Autologous tenocyte injection for the treatment of chronic recalcitrant gluteal tendinopathy: A prospective pilot study

Background: Gluteal tendinopathy is a common cause of lateral hip pain, and existing conservative treatment modalities demonstrate high symptom recurrence rates. Autologous tenocyte injection (ATI) is a promising cell therapy that may be useful for the treatment of gluteal tendinopathy. Purpose: To investigate the safety and effectiveness of ATI, specifically in patients with chronic recalcitrant gluteal tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: Twelve female patients with a clinical and radiological diagnosis of gluteal tendinopathy were recruited. Patients demonstrated a mean duration of symptoms of 33 months (range, 6-144 months), had undergone a mean 3.2 prior corticosteroid injections (range, 2-5), and had failed to respond to existing conservative treatments including physiotherapy and injections. In an initial procedure, tendon cells were harvested from a needle biopsy of the patella tendon and propagated in a certified Good Manufacturing Practice (GMP) laboratory. In a secondary procedure, a single injection of 2 mL autologous tenocytes (2-5 x 106 cells/mL) suspended in patient serum was injected into the site of the pathological gluteal tendons under ultrasound guidance. Patients were assessed preand postinjection (3, 6, 12, and 24 months) using the Oxford Hip Score (OHS), a visual analog pain scale (VAS), the Short Form-36 (SF-36), and a satisfaction scale. Magnetic resonance imaging (MRI) was undertaken at 8.7 months (range, 6-12 months) postinjection. Results: Molecular characterization of autologous tendon cells showed a profile of growth factor production in all cases, including platelet-derived growth factor a, fibroblast growth factor ß, and transforming growth factor ß. The OHS (mean, 24.0 preinjection to 38.9 at 12 months [14.9-point improvement]; 95% CI, 10.6-19.2; P <.001), VAS (mean, 7.2 preinjection to 3.1 at 12 months [4.1-point improvement]; 95% CI, 2.6-5.6; P <.001), and SF-36 (mean, 28.1 preinjection to 43.3 at 12 months [15.2-point improvement]; 95% CI, 9.8-20.5; P <.001) significantly improved to 12 months postinjection, sustained to 24 months. Eight patients were satisfied with their outcomes. Significant MRI-based improvement could not be demonstrated in the majority of cases. Conclusion: ATI for gluteal tendinopathy is safe, with improved and sustained clinical outcomes to 24 months

Hematological Disorders and Pulmonary Hypertension

Pulmonary hypertension (PH), a serious disorder with a high morbidity and mortality rate, is known to occur in a number of unrelated systemic diseases. Several hematological disorders such as sickle cell disease, thalassemia and myeloproliferative diseases develop PH which worsens the prognosis. Associated oxidant injury and vascular inflammation cause endothelial damage and dysfunction. Pulmonary vascular endothelial damage/dysfunction is an early event in PH resulting in the loss of vascular reactivity, activation of proliferative and antiapoptotic pathways leading to vascular remodeling, elevated pulmonary artery pressure, right ventricular hypertrophy and premature death. Hemolysis observed in hematological disorders leads to free hemoglobin which rapidly scavenges nitric oxide (NO), limiting its bioavailability, and leading to endothelial dysfunction. In addition, hemolysis releases arginase into the circulation which converts L-arginine to ornithine, thus bypassing NO production. Furthermore, treatments for hematological disorders such as immunosuppressive therapy, splenectomy, bone marrow transplantation, and radiation have been shown to contribute to the development of PH. Recent studies have shown deregulated iron homeostasis in patients with cardiopulmonary diseases including pulmonary arterial hypertension (PAH). Several studies have reported low iron levels in patients with idiopathic PAH, and iron deficiency is an important risk factor. This article reviews PH associated with hematological disorders and its mechanism; and iron homeostasis and its relevance to PH

51 Eri and GJ 3305: A 10-15 Myr old binary star system at 30 parsecs

Following the suggestion of Zuckerman et al. (2001, ApJ, 562, L87), we consider the evidence that 51 Eri (spectral type F0) and GJ 3305 (M0), historically classified as unrelated main sequence stars in the solar neighborhood, are instead a wide physical binary system and members of the young beta Pic moving group (BPMG). The BPMG is the nearest (d < 50 pc) of several groups of young stars with ages around 10 Myr that are kinematically convergent with the Oph-Sco-Cen Association (OSCA), the nearest OB star association. Combining SAAO optical photometry, Hobby-Eberly Telescope high-resolution spectroscopy, Chandra X-ray data, and UCAC2 catalog kinematics, we confirm with high confidence that the system is indeed extremely young. GJ 3305 itself exhibits very strong magnetic activity but has rapidly depleted most of its lithium. The 51 Eri/GJ 3305 system is the westernmost known member of the OSCA, lying 110 pc from the main subgroups. The system is similar to the BPMG wide binary HD 172555/CD -64d1208 and the HD 104237 quintet, suggesting that dynamically fragile multiple systems can survive the turbulent environments of their natal giant molecular cloud complexes, while still being imparted high dispersion velocities. Nearby young systems such as these are excellent targets for evolved circumstellar disk and planetary studies, having stellar ages comparable to that of the late phases of planet formation.Comment: 27 pages, 7 figures. Accepted for publication in the Astronomical Journal. For a version with high resolution figures, see http://www.astro.psu.edu/users/edf/51Eri.pd