This article aims to provide a comprehensive review of the current literature that pertains to the therapeutic use of autologous platelet-rich plasma (PRP). The basic science literature regarding the role of growth factors in mediating the healing process and the laboratory data from in vitro and in vivo studies that evaluated PRP are reviewed. Subsequently, the current evidence regarding PRP efficacy from animal models, human surgical studies, and human clinical studies is presented. A critical analysis of the literature follows, and the article concludes with the authors' perspectives on the state of PRP as a potentially efficacious bioregenerative treatment option for musculoskeletal and sports medicine applications. The relevant articles in this review were obtained via PubMed literature searches for PRP publications that pertain to musculoskeletal and sports medicine conditions. This article is not intended to be a formal meta-analysis.
This study aims to examine whether or not cancer stem cells exist in malignant peripheral nerve sheath tumors (MPNST). Cells of established lines, primary cultures and freshly dissected tumors were cultured in serum free conditions supplemented with epidermal and fibroblast growth factors. From one established human MPNST cell line, S462, cells meeting the criteria for cancer stem cells were isolated. Clonal spheres were obtained, which could be passaged multiple times. Enrichment of stem cell-like cells in these spheres was also supported by increased expression of stem cell markers such as CD133, Oct4, Nestin and NGFR, and decreased expression of mature cell markers such as CD90 and NCAM. Furthermore, cells of these clonal S462 spheres differentiated into Schwann cells, smooth muscle/fibroblast and neurons-like cells under specific differentiation-inducing cultural conditions. Finally, subcutaneous injection of the spheres into immunodeficient nude mice led to tumor formation at a higher rate compared to the parental adherent cells (66% versus 10% at 2.5×105). These results provide evidence for the existence of cancer stem cell-like cells in malignant peripheral nerve sheath tumors.
Regenerative therapy involves the injection of a small volume of solution into multiple sites of painful ligament and tendon insertions (entheses) and adjacent joint spaces, with the goal of reducing pain and ostensibly promoting tissue repair and growth. Dextrose and platelet-rich plasma solutions have been shown to increase expression of growth factors in vivo and have shown promising clinical results in the treatment of tendinosus. In the treatment of osteoarthritis, small clinical trials and case series to date suggest safety, symptomatic improvement, and functional improvement at up to a year of follow-up; however, most of these studies are uncontrolled. Given the methodological limitations of clinical research on regenerative injections for osteoarthritis to date, this treatment should be considered only after execution of a comprehensive assessment and treatment plan, including optimization of biomechanics, weight loss, cardiovascular exercise, resistance training, and judicious use of more established topical, oral, and injectable medications.
Evidence suggests that effective conservative treatment is available for chronic low back pain. The effectiveness of conservative treatment has recently received attention following publication of several randomized controlled trials (RCTs) that reported similar improvements in outcomes from cognitive intervention with exercise as from spinal fusion surgery. This paper will explore the conservative treatment arms of these RCTs with the goal of educating the reader about the principles of cognitive intervention with exercise. These principles can be incorporated into the care of chronic low back pain patients both as primary treatment and as a means of augmenting surgical outcomes.Recent randomized controlled trials (RCTs) by Brox (1) and Fairbank (2) captured the attention of spine surgeons and medical spine care providers. Both studies compared the effectiveness of two treatments for chronic low back pain -lumbar spine fusion (stabilization), and a cognitive intervention with exercise. Surprisingly, both studies demonstrated that each intervention produced statistically similar reductions in disability.The findings of similar disability outcome from both arms of these RCTs are certainly intriguing, especially as lumbar fusion and cognitive intervention with exercise are completely different approaches to the problem of chronic low back pain. All spine surgeons understand the theoretical basis for lumbar fusion as a treatment for chronic low back pain. It is an intervention thought to reduce pain by eliminating the pain generator -the degenerative discand/or by limiting motion, and thus the ability to stimulate pain at the degenerated motion segments. Many spine surgeons have a less complete understanding of the comparative arms in these RCTs -cognitive intervention with exercise. Because of this, many surgeons are not as familiar with how to incorporate the principals of cognitive intervention with exercise into the care of both their surgical and non-surgical back pain patients. This article will attempt to improve readers' understanding of cognitive intervention with exercise by carefully reviewing these RCTs with special attention to the conservative treatment utilized. It will also review companion studies and other selected RCTs exploring cognitive treatment with exercise, with the goal of enhancing the understanding of the components of this intervention and exploring ways in which these components can be harnessed to maximize clinical outcomes in surgical and nonsurgical patients alike.Corresponding Author: James Rainville, MD, The Spine Center, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120 USA, (617)754-5246, (617)754-6332, jrainvil@vcaregroup.harvard.edu. None of the authors have any conflict of interest regarding the contents of this article.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediti...
This study highlights clear differences regarding the presentation, localization and associations of PAD in the West Indies subjects managed in vascular surgery, especially with a severe infragenicular disease, even in claudicants. This study suggests the effect of a different distribution of risk factors as well as other ethnic and socio-economic factors.
Within this rehabilitation hospital's experience, the mean length of stay was reduced after the implementation of the LTCI. Although it was one of the primary goals of the LTCI, the rate of discharge to home did not significantly increase. Further evaluation and modification of the LTCI and more efforts to improve a patient's activities of daily living and ambulatory status at discharge will be necessary to promote in-home care in Japan.
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