Hyaluronic acid in tobacco-exposed rats. Inflammatory reaction, and duration of effect

Abstract Purpose: To evaluate the hyaluronic acid (HA) inflammatory reaction, fibroblasts, fibrosis and duration of effect in the dorsal region of tobacco-exposed rats. Methods: Ten Wistar rats were divided into two groups: tobacco-exposed-group (TEG;n=5) and air-control-group (CG;n=5). The TEG animals were tobacco-exposed twice a day, 30-minutes/session, during 60 days. After this period, all animals received 0.1 mL HA subcutaneous injection in the dorsal area. The volume of HA was measured immediately after HA injection and weekly using a hand-caliper in nine weeks. After this period, all the animals were euthanized, and a specimen of was collected to evaluate inflammatory cells, fibroblasts, and fibrosis by HE. Results: This study showed a higher inflammatory reaction in TEG than CG: inflammatory cell-count (CG: 1.07±0.9; TEG: 8.61±0.36, p<0.001); fibroblast count (CG: 2.92±0.17; TEG: 19.14±0.62, p<0.001), and fibrosis quantification (CG: 2.0; TEG: 3.75, p<0.001). The analysis of the HA volume in nine weeks in the dorsal region did not show a difference between groups (p=0.39). Conclusions: This study suggested that the HA injection in the TEG caused an increase in inflammatory cell count, fibroblast, and fibrosis quantification when compared to the CG. There was no difference in the duration of effect of HA between the groups.

Análise do impacto orçamentário da viscossuplementação no tratamento não cirúrgico da osteoartrite de joelho / Budget impact analysis of viscosupplementation for non-surgical treatment of knee osteoarthritis / Análisis del impacto presupuestario de la viscosuplementación en el tratamiento no quirúrgico de la osteoartritis de rodilla

Resumo: A osteoartrite de joelho afeta cerca de 3,8% da população mundial e se manifesta por dor, edema, rigidez e redução da função articular, impactando na qualidade de vida do paciente. O tratamento consiste na modalidade farmacológica, não farmacológica e cirúrgica. A viscossuplementação (ácido hialurônico intra-articular) se propõe a oferecer alívio dos sintomas e a possibilidade de adiamento da cirurgia. Este estudo estimou o impacto orçamentário entre a associação desse medicamento e o tratamento não cirúrgico (tratamento padrão), sob a perspectiva do Sistema Único de Saúde. Com base no pressuposto de que 5% dos portadores da doença seguem para tratamento e nos custos diretos das modalidades: farmacológica e não farmacológica foram calculados os cenários de referência e alternativos que compararam as diferentes opções de tratamento para um horizonte temporal de três anos. A análise principal estimou um impacto orçamentário incremental de aproximadamente R$ 126 milhões (1 ampola anual) e R$ 252 milhões (2 ampolas anuais). Já a diacereína, um condroprotetor oral, avaliada como uma opção alternativa, mostrou um impacto de R$ 334 milhões no orçamento em relação ao tratamento padrão, o que proporciona um aumento de 24% no custo em relação ao uso de 2 ampolas anuais de ácido hialurônico, tornando-a economicamente menos vantajosa. A viscossuplementação pode proporcionar maior qualidade de vida ao paciente, redução de custos para o sistema e otimização do fluxo de atendimento nas unidades de saúde. As estimativas apresentadas neste estudo podem auxiliar o gestor quanto à melhor utilização dos recursos financeiros e consequente tomada de decisão quanto à incorporação da tecnologia.

Abstract: Knee osteoarthritis affects 3.8% of the world population and manifests as pain, edema, stiffness, and reduced joint function, impacting the patient's quality of life. Treatment consists of the pharmacological, non-pharmacological, and surgical modalities. Viscosupplementation (intraarticular hyaluronate) has been proposed to relieve symptoms and potentially postpone surgery. This study estimated the budget impact of the association of this drug and non-surgical treatment (standard treatment) from the perspective of the Brazilian Unified National Health System. Based on the assumption that 5% of patients proceed to treatment and on the direct costs of the pharmacological and non-pharmacological modalities, the authors calculated the reference and alternative scenarios that compared the different treatment options in a three-year timeline. The principal analysis estimated an incremental budget impact of approximately BRL 126 million (U$ 32 million) for one vial of hyaluronate a year and BRL 252 million (USD 64 million) for two vials a year. Diacerein, an oral chondroprotector, assessed as an alternative, showed a budget impact of BRL 334 million (USD 86 million) in relation to standard treatment, representing a 24% cost increase compared to two vials a year of hyaluronate, making it less economically advantageous. Viscosupplementation can provide better quality of life for patients, reduce costs for the health system, and optimize the flow of care in health services. The estimates presented in this study can assist administrators in the best use of resources and thus in decision-making on the technology's incorporation.

Resumen: La osteoartritis de rodilla afecta a cerca de un 3,8% de la población mundial y se manifiesta por dolor, edema, rigidez y reducción de la función articular, impactando en la calidad de vida del paciente. El tratamiento consiste en la modalidad farmacológica, no farmacológica y quirúrgica. La viscosuplementación (ácido hialurónico intraarticular) se propone ofrecer un alivio de los síntomas y la posibilidad de un aplazamiento de la cirugía. Este estudio estimó el impacto presupuestario entre la asociación de este medicamento y el tratamiento no quirúrgico (tratamiento estándar), desde la perspectiva del Sistema Único de Salud. Basándonos en el supuesto de que un 5% de los portadores de la enfermedad siguen el tratamiento y en los costos directos de las modalidades tanto farmacológica, como no farmacológica, se calcularon los escenarios de referencia y alternativos que compararon las diferentes opciones de tratamiento para un horizonte temporal de tres años. El análisis principal estimó un impacto presupuestario incremental de aproximadamente BRL 126 millones (1 ampolla anual) y BRL 252 millones (2 ampollas anuales). En el caso de la diacereína, un condroprotector oral, evaluado como una opción alternativa, mostró un impacto de BRL 334 millones en el presupuesto, respecto al tratamiento estándar, lo que proporciona un aumento de un 24% en el costo, en relación con el uso de 2 ampollas anuales de ácido hialurónico, haciéndola económicamente menos ventajosa. La viscosuplementación puede proporcionar mayor calidad de vida al paciente, reducción de costes para el sistema y la optimización del flujo de atención en las unidades de salud. Las estimaciones presentadas en este estudio pueden ayudar al gestor en lo referente a una mejor utilización de los recursos financieros y, consecuentemente, en la toma de decisiones respecto a la incorporación de tecnología.

Infiltración subacromial de ácido hialurónico en el tratamiento del dolor crónico de hombro. Serie prospectiva de 80 pacientes seguidos durante un año / Subacromial sodium hyaluronate injection for the treatment of chronic shoulder pain: A prospective series of eighty patients

Resumen: Objetivo: Nuestro objetivo fue evaluar la efectividad de las infiltraciones subacromiales de ácido hialurónico en el tratamiento del dolor crónico de hombro como alternativa a los tratamientos quirúrgicos y no quirúrgicos actualmente disponibles. Material y métodos: Estudio prospectivo de 80 pacientes consecutivos con dolor crónico de hombro seguidos durante 12 meses. Se realizaron cinco infiltraciones subacromiales con ácido hialurónico durante cinco semanas consecutivas y se analizaron los resultados clínicos obtenidos. Resultados: La puntuación en la escala de Constant mejoró en 7.7 puntos, el cuestionario DASH disminuyó en cinco puntos y la puntuación en la escala visual analógica para el dolor disminuyó 1.6 puntos por término medio. Los pacientes que presentaban dolor de menos de 24 meses de evolución respondieron mejor al tratamiento. Las mujeres respondieron mejor. Los pacientes con disminución del espacio subacromial o lesión del manguito rotador según la resonancia magnética mejoraron, pero los pacientes que mostraron signos de artrosis acromioclavicular en la resonancia empeoraron en todas las escalas evaluadas. Discusión: Las infiltraciones subacromiales de ácido hialurónico son especialmente efectivas en el tratamiento del dolor crónico de hombro de menos de 24 meses de evolución, con disminución del espacio subacromial o lesión parcial o total del manguito rotador, pero en nuestra experiencia, su resultado no es bueno en pacientes con artrosis acromioclavicular.

Abstract: Objective: Our purpose was to assess the effectiveness of hyaluronic acid infiltrations for chronic shoulder pain as an alternative to the non-surgical and surgical treatments that are currently available. Material and methods: This is a prospective study of 80 consecutive patients suffering from chronic shoulder pain followed for twelve months. Five subacromial hyaluronic acid injections on five consecutive weeks were administrated to all patients. Results: A significant improvement within the whole group after six months was observed. Constant score improved by 7.7 points, DASH questionnaire decreased by 5 points and Visual Analog Scale for pain decreased by 1.6 points. Patients with history of less than 24 months of pain responded better to treatment. Females responded better. Patients with decreased subacromial space or cuff tear in the MRI improved but patients diagnosed by the MRI of acromioclavicular osteoarthritis worsened in all scales assessed. Discussion: Subacromial hyaluronic acid injections are specially effective in patients with history of less than 24 months of pain, a decreased subacromial space or partial or total cuff tear but, in our experience, its result is not good in patients with acromioclavicular osteoarthritis.

Rheological study of hyaluronic acid derivatives

The viscoelastic properties of four novel, low molecular weight hyaluronic acid derivatives were investigated and compared to the parent hyaluronic acid compound. Briefly, all derivatives were synthesized by first deacetylating the parent hyaluronic acid. One sample was left as such, while two others were reacytelated. The final compound, of particular interest for its anti-inflammatory properties, was butyrylated. The compounds were dissolved in phosphate buffer solution (PBS) and studied at a concentration of 5 mg/mL. Shear thinning behaviour was observed for all compounds, however, derivative samples had a lower viscosity than the parent compound at high shear rates. Viscoelastic properties were also observed to decrease as a result of the derivative preparation method. It is believed that these changes are primarily caused by a decrease in hyaluronic acid molecular weight. By increasing the concentration of the anti-inflammatory compound, it may be possible to modulate the viscoelastic properties to more closely resemble those of commercial viscosupplements. As a result, an anti-inflammatory derivative of hyaluronic acid may potentially improve upon existing viscosupplements used to treat patients who are susceptible to flare up.

Hylan GF-20 Viscosupplementation in the Treatment of Symptomatic Osteoarthritis of the Knee: Clinical Effect Survivorship at 5 Years

PURPOSE: Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis. MATERIALS AND METHODS: A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results. RESULTS: Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint. CONCLUSIONS: This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.

Uso de ácido hialurónico en osteoartritis de articulación temporomandibular en paciente adolescente / Use of hyaluronic acid in osteoarthritis of temporomandibular joint in adolescent patient

La osteoartritis es un tipo de trastorno temporomadibular de origen articular, siendo uno de los procesos degenerativos óseos que más comúnmente afectan a la articulación temporomandibular. Se caracteriza por remodelación del hueso subcondral subyacente, deterioro y abrasión del tejido articular. Las infiltraciones intraarticulares de ácido hialurónico se consideran beneficiosas para el tratamiento del dolor y la recuperación de propiedades de los tejidos articulares. El objetivo de éste artículo es describir el uso de ácido hialurónico en el manejo de osteoartritis de articulación temporomandibular en un paciente adolescente. Paciente de sexo femenino, 15 años de edad, presenta dolor de un año de evolución en la región preauricularbilateral, con aumento de dolor en apertura máxima. Considerando el examen clínico e imagenológico se diagnostica una luxación discal con reducción con componente osteoartritico e inflamatorio bilateral. Se indica reposo mandibular, dieta líquida, AINEs y se realiza la aplicación intraarticular de ácido hialurónico(Suprahyalâ 25 mg/2,5 ml) bilateral. Se cita a control a las 2, 3 y 16 semanas donde la paciente se encuentra sin dolor espontaneo y a la palpación. El uso de ácido hialurónico es una de las alternativas terapeúticas más utilizadas para el manejo de la osteoartritis de articulación temporomandibular, sin embargo es necesario que la evidencia de su aplicación intraarticular en adolescentes y niños se consolide.

Osteoarthritis is a type of articular origin Temporomandibular disorders, being one of themost common degenerative processes affecting thetemporomandibular joint. It is characterized byremodeling of the underlying subchondral bone,deterioration and abrasion of articular tissue. Intra-articular injections of hyaluronic acid are considered beneficial for treatment of pain and recovery of joint tissues properties. The aim of this article is to describe the use of hyaluronic acid in the management of osteoarthritis of temporomandibular joint in an adolescent patient. Female patient, 15 years old,presented pain with a year of progress in the bilateral preauricular region, with increased pain at maximum aperture. Considering the clinical and imaging tests the patient was diagnosed with disk displacement with reduction with bilateral osteoarthritic and inflammatory component. Mandibular rest, liquid diet, NSAIDs were indicated and the application of intra-articular hyaluronicacid (Suprahyalâ 25 mg / 2.5 ml) bilaterally. Control was quoted at 2, 3 and 16 weeks where the patient has no spontaneous pain and tenderness. The use of hyaluronic acid is one of the most commonly usedtherapeutic alternatives for the management ofosteoarthritis of temporomandibular joint. However,further evidence of its use in intra-articular application in adolescents and children should be incorporated.

Experimental osteoarthritis model by means of medial meniscectomy in rats and effects of diacerein administration and hyaluronic acid injection / Modelo experimental de osteoartrite através da meniscectomia medial em ratos e efeitos da administração de diacereína e da injeção de ácido hialurônico

CONTEXT AND OBJECTIVE: The development of a slow and progressive mechanical model for osteoarthritis is important for correlation with clinical practice, and for evaluating the effects of disease-modifying medications. A mechanical osteoarthritis model was developed to evaluate the effects of intra-articular hyaluronic acid (HA) injection and oral diacerein administration. DESIGN AND SETTING: Experimental study at the Department of Orthopedics and Traumatology, Universidade de São Paulo. METHOD: Total medial meniscectomy was performed on seven groups of ten Wistar rats each, comprising four control groups (C) and three study groups (S). C.I: operated, non-medicated; C.II: operated, injections of HA vehicle; C.III: non-operated, non-medicated; C.IV: operated, non-medicated, sacrificed three months post-meniscectomy; S.I: operated, receiving intra-articular HA injections; S.II: operated, oral diacerein from the third to the seventh postoperative month; S.III: operated, received both medications. All the animals (except C.IV) were sacrificed seven months post-meniscectomy. All femurs and tibias were assessed histologically. RESULTS: The most severe degenerative histological changes were in the tibias of the operated knees. On the contralateral side, all groups had mild changes on the tibial surface. The femoral surface had ...

CONTEXTO E OBJETIVO: Desenvolver um modelo osteoartrítico mecânico lento e progressivo é importante para correlação com a prática clínica e para avaliar os efeitos de medicamentos modificadores da doença. Um modelo mecânico de osteartrite foi desenvolvido para avaliar os efeitos de injeção intra-articular de hialuronato de sódio (AH) e de administração de diacereína oral. DESENHO E LOCAL: Estudo experimental no Departamento de Ortopedia e Traumatologia, Universidade de São Paulo. MÉTODO: Meniscectomia medial total foi feita em sete grupos de dez ratos Wistar, sendo quatro grupos controle (C) e três grupos estudo (E). C.I: operado, não medicado; C.II: operado, recebendo injeções do veículo do AH; C.III: não operado, não medicado; C.IV: operado, não medicado, sacrificado três meses pósmeniscectomia; EI: operado, recebendo injeções de AH intra-articular; E.II: operado, recebendo diacereína oral do terceiro ao sétimo mês pós-operatório; E.III: operado, recebeu ambas medicações. Todos os animais (exceto C.IV) foram sacrificados sete meses pós-meniscectomia. Todos os fêmures e tíbias foram analisados histologicamente. RESULTADOS: As alterações histológicas degenerativas ...

Efficacy of Direct Injection of Etanercept into Knee Joints for Pain in Moderate and Severe Knee Osteoarthritis

PURPOSE: Osteoarthritic (OA) pain is largely considered to be inflammatory pain. However, during the last stage of knee OA, sensory nerve fibers in the knee are shown to be significantly damaged when the subchondral bone junction is destroyed, and this can induce neuropathic pain. Several authors have reported that tumor necrosis factor-alpha (TNFalpha) in a knee joint plays a crucial role in pain modulation. The purpose of the current study was to evaluate the efficacy of etanercept, a TNFalpha inhibitor, for pain in knee OA. MATERIALS AND METHODS: Thirty-nine patients with knee OA and a 2-4 Kellgren-Lawrence grading were evaluated in this prospective study. Patients were divided into two groups; hyaluronic acid (HA) and etanercept injection. All patients received a single injection into the knee. Pain scores were evaluated before and 4 weeks after injection using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and they were compared between the groups. RESULTS: Before injection, VAS and WOMAC scores were not significantly different between the groups (p>0.05). Significant pain relief was found in the etanercept group at 1 and 2 weeks by VAS, and at 4 weeks by WOMAC score, compared with the HA group (p<0.05). No adverse events were observed in either group. CONCLUSION: Direct injection of etanercept into OA knee joints was an effective treatment for pain in moderate and severe OA patients. Furthermore, this finding suggests that TNFalpha is one factor that induces OA pain.

Efficacy of the Mineral Oil and Hyaluronic Acid Mixture Eye Drops in Murine Dry Eye

PURPOSE: To investigate the therapeutic effects of mineral oil (MO) and hyaluronic acid (HA) mixture eye drops on the tear film and ocular surface in a mouse model of experimental dry eye (EDE). METHODS: Eye drops consisting of 0.1% HA alone or mixed with 0.1%, 0.5%, or 5.0% MO were applied to desiccating stress-induced murine dry eyes. Tear volume, corneal irregularity score, tear film break-up time (TBUT), and corneal fluorescein staining scores were measured at 5 and 10 days after treatment. Ten days after treatment, goblet cells in the conjunctiva were counted after Periodic acid-Schiff staining. RESULTS: There was no significant difference in the tear volume between desiccating stress-induced groups. The corneal irregularity score was lower in the 0.5% MO group compared with the EDE and HA groups. The 0.5% and 5.0% MO groups showed a significant improvement in TBUT compared with the EDE group. Mice treated with 0.1% and 0.5% MO mixture eye drops showed a significant improvement in fluorescein staining scores compared with the EDE group and the HA group. The conjunctival goblet cell count was higher in the 0.5% MO group compared with the EDE group and HA group. CONCLUSIONS: The MO and HA mixture eye drops had a beneficial effect on the tear films and ocular surface of murine dry eye. The application of 0.5% MO and 0.1% HA mixture eye drops could improve corneal irregularity, the corneal fluorescein staining score, and conjunctival goblet cell count compared with 0.1% HA eye drops in the treatment of EDE.

Avaliação de nova técnica não cirúrgica para tratamento de deficiência de papila em área estética: estudo clínico randomizado controlado / New evaluation technique non-surgical for papilla deficiency treatment in cosmetic area: randomized controlled trial

A ausência ou perda da papila interdental cria deficiência estética, problemas fonéticos, impactação alimentar e gera muita expectativa ao paciente. Até o momento, o tratamento da ausência ou perda da papila interdental tem sido mal sucedido e não há estudos que indiquem que a regeneração da papila é um resultado previsível. O objetivo deste estudo foi avaliar a efetividade da injeção de gel de ácido hialurônico de origem não animal na redução ou eliminação da deficiência de papila entre dentes naturais comparativamente ao tratamento por meio de enxerto de tecido conjuntivo subepitelial. Foram avaliados neste estudo 20 sítios de 6 pacientes de ambos os sexos, com idade variável de 29 a 62 anos, apresentando deficiência de papila entre dentes naturais, na região anterior superior, em pelo menos dois dentes. Os 20 sítios tratados foram aleatoriamente divididos em dois grupos, de acordo com o tratamento para correção da deficiência de papila por meio de enxerto de tecido conjuntivo subepitelial (grupo controle) ou por meio de injeção de gel de ácido hialurônico (grupo teste). Um examinador único, calibrado, avaliou a distância da ponta da papila ao ponto de contato com auxílio de sonda periodontal milimetrada antes e aos 1, 3 e 6 meses após o tratamento. Além disso, foram investigados, nos sítios tratados, as medidas de profundidade de sondagem, nível de inserção, índice de sangramento do sulco, índice de placa, distância do ponto de contato à crista óssea alveolar, distância da ponta da papila à crista óssea alveolar e largura da papila. Os resultados demonstraram que aos 6 meses de pósoperatório o percentual de mudança na altura da papila foi maior no grupo teste (14,94% ± 21,35%) do que no grupo controle (-1,39% ± 31,46%), entretanto sem diferenças significantes entre os grupos (p> 0.05). Não houve variação estatisticamente significante na largura da papila antes e aos 4 meses após o tratamento nos grupos teste (p= 0.09) e controle (p= 0.16), assim como não houve variação significativa na distância entre a ponta da papila e a crista óssea alveolar. Houve melhora significativa do Índice de Estética Rosa (IER) observado aos 6 meses de acompanhamento em comparação com a condição inicial no grupo teste (p= 0.0078; Wilcoxon), enquanto que não houve mudança significativa no IER observado no grupo controle aos 6 meses de acompanhamento (p= 0.35). Os resultados obtidos permitiram concluir que o tratamento da deficiência de papila por meio de injeção de gel de ácido hialurônico promove melhora da deficiência de papila, similar aos resultados obtidos com o tratamento por meio de enxerto de tecido conjuntivo subepitelial, porém com melhora estética significativa relacionada especialmente às características de cor e textura do tecido relativamente aos tecidos moles adjacentes.(AU)

The absence or loss of interdental papilla creates an esthetic deficiency, phonetic problems and food impaction and generates a lot of expectation for the patient. Until now, the treatment for absence or loss of interdental papilla is unsuccessful e and there are no researches that show that the papilla regeneration is a predictable outcome. The aim of this study was to evaluate the effectivity of a non-animal originated hyaluronic acid injection in the reduction or elimination of papilla deficiency between natural teeth in comparison to a sub epithelial connective tissue graft treatment. The analysis was made on 20 sites in 6 patients, both genders, 29 - 62 years, showing deficiency in the papilla between natural teeth in the upper anterior region in at least two teeth. The 20 sites treated were randomly divided into two groups, according to the treatment by subepithelial connective tissue graft (control group) or by hyaluronic acid injection (test group). A single calibrated examiner evaluated the distance between the tip of the papilla to the contact point using a graduated periodontal probe before the treatment and 1, 3 and 6 months after it. Besides, it were investigated probing pocket depth, clinical attachment level, gingival bleeding index, plaque index, distance from papilla to alveolar crest, distance from contact point to alveolar crest and width of the papilla. The results showed that 6 months after the procedure, the percentage of change in the papilla level was higher in the test group (14,94% ± 21,35%) than in the control group (-1,39% ± 31,46%), though not statistically significant (p>0.05). There was no significant difference variation in the width of the papilla before and 4 months after the treatment in test group (p=0.09) and control group (p=0.16), and there was no significant difference variation in the distance between the tip of the papilla and the alveolar bone crest. There was significant improvement of the Pink Esthetic Score (PES) after 6 months in comparison to the initial condition in test group (p=0.0078; Wilcoxon), while there was no significant difference in the PES in control group 6 months after treatment (p=0.35). The results allow to conclude that the treatment for of the papilla deficiency using hyaluronic acid injection promotes improvement, similar to the results of the sub epithelial connective tissue graft treatment, but with significant esthetic improvement related specially to the color and texture characteristics of the adjacent soft tissues.(AU)

Treatment of temporomandibular joint disc perforation with injection of hyaluronic acid or disc repair / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To assess the efficacy of injection of sodium hyaluronate in the treatment of patients with disc perforation by using cone- beam computed tomography (CBCT) and temporomandibular joint (TMJ) function.</p><p><b>METHODS</b>Twenty- eight patients (38 joints) with disc perforation observed through arthrography who received injection of sodium hyaluronate and other 20 patients (29 joints) who received disc repair were included in this study. Pain (visual analog scale, scores 0 to 100), maximal mouth opening, modified Helkimo's clinical dysfunction index and TMJ examinations with CBCT were obtained before and 3, 9 months after treatment.</p><p><b>RESULTS</b>A statistically significant increase (P < 0.05) in TMJ clinical outcome was observed at each follow-up. The maximal mouth opening (MMO) increased 5.89 mm and 7.64 mm at 3 and 9 months follow-up in the hyaluronic acid (HA) group, and the MMO increased 2.75 mm and 6.10 mm at 3 and 9 months follow-up in the operation group. Osseous remodeling occurred in 66% (25 of 38 joints) of patients after HA injection and 55% (16 of 29 joints) of patients appeared bone remodeling after disc repair.</p><p><b>CONCLUSIONS</b>Both injection of hyaluronic acid and disc repair are effective for treatment of temporomandibular joint disc perforation.</p>

Effects of Adjuvant Hydrotherapy on Functional Status and Mental Relaxation in Patients with Knee Osteoarthritis: Preliminary Study

BACKGROUND: The aim of this study is to test if adjuvant hydrotherapy with viscosupplement is beneficial on management of pain, stiffness, function, and mental relaxation in knee osteoarthritis (OA). METHODS: Nineteen patients with OA were randomly assigned to hydrotherapy or control groups. All patients received viscosupplement injections once a week for 3 weeks. Hydrotherapy group (n=9) had a spa containing green tea, 3 days a week for 2 weeks. The control group (n=10) received only injections. All patients were assessed at baseline and after the third injection. All were assessed for pain (visual analog scale, VAS), pain severity, and functional status (Western Ontario and McMaster Universities osteoarthritis index, WOMAC), emotional status, quality of life (Euro quality of life health-related quality of life inventory five dimension, EQ-5D), and relative spectral power of alpha waves in electroencephalography (EEG). RESULTS: Both groups reported a statistically significant reduction of pain at the end of treatment and detailed assessment of pain, and function in WOMAC and the relative power of alpha in electroencephalogram showed statistical significant difference only in the hydrotherapy group. However, there were no significant intergroup differences, except for VAS score. CONCLUSION: Adjuvant 2-week hydrotherapy to viscosupplement might have a modest role in the management of pain and functional disability and the mental relaxation in patients with knee OA. Larger, randomized controlled trials with intervention of long term period to determine efficacy in treating knee OA are warranted.

Augmentation of Filtering Blebs with Viscoelastics in Trabeculectomy

PURPOSE: To evaluate the clinical outcome of viscoelastics (VE, sodium hyaluronate)-augmented trabeculectomy (VAT, 66 eyes) and conventional trabeculectomy (CT, 57 eyes) for glaucomatous eyes. METHODS: In the VAT group, half of the anterior chamber space was filled with VE via the paracentesis site at the end of CT and a balanced salt solution was injected into the anterior chamber. This procedure induced migration of VE from the anterior chamber into the bleb space; thus the bleb was elevated with underlying VE. Follow-up examinations were performed until 1 year after surgery. Success was defined as the attainment of an intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of success without antiglaucoma medication, it was regarded as a complete success. RESULTS: The mean postoperative IOP was significantly lower in the VAT group at postoperative 1 day, 1 week, and 1 month. The complete success rate was significantly higher in the VAT group (89%) than in the CT group (75%), though the qualified success rate was not different between the two groups. The number of IOP-lowering medications at postoperative 1 year was significantly higher in the CT group (1.30 ± 1.08 vs. 0.73 ± 0.98, p = 0.003). Among postoperative procedures, laser suture lysis was required less frequently in the VAT group (p < 0.001). CONCLUSIONS: Placing VE within the bleb at the end of surgery may result in better IOP control and less need for IOP-lowering medication without any additional materials, cost, or time.

In Situ Peripheral Iridoplasty in Phakic Eyes for the Treatment of Symptomatic Peripheral Iridotomy

No abstract available.

Intra-articular injections with corticosteroids and sodium hyaluronate for treating temporomandibular joint disorders: a systematic review

INTRODUCTION: In some cases, conservative treatment of internal derangements of the Temporomandibular Joint (TMJ) is considered little responsive. Thus, it is necessary to accomplish treatments that aim at reducing pain and improve patients' functions who present arthrogenic temporomandibular disorders. OBJECTIVE: This study, by means of a systematic review of the literature, aimed to analyze the effectiveness of intra-articular injections with corticosteroids and sodium hyaluronate for treating internal derangements of the TMJ. METHODS: Carry out a research in the following databases: MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs, and BBO, considering publications issued between 1966 and October of 2010, focusing on randomized or quasi-randomized controlled clinical trials, single or double-blind. RESULTS: After applying the inclusion criteria we collected 9 articles, 7 of which were randomized controlled double-blind clinical trials and 2 randomized controlled single-blind clinical trials. CONCLUSION: After analyzing the literature, it was found that intra-articular injection with corticosteroids and sodium hyaluronate seems to be an effective method for treating internal derangements of the TMJ. However, further randomized controlled clinical trials, with representative samples and longer follow-up time must be carried out in order to assess the real effectiveness of this technique.

INTRODUÇÃO: em algumas situações, o tratamento conservador das alterações internas da articulação temporomandibular apresenta-se pouco responsivo. Nessas condições, torna-se necessária a realização de tratamentos que visem reduzir a dor e melhorar a função dos pacientes frente a disfunções temporomandibulares articulares. OBJETIVO: esse trabalho, por meio de uma revisão sistemática de literatura, teve como objetivo analisar a efetividade de infiltrações intra-articulares com corticosteroides e com hialuronato de sódio no tratamento para as alterações internas da ATM. MÉTODOS: foi feito levantamento nas bases de pesquisa MEDLINE, Cochrane, EMBASE, PubMed, Lilacs e BBO, abrangendo os anos de 1966 a outubro de 2010, com enfoque em estudos clínicos controlados randomizados ou quase-randomizados, cegos ou duplo-cegos. RESULTADOS: após a aplicação dos critérios de inclusão, chegou-se a nove artigos, sendo que sete eram estudos clínicos controlados randomizados duplo-cego e dois eram estudos clínicos controlados randomizados apenas cegos. CONCLUSÕES: pela análise da literatura, verifica-se que a infiltração intra-articular com corticosteroides e hialuronato de sódio parece ser um método efetivo no tratamento das alterações internas da ATM. Porém, são necessários mais estudos clínicos controlados randomizados, com amostras representativas e tempo de acompanhamento longo, para avaliar a real efetividade da técnica.

Tempo de reepitelização corneana com a instilação de colírio contendo hialuronato de sódio e carboximetilcelulose / Corneal reepithelialization time with instillation of eye drops containing sodium hyaluronate and carboxymethylcellulose

OBJETIVO: Avaliar o tempo de reepitelização corneana pós abrasão usando colírios comercialmente disponíveis, um contendo hialuronato de sódio a 0,4%, outro contendo carboximetilcelulose a 1%, e comparar com a reepitelização sem instilação de colírio. MÉTODOS: Foram utilizados 24 coelhos, nos quais foi feita a abrasão mecânica da córnea nos 8 mm centrais. Esses animais foram divididos em três grupos. O primeiro grupo recebeu um colírio disponível comercialmente contendo hialuronato de sódio 0,4%, o segundo recebeu um colírio contendo carboximetilcelulose 1% e o terceiro não recebeu nenhuma droga. A avaliação foi feita a cada 24 horas por meio da análise de fotografias digitais sob luz azul de cobalto e coramento das córneas com fluoresceína a 2%. O estudo das imagens foi feito pelo sistema de análise de imagens do Autocad 2009®. A análise dos dados foi feita comparando o tempo total de reepitelização da córnea e a cada 24 horas entre os três grupos. RESULTADOS: A velocidade de reepitelização do grupo que usou colírio contendo hialuronato de sódio foi em média 90 horas; o grupo que usou carboximetilcelulose apresentou média de 105 horas; e o grupo que não usou nenhum tipo de lubrificante apresentou média de 108 horas para total reepitelização. Houve uma melhor performance na reepitelização após 96 horas nas córneas dos coelhos que usaram os colírios lubrificantes, sendo essa diferença estatisticamente comprovada. CONCLUSÃO: O colírio contendo hialuronato de sódio 0,4% mostrou índice de eficácia maior que aquele contendo carboximetilcelulose 1%, e este maior eficácia que o controle. Os resultados encontrados neste estudo mostram que o uso de lubrificantes no processo de reepitelização são de extrema valia e devem ser usados de rotina na clínica oftalmológica.

PURPOSE: Evaluate the time of post-abrasion corneal re-epithelialization using commercially available eye drops, one of which containing 0.4% sodium hialuronate, and the other containing 1% carboxymethylcellulose, and compare them to the re-epithelialization without the drops. METHODS: 24 rabbits were used, which had the mechanical abrasion of the central 8 mm of their corneas done. These animals were divided in 3 groups. The first one received the drops containing 0.4% of sodium hialuronate, the second one received the drops containing 1% of carboxymethylcellulose and the third group did not receive any drugs. The evaluations took place every 24 hours through the analysis of digital pictures under cobalt blue light and coloring of the corneas with 2% fluorescein. The pictures were analyzed with the software Autocad 2009®. The data was analyzed through the comparison of the total re-epithelialization time among the three groups RESULTS: The time of total re-epithelialization of the group using sodium hialuronate was on average 90 hours and the group using carboxymethylcellulose 105 hours, while the group using no drugs was 108 hours. There was a better performance of those groups using the drops and this difference can be proved statistically. CONCLUSION: The drops containing 0.4% of sodium hialuronate showed a higher efficiency rate compared to the drops containing 1% of carboxymethylcellulose, which was higher than the control group. The results of the present study show that the use of lubricants in the process of re-epithelialization are extremely valid and must be used frequently in ophthalmologic clinic.

Effects of one-time and two-time intra-articular injection of hyaluronic acid sodium salt after joint surgery in dogs

Thirty-one dogs with patellar luxation (grades 2 and 3) were categorized into three groups. Group 1 (G.1; n = 12) had sodium hyaluronate (SHA) intra-articularly injected into the stifle joint that received surgery. Group 2 (G.2; n = 10) received SHA twice: first after surgery and then 1 week later. Group 3 (G.3; n = 9) served as a control, without injection. Blood was collected before injection and then once a week for 4 weeks after injection for evaluation of chondroitin sulfate (CS-WF6) and hyaluronan (HA). The results revealed significantly (p 0.05) was observed in serum biomarkers between G.1 and G.2. In conclusion, intra-articular injection with SHA after joint surgery may improve homeostasis of the joint, retarding the process of OA.

A clinical comparison between DisCoVisc and 2% hydroxypropylmethylcellulose in phacoemulsification: a fellow eye study

OBJECTIVE: This study sought to compare the effects and outcomes of two ophthalmic viscosurgical devices, 1.6% hyaluronic acid/4.0% chondroitin sulfate and 2.0% hydroxypropylmethylcellulose, during phacoemulsification. METHODS: This prospective, randomized clinical trial comprised 78 eyes (39 patients) that received phacoemulsification performed by the same surgeon using a standardized technique. Patients were randomly assigned to receive either 1.6% hyaluronic acid/4.0% chondroitin sulfate or 2.0% hydroxypropylmethylcellulose on the first eye. The other eye was treated later and received the other viscoelastic agent. Preoperative and postoperative examinations (5, 24 and 48 hours; 7 and 14 days; 3 and 6 months) included measurements of the total volume of the ophthalmic viscosurgical device, ultrasound and washout times to completely remove the ophthalmic viscosurgical device, intraocular pressure, central corneal thickness and best-corrected visual acuity. The corneal endothelial cell count was measured at baseline and at six months postoperatively. ClinicalTrials.gov: NCT01387620. RESULTS: There were no statistically significant differences between groups in terms of cataract density or ultrasound time. However, it took longer to remove 2.0% hydroxypropylmethylcellulose than 1.6% hyaluronic acid/ 4.0% chondroitin sulfate, and the amount of viscoelastic material used was greater in the 2.0% hydroxypropylmethylcellulose group. In addition, the best-corrected visual acuity was significantly better in the hyaluronic acid/ chondroitin sulfate group, but this preferable outcome was only observed at 24 hours after the operation. There were no statistically significant differences between the two ophthalmic viscosurgical devices regarding the central corneal thickness or intraocular pressure measurements at any point in time. The corneal endothelial cell count was significantly higher in the hyaluronic acid/chondroitin sulfate group. CONCLUSION: The ophthalmic viscosurgical device consisting of 1.6% hyaluronic acid/4.0% chondroitin sulfate was more efficient during phacoemulsification and was easier to remove after IOL implantation than 2.0% hydroxypropylmethylcellulose. In addition, the corneal endothelial cell count was significantly higher following the use of hyaluronic acid/chondroitin sulfate than with hydroxypropylmethylcellulose, which promoted an improved level of corneal endothelium protection.

Viscosuplementación: puesta al día / Viscosupplementation: an update

La osteoartritis es el desorden degenerativo más frecuente de las articulaciones, con una incidencia que se estima va a ir en aumento con el envejecimiento de la población. Clásicamente, los tratamientos han ido orientados a una mejora sintomática, sin interceder mayormente en la evolución natural de la enfermedad. El ácido hialurónico (AH) en la osteoartrits se encuentra en menor concentración y peso molecular, alterando la capacidad del líquido sinovial de absorber y facilitar los movimientos articulares, aumentando la carga y el daño sobre el cartílago. La terapia de viscosuplementación busca restaurar las características originales y así recuperar las propiedades viscoelásticas del líquido sinovial. Sin embargo, se ha observado efectos biológicos adicionales a los mecánicos, lo que prolonga la efectividad en el tiempo. Existen varias formas disponibles de AH en el mercado, con distinto peso molecular y distintas dosis. En general, la inyección de AH es un procedimiento bien tolerado, con baja tasa de efectos adversos. La eficacia en relación a la disminución del dolor y mejoría de la funcionalidad en pacientes con osteoartritis es variable según la articulación afectada, observándose buenos resultados en rodilla, cadera, hombro y tobillo. Se realiza una revisión de la literatura evaluando el mecanismo de acción, formas disponibles, efectos adversos, eficacia y relación costo – beneficio relacionado con la terapia de viscosuplementación.

Osteoarthritis is the most common degenerative disorder of the joints, with an estimated incidence that will be increasing with the aging population. Traditionally, treatments have been expected at symptomatic improvement, mostly without interceding in the natural history of the disease. Hyaluronic acid (HA) in osteoartrits is found in lower molecular weight and lower concentration, altering the ability to absorb fluid and facilitate synovial joint movements, and increasing the load on cartilage. Viscosupplementation therapy seeks to restore the original characteristics and thus recover the viscoelastic properties of synovial fluid. However, biological effects have been observed in addition to the mechanical, prolonging the effectiveness over time. There are several forms of HA available, with different molecular weight and different doses. In general, the injection of HA is a well tolerated procedure, with lower rate of adverse effects. The efficacy in relation to pain reduction and improved function in osteoarthritis patients varies according to the affected joint, showing good results in knee, hip, shoulder and ankle. A review of the literature was conducted, evaluating the mechanism of action, available forms, side effects, efficacy and cost - benefit related to viscosupplementation therapy.