44 research outputs found
Platelet-Rich Plasma Guided Injections: Clinical Application in Peripheral Neuropathies
Platelet-Rich Plasma (PRP) is defined as an autologous concentrated preparation of platelets and their associated growth factors in a small volume of plasma. The presence of these growth factors has stimulated the scientific community to search about possible benefits of the use of PRP in tissue regeneration. Provided that previously in vitro and animal research demonstrated that PRP could probably play an important role in the treatment of neural tissue disorders, we aimed to review the current literature, regarding the clinical studies that have been conducted to confirm this hypothesis. More specifically, we have reviewed the literature concerning the clinical application of PRP in peripheral neuropathies and investigated if there is strong evidence to establish the use of PRP in clinical practice as a therapeutic option. In contrast with animal studies, we have been able to identify only few clinical data concerning the use of Platelet-Rich Plasma (PRP) in peripheral neuropathies. We found 5 trials matched to our research that have yield positive and promising results for the future for the application of PRP for the therapy of disorders of the peripheral nervous system. It is obvious that this interesting field of research gives to the scientists the ability to expand it extensively, in terms of both quality and quantity
Deciphering osteoarthritis genetics across 826,690 individuals from 9 populations
Osteoarthritis affects over 300 million people worldwide. Here, we conduct a genome-wide association study meta-analysis across 826,690 individuals (177,517 with osteoarthritis) and identify 100 independently associated risk variants across 11 osteoarthritis phenotypes, 52 of which have not been associated with the disease before. We report thumb and spine osteoarthritis risk variants and identify differences in genetic effects between weight-bearing and non-weight-bearing joints. We identify sex-specific and early age-at-onset osteoarthritis risk loci. We integrate functional genomics data from primary patient tissues (including articular cartilage, subchondral bone, and osteophytic cartilage) and identify high-confidence effector genes. We provide evidence for genetic correlation with phenotypes related to pain, the main disease symptom, and identify likely causal genes linked to neuronal processes. Our results provide insights into key molecular players in disease processes and highlight attractive drug targets to accelerate translation
Deciphering osteoarthritis genetics across 826,690 individuals from 9 populations
Funding Information: T.R.G. and J.Z. receive research funding from GlaxoSmithKline. T.R.G. receives research funding from Biogen. U.S., K.S., L. Stefánsdóttir, G.B., S.H.L., U.T., and G. T. are employed by deCODE genetics/Amgen Inc. A.M.V. is a consultant for Zoe Global Ltd. All other authors report no competing interests. All Regeneron Genetics Center banner authors are current employees and/or stockholders of Regeneron Pharmaceuticals. Funding Information: We thank Nigel W. Rayner and Ahmed Elhakeem for their input. This research was conducted using the UK Biobank Resource under application numbers 9979 and 23359. G.D.S. and T.R.G. work in the Medical Research Council Integrative Epidemiology Unit at the University of Bristol MC_UU_00011/1&4. A.M.V. is funded by the NIHR Nottingham BRC. J.Z. is funded by a Vice-Chancellor Fellowship from the University of Bristol. This research was also funded by the UK Medical Research Council Integrative Epidemiology Unit (MC_UU_00011/4). Study design and project coordination, E. Zeggini; Writing Group, U.S. J.B.J.v.M. J.M.W. M.T.M.L. K.S.E.C. L.S. C.G.B. K.H. Y.Z. R.C.d.A. L. Stef?nsd?ttir, E. Zeggini, A.P.M. G.T. P.C.S. J.Z. and T.R.G.; Core Analyses, C.G.B. K. Hatzikotoulas, L. Southam, L. Stef?nsd?ttir, Y.Z. R.C.d.A. T.T.W. J.Z. A.H. M.T.-L. and J.M.W.; Individual Study Design and Principal Investigators, E. Zeggini, U.S. J.B.J.v.M. M.T.M.L. I.M. J.M.W. T.E. K. Hveem, S.I. K.S.E.C. A.T. A.M.V. K.S. P.E.S. P.C. G.D.S. J.H.T. T.R.G. S.A.L. G.C.B. A.G.U. U.T. P.K. J.H.K. arcOGEN Consortium, HUNT All-In Pain, ARGO Consortium, and Regeneron Genetics Center; Analyses, Genotyping, and Phenotyping in Individual Studies, C.G.B. K.H. L. Southam, J.M.W. L. Stef?nsd?ttir, Y.Z. R.C.d.A. T.T.W. J.Z. A.H. M.T.-L. A.H.S. C.T. E. Zengini, A.B. G.T. G.B. H.J. T.I. R.M. H.T. M.K. M.T. R.R.G.H.H.N. M.M. J.P.Y.C. D.S. J.-A.Z. A.L. M.B.J. L.F.T. B.W. M.E.G. J.S. M.S. G.A. A.G. S.H.L. arcOGEN Consortium, HUNT All-In Pain, ARGO Consortium, and Regeneron Genetics Center. All authors contributed to the final version of the manuscript. T.R.G. and J.Z. receive research funding from GlaxoSmithKline. T.R.G. receives research funding from Biogen. U.S. K.S. L. Stef?nsd?ttir, G.B. S.H.L. U.T. and G. T. are employed by deCODE genetics/Amgen Inc. A.M.V. is a consultant for Zoe Global Ltd. All other authors report no competing interests. All Regeneron Genetics Center banner authors are current employees and/or stockholders of Regeneron Pharmaceuticals. Funding Information: We thank Nigel W. Rayner and Ahmed Elhakeem for their input. This research was conducted using the UK Biobank Resource under application numbers 9979 and 23359. G.D.S. and T.R.G. work in the Medical Research Council Integrative Epidemiology Unit at the University of Bristol MC_UU_00011/1&4. A.M.V. is funded by the NIHR Nottingham BRC . J.Z. is funded by a Vice-Chancellor Fellowship from the University of Bristol . This research was also funded by the UK Medical Research Council Integrative Epidemiology Unit ( MC_UU_00011/4 ). Publisher Copyright: © 2021 The AuthorsOsteoarthritis affects over 300 million people worldwide. Here, we conduct a genome-wide association study meta-analysis across 826,690 individuals (177,517 with osteoarthritis) and identify 100 independently associated risk variants across 11 osteoarthritis phenotypes, 52 of which have not been associated with the disease before. We report thumb and spine osteoarthritis risk variants and identify differences in genetic effects between weight-bearing and non-weight-bearing joints. We identify sex-specific and early age-at-onset osteoarthritis risk loci. We integrate functional genomics data from primary patient tissues (including articular cartilage, subchondral bone, and osteophytic cartilage) and identify high-confidence effector genes. We provide evidence for genetic correlation with phenotypes related to pain, the main disease symptom, and identify likely causal genes linked to neuronal processes. Our results provide insights into key molecular players in disease processes and highlight attractive drug targets to accelerate translation.Peer reviewe
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries
Charnley Low-Friction Arthroplasty in Young Patients with Osteoarthritis Outcomes at a Minimum of Twenty-two Years
Background: We previously reported the outcomes at a minimum of twelve
years after eighty-four Charnley low-friction arthroplasties performed
in patients with osteoarthritis who were less than fifty-six years old
at the time of the surgery. We now update the results of that cohort at
a minimum of twenty-two years postoperatively.
Methods: Eighty-four hips (in sixty-nine patients) with osteoarthritis,
which was secondary to congenital hip disease in sixty-four (76%) of
them, were followed prospectively with use of the Merle D’Aubigne and
Postel scoring system as modified by Charnley and with serial
radiographs.
Results: At the time of the latest follow-up, thirty-seven hips (44%)
had failed. Twenty-eight acetabular and thirty femoral components, in a
total of thirty-two hips, had been revised because of aseptic loosening;
six of the loose femoral components were broken. Three hips were
infected and were converted to a resection arthroplasty. A
periprosthetic femoral fracture occurred in two additional hips, three
and ten years postoperatively, and both were treated with internal
fixation. Thirty-seven original acetabular components and thirty-six
original femoral components were in place for an average of twenty-nine
years. The probability of survival for both components, with failure for
any reason as the end point, was 0.51 (95% confidence interval, 0.39 to
0.62) at twenty-five years.
Conclusions: These long-term results can be used as a benchmark with
which to compare outcomes of different designs when total hip
arthroplasty is performed in young patients when the majority have
congenital hip disease
A Comparison of the Outcome of Cemented All-Polyethylene and Cementless Metal-Backed Acetabular Sockets in Primary Total Hip Arthroplasty
We compared, after a 10-year-minimum follow-up, the outcome of 50
cemented all-polyethylene Charnley acetabular sockets with that of 51
cementless metal-backed sockets in 2 comparable cohorts of young
patients. Although the revision rate for the cemented and cementless
group was 28% and 35%, respectively, the revision rate for aseptic
loosening was 28% for the cemented and 12% for the cementless group.
The mean polyethylene wear was 0.112 and 0.114 mm/y, respectively, for
the 2 groups. Linear osteolysis was observed in 18 of 50 cemented
sockets. Expansile osteolysis presented in 10 of 51 cementless sockets
and only in one of the cemented sockets. in conclusion, cementless
components hall more durable fixation than cemented components. However,
they presented more aggressive expansile osteolysis caused by the
coexistence of polyethylene and metal debris
The morphologic variations of low and high hip dislocation
Three different types of congenital hip disease in adults have been
distinguished based upon the position of the femoral head relative to
the acetabulum and the underlying pathoanatomy of the joint: (1)
dysplasia; (2) low dislocation; and (3) high dislocation. To facilitate
classification of borderline or ambiguous cases, we studied the
morphologic variations of low and high dislocation as observed on the
radiographs of 101 hips with low and 74 hips with high dislocation. In
low dislocation, 54 hips (53.5%) had extended coverage of the true
acetabulum (Type B1) and 47 hips (46.5%) had limited coverage (Type
B2). Among the cases with high dislocation, a false acetabulum with an
adjacent femoral head occurred in 46 hips (62.2%) (Type C1), and the
femoral head was floating within the gluteal muscles in 28 hips (37.8%)
(Type C2). The kappa value for interobserver agreement between two
raters who made radiographic measurements was 0.963, and for
intraobserver agreement between the two evaluations of the same observer
it was 0.946 and 0.971, respectively. The two types of low and high
dislocation were associated with high intra- and interobserver
agreement. Whether these distinctions have clinical utility requires
further validation