Pain and functional outcomes of the sacroiliac joint after platelet-rich plasma injection: a descriptive review.

The purpose of this manuscript is to highlight and review the status of literature regarding efficacy of platelet-rich plasma (PRP) in the treatment of sacroiliac joint (SIJ) dysfunction. A review of the literature on PRP interventions on the SIJ or ligaments was performed. Seven studies had improvements in their respective primary end point and demonstrated a strong safety profile without any serious adverse events. Only five articles demonstrated clinical efficacy of >50% in their primary outcome measures. There appears to be inconsistent and insufficient evidence for a conclusive recommendation for or against SIJ PRP. There is a need for adequately powered well-designed, standardized, double-blinded randomized clinical trials to determine the effectiveness of PRP in SIJ-mediated pain.

Non-operative orthobiologic use for rotator cuff disorders and glenohumeral osteoarthritis: A systematic review.

BACKGROUND: Shoulder pain from rotator cuff pathology and glenohumeral osteoarthritis is a common entity encountered in musculoskeletal practices. Orthobiologic agents are being increasingly used as a treatment option and understanding their safety and efficacy is necessary. OBJECTIVE: To systematically evaluate the available evidence for orthobiologic use in rotator cuff and glenohumeral pathology. METHODS: A systematic review was undertaken following PRISMA guidelines. Randomized clinical trials (RCTs) and prospective cohort studies evaluating non-operative treatment with prolotherapy, platelet-rich plasma (PRP), or medicinal signaling cells (MSCs) for rotator cuff pathology and glenohumeral osteoarthritis were included. Bias risk assessments used were the Cochrane tool and Newcastle-Ottawa score. RESULTS: The search yielded 852 potential articles, of which 20 met the inclusion criteria with a breakdown of 5 prolotherapy, 13 PRP, and 2 MSC. Sixteen studies were RCTs and 4 were cohort studies. Six studies were deemed "low risk of bias or good quality". Efficacy results were mixed, and no serious adverse events were reported from orthobiologic treatment. CONCLUSIONS: Orthobiologics offer a relatively safe management option with inconclusive evidence for or against its use for rotator cuff pathology. No studies on glenohumeral osteoarthritis met the inclusion criteria. Adoption of standardized preparation reporting and consistent use of functional outcome measures is imperative for future studies to consider.

Assessing clinical implications and perspectives of the pathophysiological effects of erythrocytes and plasma free hemoglobin in autologous biologics for use in musculoskeletal regenerative medicine therapies. A review.

Autologous biologics, defined as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC), are cell-based therapy treatment options in regenerative medicine practices, and have been increasingly used in orthopedics, sports medicine, and spinal disorders. These biological products are produced at point-of-care; thereby, avoiding expensive and cumbersome culturing and expansion techniques. Numerous commercial PRP and BMC systems are available but reports and knowledge of bio-cellular formulations produced by these systems are limited. This limited information hinders evaluating clinical and research outcomes and thus making conclusions about their biological effectiveness. Some of their important cellular and protein properties have not been characterized, which is critical for understanding the mechanisms of actions involved in tissue regenerative processes. The presence and role of red blood cells (RBCs) in any biologic has not been addressed extensively. Furthermore, some of the pathophysiological effects and phenomena related to RBCs have not been studied. A lack of a complete understanding of all of the biological components and their functional consequences hampers the development of clinical standards for any biological preparation. This paper aims to review the clinical implications and pathophysiological effects of RBCs in PRP and BMC; emphasizes hemolysis, eryptosis, and the release of macrophage inhibitory factor; and explains several effects on the microenvironment, such as inflammation, oxidative stress, vasoconstriction, and impaired cell metabolism.

Suppression of stimulated Brillouin scattering in high power fibers using nonlinear phase demodulation.

We demonstrate a modulation approach that relaxes the limitations imposed by stimulated Brillouin scattering (SBS) on amplification and propagation of narrow-linewidth light in fibers. By imposing synchronous amplitude and phase modulation on an input field, the optical spectrum after high-power fiber transmission is compressed using nonlinear self-phase modulation. This effectively reduces the SBS interaction length and increases the SBS threshold, enabling narrower linewidths. Using this technique, we demonstrate >2 × increase in SBS-limited spectral brightness from a kW-class amplifier. We show that SBS suppression becomes more effective for higher powers and longer fibers.

Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison.

BACKGROUND: In vivo amniotic fluid is known to contain a population of mesenchymal stem cells (MSCs) and growth factors and has been shown to assist in healing when used as an adjunct in procedures across multiple medical specialties. It is unclear whether amniotic fluid products (AFPs) contain MSCs and, if so, whether the cells remain viable after processing. PURPOSE: To determine whether MSCs, growth factors, and hyaluronan are present in commercially available AFPs. STUDY DESIGN: Descriptive laboratory study. METHODS: Seven commercial companies that provide amniotic fluid were invited to participate in the study; 3 companies (the manufacturers of PalinGen, FloGraft, and Genesis AFPs) agreed to participate and donated AFPs for analysis. The AFPs were evaluated for the presence of MSCs, various growth factors relevant to orthopaedics (platelet-derived growth factor ßß, vascular endothelial growth factor, interleukin 8, bone morphogenetic protein 2, transforming growth factor ß1), and hyaluronan by enzyme-linked immunosorbent assay and culture of fibroblast colony-forming units. These products were compared with unprocessed amniotic fluid and 2 separate samples of MSCs derived from human bone marrow aspirates. All groups used the same culture medium and expansion techniques. Identical testing and analysis procedures were used for all samples. RESULTS: MSCs could not be identified in the commercial AFPs or the unprocessed amniotic fluid. MSCs could be cultured from the bone marrow aspirates. Nucleated cells were found in 2 products (PalinGen and FloGraft), but most of these cells were dead. The few living cells did not exhibit established characteristics of MSCs. Growth factors and hyaluronan were present in all groups at varying levels. CONCLUSION: The AFPs studied should not be considered "stem cell" therapies, and researchers should use caution when evaluating commercial claims that products contain stem cells. Given their growth factor content, however, AFPs may still represent a promising tool for orthopaedic treatment. CLINICAL RELEVANCE: Amniotic fluid has been proposed as an allogenic means for introducing MSCs. This study was unable to confirm that commercial AFPs contain MSCs.

Bone Marrow-Derived and Adipose-Derived Mesenchymal Stem Cell Therapy in Primary Knee Osteoarthritis: A Narrative Review.

Regenerative medicine in the context of musculoskeletal injury is a broad term that offers potential therapeutic solutions to restore or repair damaged tissue. The current focus in recent literature and clinical practice has been on cell based therapy. In particular, much attention has been centered on autologous bone marrow concentrate and adipose-derived mesenchymal stem cells (MSCs) for cartilage and tendon disorders. This article provides an overview of MSC-derived therapy and offers a comprehensive review of adipose- and bone marrow-derived MSC therapy in primary knee osteoarthritis. LEVEL OF EVIDENCE: IV.

The Role of Low-Intensity Pulsed Ultrasound on Cartilage Healing in Knee Osteoarthritis: A Review.

Ultrasound (US) is a therapeutic modality that has been used in the treatment of musculoskeletal conditions for decades. In recent years, there have been technological advancements using low-intensity pulsed ultrasound (LIPUS) as a clinical modality. The purpose of this review was to critically examine the medical literature to determine the effects of LIPUS on the chondrogenic properties of knee osteoarthritis. A literature search of 3 major databases (PubMed, Scopus, and EMBASE) was performed. Two independent physician reviewers screened titles and abstracts, yielding a total of 18 relevant articles after the inclusion and exclusion criteria were applied. Results favored that LIPUS has a promising effect on the cellular elements in articular cartilage, specifically on chondrocytes in knee osteoarthritis. Although the use of LIPUS is encouraging based on basic science and preclinical data, there is a paucity of evidence with respect to humans. Consequently, there is insufficient evidence to recommend for or against LIPUS in clinical OA populations. We suggest future directions for research centered on LIPUS in both human and animal models to delineate the effect on the biologic properties of cartilage in knee osteoarthritis. LEVEL OF EVIDENCE: III.

Intractable Seizures and Rehabilitation in Ciguatera Poisoning.

Ciguatera fish poisoning is the most frequently reported seafood toxin illness associated with the ingestion of contaminated tropical fish. Diagnosis relies on a history of recent tropical fish ingestion and subsequent development of gastrointestinal, cardiovascular, and neurological symptoms. Ciguatera poisoning usually has a self-limited time course, and its management involves symptomatic control and supportive care. This case report presents an uncommon case of ciguatera poisoning with prolonged intractable seizures refractory to standard antiseizure medications. The patient also had significant functional decline that responded to rigorous inpatient rehabilitation not previously described in literature.

Atmospheric propagation and combining of high power lasers: comment.

Nelson et al. [Appl. Opt.55, 1757 (2016)APOPAI0003-693510.1364/AO.55.001757] recently concluded that coherent beam combining and remote phase locking of high-power lasers are fundamentally limited by the laser source linewidth. These conclusions are incorrect and not relevant to practical high-power coherently combined laser architectures.

Two-dimensional diffractive coherent combining of 15 fiber amplifiers into a 600 W beam.

We demonstrate coherent beam combining using a two-dimensionally patterned diffractive optic combining element. Fifteen Yb-doped fiber amplifier beams arranged in a 3×5 array were combined into a single 600 W, M²=1.1 output beam with 68% combining efficiency. Combining losses under thermally stable conditions at 485 W were found to be dominated by spatial mode-mismatch between the free space input beams, in quantitative agreement with calculations using the measured amplitude and phase profiles of the input beams.

Diffractive coherent combining of a 2.5 kW fiber laser array into a 1.9 kW Gaussian beam.

Five 500 W fiber amplifiers were coherently combined using a diffractive optical element combiner, generating a 1.93 kW beam whose M(2)=1.1 beam quality exceeded that of the inputs. Combining efficiency near 90% at low powers degraded to 79% at full power owing to thermal expansion of the fiber tip array.

Perturbative analysis of coherent combining efficiency with mismatched lasers.

Coherent combining efficiency is examined analytically for large arrays of non-ideal lasers combined using filled aperture elements with nonuniform splitting ratios. Perturbative expressions are developed for efficiency loss from combiner splitting ratios, power imbalance, spatial misalignments, beam profile nonuniformities, pointing and wavefront errors, depolarization, and temporal dephasing of array elements. It is shown that coupling efficiency of arrays is driven by non-common spatial aberrations, and that common-path aberrations have no impact on coherent combining efficiency. We derive expressions for misalignment losses of Gaussian beams, providing tolerancing metrics for co-alignment and uniformity of arrays of single-mode fiber lasers.

Active phase and polarization locking of a 1.4 kW fiber amplifier.

A three-stage Yb-fiber amplifier emitted 1.43 kW of single-mode power when seeded with a 25 GHz linewidth master oscillator (MO). The amplified output was polarization stabilized and phase locked using active heterodyne phase control. A low-power sample of the output beam was coherently combined to a second fiber amplifier with 90% visibility. The measured combining efficiency agreed with estimated decoherence effects from fiber nonlinearity, linewidth, and phase-locking accuracy. This is the highest-power fiber laser that has been coherently locked using any method that allows brightness scaling.

Low-phase-noise, single-frequency, single-mode 608 W thulium fiber amplifier.

A chain of four Tm-doped fibers amplified a single-frequency, 2040 nm diode laser to 608 W with M(2)=1.05+/-0.03, limited by available pump power. Stimulated Brillouin scattering limits were investigated by splicing different lengths of passive fiber to the output of the final amplifier stage. Integrated rms phase noise above 1 kHz was less than lambda/30, suggesting the possibility of further scaling via coherent beam combining. To our knowledge, this is the highest power obtained from any single-frequency, single-mode fiber laser.

Phase-only sampled 45 channel fiber Bragg grating written with a diffraction-compensated phase mask.

A novel phase-only sampled 45 channel fiber Bragg grating (channel spacing, 100 GHz) with high interchannel and intrachannel reflection uniformity and precise dispersion matching capability to an 80 km SMF-28 fiber is demonstrated. This grating is fabricated by the side-writing technique, in which phase information of continuous phase-only sampling is completely incorporated into a diffraction-compensated phase mask.

Optimization of a continuous phase-only sampling for high channel-count fiber Bragg gratings.

A novel continuous phase-only sampling function capable of producing up to 81-channel FBG with excellent channel uniformity and high in-band energy efficiency is presented and optimized by using the simulated annealing algorithm. In order to fabricate this kind of FBG with a conventional side-writing phase-mask technique, both the diffraction effects and fabrication tolerance of the phase-shifted phase mask have also been addressed. Compared with the numerical results, a 45-channel (spacing 100 GHz) and an 81-channel (spacing of 50 GHz) phase-only sampled linearly chirped FBG are successfully demonstrated.

Influence of cladding-mode coupling losses on the spectrum of a linearly chirped multi-channel fiber bragg grating.

Influence of cladding-mode coupling losses on the spectrum of multi-channel fiber Bragg grating (FBG) has been numerically investigated on the basis of the extended coupled-mode equations. It has been shown that there exists a reflection slope in the spectrum of both the intra- and inter-channels due to the existences of the cladding modes. This slope could be larger than 1 dB when the induced index change is about 3x10-3, which makes the channels considerably asymmetric. For comparison, a 39-channel linearly chirped FBG with a channel spacing of 0.8 nm and a chromatic dispersion of -850 ps/nm has been designed and fabricated. The experimental results show good agreement with the numerical ones. Finally, one method to pre-compensate the reflection slope within the intra-channels has been proposed and successfully demonstrated.