- Amniotic Tissue Modulation of Knee Pain-A Focus on Osteoarthritis. [Journal Article]
- JKJ Knee Surg 2018 Dec 13
- The use of intra-articular therapies as sources of growth factors, anti-inflammatory mediators, and medicinal signaling cells for osteoarthritis (OA) is rapidly evolving. Amnion, chorion, amniotic fl...
The use of intra-articular therapies as sources of growth factors, anti-inflammatory mediators, and medicinal signaling cells for osteoarthritis (OA) is rapidly evolving. Amnion, chorion, amniotic fluid, and the umbilical cord are distinct placental tissues that have been investigated for use in OA. Amniotic membrane (AM) synthesizes a variety of growth factors, cytokines, and vasoactive peptides that modulate inflammation. In addition, they contain amniotic epithelial cells and amniotic mononuclear undifferentiated stromal cells, which have chondrogenic and osteogenic differentiation capacity. AMs are also rich sources of hyaluronic acid and proteoglycans, which could play a role in the potential therapeutic relief of OA. Currently, there are several commercially available formulations of AM that differ based on content as well as how they were preserved. Understanding the processing of amniotic tissue is important because of their distinct mechanical and biologic effects of preservation on AM grafts. To date, there have been two preclinical and only one clinical study on the use of AM for OA, which show promising results. Many high level of evidence clinical trials are currently underway investigating the use of AM of OA. Future basic science and clinical research is warranted to better understand the anti-inflammatory and chondroregenerative properties of amniotic tissue and to determine clinically what amniotic tissue product is most efficacious for symptomatic OA.
- Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review. [Journal Article]
- SHSports Health 2018 Dec 13; :1941738118818060
- CONCLUSIONS: Pectoralis major tendon repair is an effective treatment that results in a high rate of return to sport and work, pain relief, and improved cosmetic appearance, albeit with a significant rate of complication. The evidence supporting all outcomes was limited by the rarity of the injury, the variable surgical techniques, and outcome assessment criteria.
- Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. [Journal Article]
- JAJ Altern Complement Med 2018 Dec 13
- CONCLUSIONS: Administration of oral CBD in addition to routine psychiatric care was associated with PTSD symptom reduction in adults with PTSD. CBD also appeared to offer relief in a subset of patients who reported frequent nightmares as a symptom of their PTSD. Additional clinical investigation, including double-blind, placebo-controlled trials, would be necessary to further substantiate the response to CBD that was observed in this study.
- Patients' expectations of osteotomies around the knee are high regarding activities of daily living. [Journal Article]
- KSKnee Surg Sports Traumatol Arthrosc 2018 Dec 12
- CONCLUSIONS: Patients' expectations of osteotomies around the knee are high in terms of capacity to work, pain relief, and restoring functions. The natural course of osteoarthritis and the potential need for conversion to TKA were underestimated by a substantial proportion of the study population. However, the expectation regarding survival rate is in line with the reported literature. The results of this study should assist surgeons in discussing realistic expectations when considering and counselling patients regarding osteotomies around the knee. This may help to clarify realistic expectations preoperatively and ultimately improve patients' satisfaction.
- Crisis on the game board - a novel approach to teach medical students about disaster medicine. [Journal Article]
- GJGMS J Med Educ 2018; 35(4):Doc46
- Introduction: Every year, natural and other disasters cause significant loss of life around the world. This calls for an improved response from, among others, the health professions to strengthen dis...
Introduction: Every year, natural and other disasters cause significant loss of life around the world. This calls for an improved response from, among others, the health professions to strengthen disaster medicine, whether relating to prevention, emergency response or recovery. It includes both knowledge and competencies, such as planning, coordination, and communication. Simulations can be used to acquire these competencies. Project description: In 2016, the German Medical Students' Association founded the project "Disaster Medicine" with the goal of educating and connecting medical students interested in the topic. AFTERSHOCK, a board game simulating early disaster response after an earthquake, was utilized for workshops. It highlights the need for interagency cooperation and the challenges of responding to disasters in dynamic and highly complex settings. Seven workshops were facilitated between October 2016 and December 2017. A survey was conducted to assess participant satisfaction and the design of the workshop. Results: 89 German medical students participated and 74 (83 %) responded with written evaluation. Students generally reported moderate to low levels of previous knowledge. The event produced very positive feedback, with participants overwhelmingly finding the simulation to be a useful or very useful way to learn about the challenges of humanitarian assistance and disaster relief. Qualitative feedback included requests for more theoretical background information and highlighted the need for small group sizes. Discussion and Conclusion: Board games such as AFTERSHOCK are well-suited for medical education and enjoy high rates of acceptance among students. To ensure deeper and longer-term learning, they should be accompanied by theoretical coursework.
- Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis. [Journal Article]
- JPJ Pain Res 2018; 11:2943-2948
- CONCLUSIONS: Stand-alone IPD is associated with a marked decrease in the need for opioid medications to manage symptoms related to LSS. In light of the current opiate epidemic, such alternatives as IPD may provide effective pain relief in patients with LSS without the need for opioid therapy.
- Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials. [Review]
- LRLocal Reg Anesth 2018; 11:91-109
- Regional anesthesia is becoming increasingly popular among anesthesiologists in the management of postoperative analgesia following pediatric surgery. The main objective of this review was to systema...
Regional anesthesia is becoming increasingly popular among anesthesiologists in the management of postoperative analgesia following pediatric surgery. The main objective of this review was to systematically evaluate the last 5 years of randomized controlled trials on the role of regional anesthesia techniques in alleviating postoperative pain associated with various pediatric surgical procedures. Forty studies on 2,408 pediatric patients were evaluated. The majority of the articles published from 2013 to 2017 reported that the use of regional anesthesia minimized postoperative pain and reduced opioid consumption. Only a few surgical procedures (cholecystectomy, inguinal hernia repair, and non-laparoscopic major abdominal surgery) reported no significant difference in the postoperative pain relief compared with the standard anesthetic management. The growing number of randomized controlled trials in the pediatric literature is very promising; however, additional confirmation is needed to reinforce the use of specific regional anesthesia techniques to provide optimal postoperative pain relief for a few surgical procedures (reconstructive ear surgery, chest wall deformity, hypospadias, umbilical hernia, cleft palate repair) in pediatric patients. More randomized controlled trials are needed to establish regional anesthesia as an essential component of postoperative analgesia management in children.
- Intra-articular Corticosteroid Injections for Symptomatic Knee Osteoarthritis: What the Orthopaedic Provider Needs to Know. [Journal Article]
- JAJ Am Acad Orthop Surg 2018 Dec 05
- Intra-articular corticosteroid injections have been used for decades in the management of symptomatic osteoarthritis of the knee and remain a common practice. The pain relief from a steroid injection...
Intra-articular corticosteroid injections have been used for decades in the management of symptomatic osteoarthritis of the knee and remain a common practice. The pain relief from a steroid injection is thought to work by reducing inflammation within the arthritic knee. Substantial variability remains among providers with regard to the technique used to perform the procedure, including the site of the injection, the medications injected, and the level of sterility. The success of steroid injections in relieving arthritic knee pain most often occurs in the short term. However, the efficacy of intra-articular corticosteroid injections varies within the published literature. The latest American Academy of Orthopaedic Surgeons clinical practice guideline does not support conclusive recommendations about the use of intra-articular corticosteroid injections for symptomatic knee osteoarthritis. Providers should be aware of the adverse effects and potential complications of these injections when using them in clinical practice.
- Penetration and efficacy of transdermal NSAIDs in a model of acute joint inflammation. [Journal Article]
- JPJ Pain Res 2018; 11:2809-2819
- CONCLUSIONS: DEL formulations of ibuprofen and celecoxib successfully introduced these NSAIDs into synovial fluid at concentrations similar to those observed in circulation. Furthermore, these formulations reduced symptoms of pain associated with acute inflammation. Oral and transdermally delivered NSAIDs have similar pain relief effects; therefore, a replacement or combinatorial treatment may provide a more stable pain relief profile. In conclusion, this work supports further investigation of TD products in the treatment of regional inflammatory events.
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- Gender, genetics, and analgesia: understanding the differences in response to pain relief. [Review]
- JPJ Pain Res 2018; 11:2729-2739
- Genetic variations and gender contribute significantly to the large interpatient variations in opioid-related serious adverse effects and differences in pain relief with other analgesics. Opioids are...
Genetic variations and gender contribute significantly to the large interpatient variations in opioid-related serious adverse effects and differences in pain relief with other analgesics. Opioids are the most commonly used analgesics to relieve moderate-to-severe postoperative pain. Narrow therapeutic index and unexplained large interpatient variations in opioid-related serious adverse effects and analgesia negatively affect optimal perioperative outcomes. In surgical, experimental, chronic, and neuropathic pain models, females have been reported to have more pain than males. This review focuses on literature evidence of differences in pain relief due to multiple genetic variations and gender of the patient.