General

  • Doctors Shun Insurance, Offering Care for Cash

    LAREDO, Tex. — For 12 hours a day, the waiting room at Dr. Gustavo Villarreal\'s family practice is packed with patients who pay a flat $50 fee for the convenience — or necessity — of a walk-in, quick-turn doctor\'s visit.

    Efforts at both the state and federal level are underway to decrease Texas\' sky-high rate of residents without health coverage. But in a city where nearly a third of the population lives below the poverty line, Dr. Villarreal does not accept health insurance. Instead, he has switched to a cash-based model, eschewing the laborious practice of filing out insurance forms in order to get paid.

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  • Platelet-rich Plasma: Applications in Sports Medicine

    Abstract

    The use of platelet-rich plasma (PRP) in sports medicine is a recently developed technique in which concentrated autologous blood is used to increase the healing rate of various tissues. PRP has been most extensively used in the treatment of different musculoskeletal disorders, particularly in athletic injuries. Owing to its apparent safety and ease of preparation and administration, there has been an increased interest in the efficacy of PRP in a large number of different clinical settings. PRP has been used to treat conditions such as lateral epicondylitis, ligamentous strains, muscular strains, and fracture nonunion in athletes. PRP can be injected to the site of the pathology, either during surgery or in the physician\'s office. The benefits of PRP in the clinical field appear to be promising, and many investigators are still exploring new ways to use this therapy effectively. However, the clinical evidence for the benefits of PRP in the field of sports medicine is unclear. The purpose of this article was to review the current evidence on PRP therapy in this field.

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  • Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial

    Abstract

    Purpose

    To compare the effectiveness of intraarticular (IA) multiple and single platelet-rich plasma (PRP) injections as well as hyaluronic acid (HA) injections in different stages of osteoarthritis (OA) of the knee.

    Methods

    A total of 162 patients with different stages of knee OA were randomly divided into four groups receiving 3 IA doses of PRP, one dose of PRP, one dose of HA or a saline injection (control). Then, each group was subdivided into two groups: early OA (Kellgren-Lawrence grade 0 with cartilage degeneration or grade I-III) and advanced OA (Kellgren-Lawrence grade IV). The patients were evaluated before the injection and at the 6-month follow-ups using the EuroQol visual analogue scale (EQ-VAS) and International Knee Documentation Committee (IKDC) subjective scores. Adverse events and patient satisfaction were recorded.

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  • Role of autologous platelet-rich plasma in treatment of long-bone nonunions: a prospective study

    Abstract

    Purpose

    Fracture union is a complex biological process, which depends upon several systemic and local factors. Disturbance of any of these factors may lead to nonunion of the fracture. These nonunions have a huge impact on quality of life as well as socioeconomical aspects. The platelets on activation release a number of growth factors and differentiation factors, which play important role in fracture healing. This study aimed to look for efficacy of platelet-rich plasma in the treatment of established fracture nonunions of long bones.

    Methods

    A total of 94 patients with established nonunion of long bone (35 tibia, 30 femur, 11 humerus, 4 radius, 12 ulna, 2 with both radius and ulna) were included in this study. We injected 15-20  ml of autologous platelet-rich plasma (>2,000,000  platelets/μl) under image intensifier at each nonunion site. The fracture union was evaluated clinically and radiologically regularly at monthly interval till 4  months.

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  • Effect of single injection of Platelet-Rich Plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial

    Abstract

    AIM: Evidence on the effect of Platelet-Rich Plasma (PRP) in treating osteoarthritis (OA) is insufficient. Therefore, the present study compares the effects of a one-time injection of PRP and corticosteroid (CS) as two types of treatment for the patients suffering from osteoarthritis. METHODS: In the present randomized double blind clinical trial, the participants who suffered from knee osteoarthritis (Grades II/III), were randomly divided into two groups: intra articular injection of PRP and CS. Knee injury and osteoarthritis outcome score (KOOS), the 20-meter-walk test, active and passive ranges of motions (ROM), flexion contracture, and pain intensity based on Visual Analog Scale (VAS) were assessed before, 2-months, and 6-months after interventions. RESULTS: 41 participants (48 knees) were involved in the research (66.7% women; average age of 61.1 ±7.0 years old). Compared to the group treated with corticosteroid, pain relief (df:6 ,35 ;F=11.0 ;p=0.007), symptom free (df:6 ,35 ;F=23.0 ;p<0.001), activities of daily living (ADL) (df:6 ,35 ;F=10.7 ;p=0.005) and quality of life (df:6 ,35 ;F=5.2 ;p=0.02) in the RPR group were significantly higher, but sporting ability was not different between the 2 groups (df:6 ,35 ;F=0.6 ;p=0.55). PRP prescription was significantly more helpful for relieving patients\' pain (VAS) compared to corticosteroids (df:6,35;F=32.0 ;p,0.001).It\'s also notable that using PRP was more helpful in improving the 20-meter-walk test than corticosteroid treatment (df:6 ,35 ;F=7.4 ;p=0.04) but none of the treatments had any impact on active flexion ROM ØŒpassive flexion ROM and flexion contracture (p>0.05).

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  • Re: Ultrasound-guided platelet-rich-plasma injection for distal biceps tendinopathy

    We would like to congratulate Barker et

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  • A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain

    Abstract

    OBJECTIVES: Controversy exists regarding the efficacy of ligament prolotherapy in alleviating sacroiliac joint pain. The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies. It was hypothesized that intra-articular prolotherapy for patients with a positive response to diagnostic block may mitigate the drawbacks of ligament prolotherapy. The purpose of this study was to evaluate the efficacy and long-term effectiveness of intra-articular prolotherapy in relieving sacroiliac joint pain, compared with intra-articular steroid injection.

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  • Autologous Platelet-Rich Plasma Preparations - Influence of Nonsteroidal Anti-inflammatory Drugs on Platelet Function

    Abstract

    Background Autologous platelet-rich plasma (PRP) has been widely used for the treatment of sports injuries. It has been associated with improved healing and regeneration of soft tissues in elite athletes. Athletes are commonly receiving nonsteroidal anti-inflammatory drugs (NSAIDs). As yet, the effect of these drugs on platelet function in PRP formulations has not been taken into consideration.

    Hypothesis The function of platelets in PRP produced under the influence of NSAIDs is inhibited and may lessen a possible healing effect on the site of injury.

    Study Design Controlled laboratory study.

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  • AB0853 €…Efficacy of Ultrasound-Guided Intra-Articular Injections of Platelet-Rich Plasma and Hyaluronic Acid for Hip Osteoarthritis

    Abstract

    Background The concentrated platelets found in Platelet Rich Plasma (PRP) include growth factors among the huge reservoirs of bioactive proteins that are vital to initiate and accelerate tissue repair and regeneration.

    Objectives To evaluate the assess the duration of effectiveness of 4 intra-articular injection: two infiltration of platelet gel followed by two ultrasound guided infiltration of hyaluronic acid under ultrasound (US) guidance in symptomatic osteoarthritis of the hip.

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  • Regenerative Injection Treatment in the Spine: Review and Case Series with Platelet Rich Plasma

    Abstract

    Background: Platelet-Rich Plasma (PRP) has been used for a variety of musculoskeletal disorders including tendinopathies and Osteoarthritis. Fewstudies exist for PRP in the spine, except for studies involving disc pathology. However, numerous studies exist involving the use of Prolotherapy for spinal disorders. Both Prolotherapy and PRP can be considered within the broad category of Regenerative Injection Treatment (RIT), which are proposed to strengthen or repair injured ligaments, tendons, muscle, cartilage, and bone via injections of proliferative solutions, growth factors, or cells. Provided that double blind randomized controlled trials have shownboth PRP and Prolotherapy to be effective in treating similar regions of the body, it is reasonable to consider that PRP could be comparatively effective as Prolotherapy in treating pain related to the facet joints, capsules and associated spinal ligaments.

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  • Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction

    Abstract

    Platelet-rich plasma (PRP) has been tested in vitro, in animal models, and clinically for its efficacy in enhancing the rate of wound healing, reducing pain associated with injuries, and promoting axon regeneration. Although extensive data indicate that PRP-released factors induce these effects, the claims are often weakened because many studies were not rigorous or controlled, the data were limited, and other studies yielded contrary results. Critical to assessing whether PRP is effective are the large number of variables in these studies, including the method of PRP preparation, which influences the composition of PRP; type of application; type of wounds; target tissues; and diverse animal models and clinical studies. All these variables raise the question of whether one can anticipate consistent influences and raise the possibility that most of the results are correct under the circumstances where PRP was tested. This review examines evidence on the potential influences of PRP and whether PRP-released factors could induce the reported influences and concludes that the preponderance of evidence suggests that PRP has the capacity to induce all the claimed influences, although this position cannot be definitively argued. Well-defined and rigorously controlled studies of the potential influences of PRP are required in which PRP is isolated and applied using consistent techniques, protocols, and models. Finally, it is concluded that, because of the purported benefits of PRP administration and the lack of adverse events, further animal and clinical studies should be performed to explore the potential influences of PRP.

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  • Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses

    Purpose

    The aims of this study were (1) to perform a systematic review of meta-analyses evaluating platelet-rich plasma (PRP) injection in the treatment of knee joint cartilage degenerative pathology, (2) to provide a framework for analysis and interpretation of the best available evidence to provide recommendations for use (or lack thereof) of PRP in the setting of knee osteoarthritis (OA), and (3) to identify literature gaps where continued investigation would be suggested.

    Methods

    Literature searches were performed for meta-analyses examining use of PRP versus corticosteroids, hyaluronic acid, oral nonsteroidal anti-inflammatory drugs, or placebo. Clinical data were extracted, and meta-analysis quality was assessed. The Jadad algorithm was applied to determine meta-analyses that provided the highest level of evidence.

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  • Platelet-rich plasma increases proliferation of tendon cells by modulating Stat3 and p27 to up-regulate expression of cyclins and cyclin-dependent kinases

    Objectives

    To investigate effects of platelet-rich plasma on tendon cell proliferation and the underlying molecular mechanisms.

    Materials and methods

    Platelet-rich plasma was prepared manually by two-step centrifugation. Proliferation was evaluated in cultured rat tendon cells by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay. Cell cycle progression was assessed by flow cytometry. Messenger RNA expression of proliferating cell nuclear antigen (PCNA), cyclin E1, A2 and B1, and cyclin-dependent kinases (Cdks) 1 and 2 was assessed by real-time polymerase chain reaction. Protein expression of the above cyclins and Cdks and of signal transducer and activator of transcription (Stat) 3 and p27 was evaluated by western blotting.

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  • In Vivo Kinetics of Mesenchymal Stem Cells Transplanted into the Knee Joint in a Rat Model Using a Novel Magnetic Method of Localization

    Abstract

    We have developed a magnetic system for targeting cells in minimally invasive cell transplantation. Magnetically labeled MSCs (m-MSCs) with nanoscale iron particles can be guided into the desired region by magnetic force from an extracorporeal device. We reported that magnetic targeting of m-MSCs enhances cartilage repair in a mini-pig model. However, the detailed kinetics of these magnetically targeted m-MSCs remain unknown. For clinical use, this aspect should be clarified from a safety standpoint. We therefore investigated the spatial and temporal distribution of the fluorescently-labeled m-MSCs transplanted into the knee joint using in vivo fluorescence combined with three-dimensional computed tomographic imaging in a rat model. Although the intraarticularly injected m-MSCs were spread throughout the joint cavity in the absence of magnetic force, the magnetic force caused the injected m-MSCs to accumulate around the chondral lesion. Further examinations including ex vivo imaging, histological assessments and reverse transcription polymerase chain reaction revealed that transplanted MSCs were not present in any major organs after intraarticular administration, regardless of magnetic targeting. Our data suggest that m-MSCs can be accumulated efficiently into a chondral lesion using our magnetic targeting system, while none of the intraarticularly transplanted MSCs migrate to other major organs. Clin Trans Sci 2015;

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  • The Effect of Low-Level Laser in Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Trial

    Abstract

    Introduction: Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA). Materials and Methods: Patients with mild or moderate KOA were randomized to receive either LLLT or placebo LLLT. Treatments were delivered twice a week over a period of 4 wk with a diode laser (wavelength 830 nm, continuous wave, power 50 mW) in skin contact at a dose of 6 J/point. The placebo control group was treated with an ineffective probe (power 0.5 mW) of the same appearance. Before examinations and immediately, 2 wk, and 2 mo after completing the therapy, thermography was performed (bilateral comparative thermograph by AGA infrared camera); joint flexion, circumference, and pressure sensitivity were measured; and the visual analogue scale was recorded. Results: In the group treated with active LLLT, a significant improvement was found in pain (before treatment [BT]: 5.75; 2 mo after treatment: 1.18); circumference (BT: 40.45; AT: 39.86); pressure sensitivity (BT: 2.33; AT: 0.77); and flexion (BT: 105.83; AT: 122.94). In the placebo group, changes in joint flexion and pain were not significant. Thermographic measurements showed at least a 0.5 °C increase in temperature —and thus an improvement in circulation compared to the initial values. In the placebo group, these changes did not occur. Conclusion: Our results show that LLLT reduces pain in KOA and improves microcirculation in the irradiated area.

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  • Meniscus repair using mesenchymal stem cells - a comprehensive review

    Abstract

    The menisci are a pair of semilunar fibrocartilage structures that play an essential role in maintaining normal knee function. Injury to the menisci can disrupt joint stability and lead to debilitating results. Because natural meniscal healing is limited, an efficient method of repair is necessary. Tissue engineering (TE) combines the principles of life sciences and engineering to restore the unique architecture of the native meniscus. Mesenchymal stem cells (MSCs) have been investigated for their therapeutic potential both in vitro and in vivo. This comprehensive review examines the English literature identified through a database search using Medline, Embase, Engineering Village, and SPORTDiscus. The search results were classified based on MSC type, animal model, and method of MSC delivery/culture. A variety of MSC types, including bone marrow-derived, synovium-derived, adipose-derived, and meniscus-derived MSCs, has been examined. Research results were categorized into and discussed by the different animal models used; namely murine, leporine, porcine, caprine, bovine, ovine, canine, equine, and human models of meniscus defect/repair. Within each animal model, studies were categorized further according to MSC delivery/culture techniques. These techniques included direct application, fibrin glue/gel/clot, intra-articular injection, scaffold, tissue-engineered construct, meniscus tissue, pellets/aggregates, and hydrogel. The purpose of this review is to inform the reader about the current state and advances in meniscus TE using MSCs. Future directions of MSC-based meniscus TE are also suggested to help guide prospective research.

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  • Anti-inflammatory effects of platelet biomaterials in a macrophage cellular model

    Background and Objectives

    Recent clinical data suggested that platelet materials used in regenerative medicine exert anti-inflammatory effects. One must understand whether functionality varies among platelet preparations and also the role of the various protein compartments.

    Materials and Methods

    Platelet-poor-plasma (PPP), platelet lysate with cell debris (PL) or cell-free (CFPL), platelet gel releasate (PGR) and solvent/detergent-treated PL (SDPL) were prepared from four apheresis platelet donations. Protein profile was examined by SDS-PAGE, and growth factors and cytokines by ELISA, multiplexed Luminex assay and cytokine array. Anti-inflammatory activity was evaluated in RAW 264 ·7 mouse macrophages treated for 24  h with the blood fractions followed by 24  h of stimulation with 500  ng/ml lipopolysaccharides (LPS). Inflammatory marker nitric oxide (NO) was determined by colorimetry, tumour necrosis factor (TNF)-α by ELISA and inducible NO synthase (iNOS) and cyclooxygenase (COX)-2 by Western blotting.

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  • Hypertonic Dextrose Injection (Prolotherapy) for knee osteoarthritis: Long term outcomes

    Abstract

    Objective

    Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p<.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA.

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  • Ultrasound guided Distal Bicep Tendon injection using a posterior approach

    Abstract

    Distal biceps tendinopathy is an uncommon but increasingly diagnosed etiology in individuals with elbow pain. When traditional treatments are unsuccessful, practitioners have utilized ultrasound-guided tendon injections to this region using an anterior approach. Though there has been reported success, this approach may lead to a neurovascular injury. This is the first case report in the literature describing an ultrasound- guided distal bicep tendon injection via a posterior approach. The patient had an excellent clinical outcome with no adverse events. This outcome suggests that ultrasound guided posterior percutaneous tendon injection might be a safe, viable non-surgical option for recalcitrant distal biceps tendinopathy.

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  • Engineering physiologically stiff and stratified human cartilage by fusing condensed mesenchymal stem cells

    Abstract

    For a long time, clinically sized and mechanically functional cartilage could be engineered from young animal chondrocytes, but not from adult human mesenchymal stem cells that are of primary clinical interest. The approaches developed for primary chondrocytes were not successful when used with human mesenchymal cells. The method discussed here was designed to employ a mechanism similar to pre-cartilaginous condensation and fusion of mesenchymal stem cells at a precisely defined time. The formation of cartilage was initiated by press-molding the mesenchymal bodies onto the surface of a bone substrate. By image-guided fabrication of the bone substrate and the molds, the osteochondral constructs were engineered in anatomically precise shapes and sizes. After 5

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