Efficacy and Safety of Intra-articular Injections of Hyaluronic Acid Combined With Polydeoxyribonucleotide in the Treatment of Knee Osteoarthritis

Objective To assess the clinical efficacy and safety of intra-articular injection of hyaluronic acid (HA) combined with polydeoxyribonucleotide (PDRN) in patients with knee osteoarthritis in comparison with that of HA alone. Methods The current single-center, prospective, randomized, double-blind, controlled study was conducted in 36 patients with knee osteoarthritis at our medical institution. All the eligible patients (n=30) were equally assigned to two treatment arms (trial group ‘HA+PDRN’ and control group ‘HA’). For efficacy assessment, the patients were evaluated for the visual analogue scale (VAS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Scores (KSS), all of which served as efficacy outcome measures. We monitored time-dependent changes in efficacy outcome measures at baseline and 1, 3 and 6 months. Subsequently, we compared differences in changes in efficacy outcome measures at 6 months from baseline between the two groups. Moreover, we assessed the safety based on the treatment-emergent adverse events (TEAEs), adverse drug reactions (ADRs) and any other complications serving as safety outcome measures. Results There were significant differences in changes in the VAS scores, the WOMAC scores in all domains, except ‘Stiffness’, the total WOMAC scores, and the KSS scores in all the domains at 6 months from baseline between the two groups (p<0.05). In our series, there were no TEAEs, ADRs, and any other complications. Conclusion Intra-articular injections of HA combined with PDRN can also be considered in the treatment of knee osteoarthritis. However, further large-scale and multi-center studies are required to demonstrate the potential of the proposed combination

Endophytic fungal association via gibberellins and indole acetic acid can improve plant growth under abiotic stress: an example of Paecilomyces formosus LHL10

<p>Abstract</p> <p>Background</p> <p>Endophytic fungi are little known for exogenous secretion of phytohormones and mitigation of salinity stress, which is a major limiting factor for agriculture production worldwide. Current study was designed to isolate phytohormone producing endophytic fungus from the roots of cucumber plant and identify its role in plant growth and stress tolerance under saline conditions.</p> <p>Results</p> <p>We isolated nine endophytic fungi from the roots of cucumber plant and screened their culture filtrates (CF) on gibberellins (GAs) deficient mutant rice cultivar <it>Waito-C </it>and normal GAs biosynthesis rice cultivar Dongjin-byeo. The CF of a fungal isolate CSH-6H significantly increased the growth of <it>Waito-C </it>and Dongjin-byeo seedlings as compared to control. Analysis of the CF showed presence of GAs (GA₁, GA₃, GA₄, GA₈, GA₉, GA₁₂, GA₂₀and GA₂₄) and indole acetic acid. The endophyte CSH-6H was identified as a strain of <it>Paecilomyces formosus </it>LHL10 on the basis of phylogenetic analysis of ITS sequence similarity. Under salinity stress, <it>P. formosus </it>inoculation significantly enhanced cucumber shoot length and allied growth characteristics as compared to non-inoculated control plants. The hypha of <it>P. formosus </it>was also observed in the cortical and pericycle regions of the host-plant roots and was successfully re-isolated using PCR techniques. <it>P. formosus </it>association counteracted the adverse effects of salinity by accumulating proline and antioxidants and maintaining plant water potential. Thus the electrolytic leakage and membrane damage to the cucumber plants was reduced in the association of endophyte. Reduced content of stress responsive abscisic acid suggest lesser stress convened to endophyte-associated plants. On contrary, elevated endogenous GAs (GA₃, GA₄, GA₁₂and GA₂₀) contents in endophyte-associated cucumber plants evidenced salinity stress modulation.</p> <p>Conclusion</p> <p>The results reveal that mutualistic interactions of phytohormones secreting endophytic fungi can ameliorate host plant growth and alleviate adverse effects of salt stress. Such fungal strain could be used for further field trials to improve agricultural productivity under saline conditions.</p

Femoral Head Fracture without Dislocation by Low-Energy Trauma in a Young Adult

We describe the case of a healthy young man with a femoral head fracture by low-energy trauma that occurred without evidence of hip dislocation. While plain radiographs showed no definite fracture or dislocation, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a femoral head fracture with a wedge-shaped cortical depression at the superomedial aspect of the femoral head. Our patient reported feeling that the right hip had been displaced from its joint for a moment. This probably represented subluxation with spontaneous relocation. The characteristic findings and possible mechanisms of this fracture were postulated on the basis of the sequential 3 dimensional-CT and MRI. The clinical results of conservative treatment were better than those of previously reported indentation fractures

Fate of untreated asymptomatic osteonecrosis of the femoral head

BACKGROUND: Magnetic resonance imaging has made it possible to detect asymptomatic lesions of osteonecrosis of the femoral head before abnormalities appear on plain radiographs. The extent of a necrotic lesion is known to be an important prognostic factor. In this study, we evaluated the fate of untreated asymptomatic osteonecrosis of the femoral head with an emphasis on the size of the lesion. We hypothesized that a lesion smaller than a certain size would not progress to symptomatic disease. METHODS: One hundred and five initially asymptomatic hips of patients with bilateral nontraumatic osteonecrosis of the femoral head who had been followed without any treatment for at least five years or until pain developed were enrolled in this study. The extent of a lesion was estimated according to the area of the lesion based on a two-dimensional analysis on magnetic resonance images or on plain radiographs at the time of diagnosis. RESULTS: Sixty-two hips became symptomatic, and forty-three hips remained asymptomatic for more than five years (average, eight years and seven months). Of the twenty-one hips with a small necrotic lesion (50% of the area of the femoral head), fifty became painful. Forty-six of the sixty-two hips that became symptomatic required surgery. Pain developed within five years after the diagnosis in fifty-eight (94%) of the sixty-two symptomatic hips. CONCLUSIONS: No treatment appears to be necessary for asymptomatic necrotic lesions with an area smaller than 30% of the femoral head, as the vast majority of these lesions will remain asymptomatic for more than five years

Alumina-on-Alumina Total Hip Arthroplasty A Concise Follow-up, at a Minimum of Ten Years, of a Previous Report

We previously reported the five-to-six-year results of the use of third-generation alumina-on-alumina bearings in a consecutive series of 100 primary cementless total hip arthroplasties. This report presents the longer-term outcomes of these same bearings, at a minimum of ten years postoperatively. Eighty-six of eighty-eight hips available for the study retained the original bearings at the time of the latest follow-up. Thirteen hips were associated with noise, and six hips demonstrated fretting of the femoral neck on radiographs. Two hips required a change of the bearings because of a ceramic head fracture. The ten-year survival rate of the alumina-on-alumina total hip prostheses, with revision of any implant for any reason as the end point, was 99.0%. On the basis of those results, we concluded that the rate of survival of primary cementless total hip prostheses with third-generation alumina-on-alumina bearings is excellent at ten years. However, the risk of ceramic fracture, noise, and impingement between the metal neck and the ceramic liner should be a concern to surgeons, and patients should be informed of these risks before surgery.Koo KH, 2008, J BONE JOINT SURG AM, V90A, P329, DOI 10.2106/JBJS.F.01489Sugano N, 2007, J BONE JOINT SURG BR, V89B, P455Yoo JJ, 2005, J BONE JOINT SURG AM, V87A, P530, DOI 10.2106/JBJS.D01753Allain J, 1998, J BONE JOINT SURG AM, V80A, P1355Joshi RP, 1998, J BONE JOINT SURG BR, V80B, P585MARTELL JM, 1993, J BONE JOINT SURG AM, V75A, P554MALONEY WJ, 1990, J BONE JOINT SURG AM, V72A, P1025BELLAMY N, 1988, J RHEUMATOL, V15, P1833ENGH CA, 1987, J BONE JOINT SURG BR, V69, P45SARMIENTO A, 1985, J BONE JOINT SURG AM, V67A, P48GRUEN TA, 1979, CLIN ORTHOP RELAT R, P17DELEE JG, 1976, CLIN ORTHOP RELAT R, P20HARRIS WH, 1969, J BONE JOINT SURG AM, VA 51, P737KAPLAN EL, 1958, J AM STAT ASSOC, V53, P457

Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study

BACKGROUND: Ceramic-on-ceramic couplings are attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. Disappointing experiences with alumina ceramic bearings in the past have led to many improvements in the manufacture and design of ceramic implants. The purpose of the present study was to report the results of contemporary alumina-on-alumina total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum duration of follow-up of five years. METHODS: We evaluated the results of a consecutive series of 100 primary alumina-on-alumina total hip arthroplasties that had been performed with use of a metal-backed socket and a cementless stem in eighty-four patients. All of the patients were sixty-five years of age or younger (mean age, forty-one years), and a single surgeon performed all of the procedures. After a minimum duration of follow-up of sixty months, one patient (one hip) had died and four patients (six hips) had been lost to follow-up, leaving a total of seventy-nine patients (ninety-three hips) available for study. All of these patients were evaluated clinically and radiographically with special attention to wear, periprosthetic osteolysis, and ceramic failure. RESULTS: The mean Harris hip score was 97 points at the time of the latest follow-up evaluation. All prostheses demonstrated radiographic evidence of bone ingrowth. No implant was loose radiographically, and no implant was revised. Ceramic wear was not detectable in the thirty-seven hips in which the femoral head could be differentiated from the cup on radiographs. Periprosthetic osteolysis was not observed in any hip. A fracture of the alumina femoral head and a peripheral chip fracture of the alumina insert occurred in one hip following a motor-vehicle accident. CONCLUSIONS: The results of contemporary alumina-on-alumina total hip arthroplasty with a metal-backed socket and a cementless stem were encouraging after a minimum duration of follow-up of five years. We believe that these improved alumina-on-alumina bearing implants offer a promising option for younger, active patients

Left Ventricular Metastasis From Renal Cell Carcinoma Causing Left Ventricular Outflow Tract Obstruction

Most cases of cardiac metastasis from renal cell carcinoma (RCC) involve the vena cava or right atrium. Left ventricular metastases from RCC without involving the vena cava or right atrium are extremely rare. Herein we report a case of RCC with left ventricular metastasis causing left ventricular outflow obstruction (LVOT)