Systematic review for non-surgical interventions for the management of late radiation proctitis

Chronic radiation proctitis produces a range of clinical symptoms for which there is currently no recommended standard management. The aim of this review was to identify the various non-surgical treatment options for the management of late chronic radiation proctitis and evaluate the evidence for their efficacy. Synonyms for radiation therapy and for the spectrum of lower gastrointestinal radiation toxicity were combined in an extensive search strategy and applied to a range of databases. The included studies were those that involved interventions for the non-surgical management of late radiation proctitis. Sixty-three studies were identified that met the inclusion criteria, including six randomised controlled trials that described the effects of anti-inflammatory agents in combination, rectal steroids alone, rectal sucralfate, short chain fatty acid enemas and different types of thermal therapy. However, these studies could not be compared. If the management of late radiation proctitis is to become evidence based, then, in view of its episodic and variable nature, placebo controlled studies need to be conducted to clarify which therapeutic options should be recommended. From the current data, although certain interventions look promising and may be effective, one small or modest sized study, even if well-conducted, is insufficient to implement changes in practice. In order to increase recruitment to trials, a national register of cases with established late radiation toxicity would facilitate multi-centre trials with specific entry criteria, formal baseline and therapeutic assessments providing standardised outcome data

Carrageenan based hydrogels for drug delivery, tissue engineering and wound healing

Carrageenan is a class of naturally occurring sulphated polysaccharides, which is currently a promising candidate in tissue engineering and regenerative medicine as it resemblances native glycosaminoglycans. From pharmaceutical drug formulations to tissue engineered scaffolds, carrageenan has broad range of applications. Here we provide an overview of developing various forms of carrageenan based hydrogels. We focus on how these fabrication processes has an effect on physiochemical properties of the hydrogel. We outline the application of these hydrogels not only pertaining to sustained drug release but also their application in bone and cartilage tissue engineering as well as in wound healing and antimicrobial formulations. Administration of these hydrogels through various routes for drug delivery applications has been critically reviewed. Finally, we conclude by summarizing the current and future outlook that promotes the seaweed-derived polysaccharide as versatile, promising biomaterial for a variety of bioengineering applications

Injectable angiogenic and osteogenic carrageenan nanocomposite hydrogel for bone tissue engineering

Functional biomaterials that couple angiogenesis and osteogenesis processes are vital for bone tissue engineering and bone remodeling. Herein we developed an injectable carrageenan nanocomposite hydrogel incorporated with whitlockite nanoparticles and an angiogenic drug, dimethyloxallylglycine. Synthesized whitlockite nano particles and nanocomposite hydrogels were characterized using SEM, TEM, EDS and MR Developed hydrogels were injectable, mechanically stable, cytocompatible and has better protein adsorption. Incorporation of dimethyloxallylglycine resulted in initial burst release followed by sustained release for 7 days. Human umbilical vein endothelial cells exposed to dimethyloxallylglycine incorporated nanocomposite hydrogel showed enhanced cell migration and capillary tube-like structure formation. Osteogenic differentiation in rat adipose derived mesenchymal stem cells after 7 and 14 days revealed increased levels of alkaline phosphatase activity in vitro. Furthermore, cells exposed to nanocomposite hydrogel revealed enhanced protein expressions of RUNX2, COL and OPN. Overall, these results suggest that incorporation of whitlockite and dimethyloxallylglycine in carrageenan hydrogel promoted osteogenesis and angiogenesis in vitro. (C) 2018 Elsevier B.V. All rights reserved

Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?

Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate alignment of prostheses. We aimed to compare the outcome of computer-navigated and conventional TKA and to analyse the radiologically malaligned knees. We analysed 637 primary TKA, carried out by a single surgeon, over five consecutive years and divided them into two cohorts: group 1 = STA (standard instrumentation) and group 2  = CAS (computer-assisted surgery). There was no significant difference between the average Oxford Knee Scores (OKS) of the two groups at any time from one to five years. However, the malaligned TKA at three years had a worse OKS. At medium term there is no difference in clinical outcome measures that can be attributed to the surgeon having used computer-assisted navigation for TKA. But group 1, having a higher proportion of malaligned TKA, might show worsening of OKS at long term