, 7, 8]. Alpha-granules also contain cytokines, chemokines, and many other bioactive proteins that stimulate chemotaxis, cell proliferation, and maturation, modulate inflammatory molecules, and attract leukocytes [8].

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