Wiley
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Lumbar Intradiskal Platelet‐Rich Plasma (PRP) Injections: A Prospective, Double‐Blind, Randomized Controlled Study Abstract Objective To determine whether single injections of autologous platelet‐rich plasma (PRP) into symptomatic degenerative intervertebral disks will improve participant‐reported pain and function. Design Prospective, double‐blind, randomized controlled study. Setting Outpatient physiatric spine practice. Participants Adults with chronic (≥6 months), moderate‐to‐severe lumbar diskogenic pain that was unresponsive to conservative treatment. Methods Participants were randomized to receive intradiskal PRP or contrast agent after provocative diskography. Data on pain, physical function, and participant satisfaction were collected at 1 week, 4 weeks, 8 weeks, 6 months, and 1 year. Participants in the control group who did not improve at 8 weeks were offered the option to receive PRP and subsequently followed. Main Outcome Measures Functional Rating Index (FRI), Numeric Rating Scale (NRS) for pain, the pain and physical function domains of the 36‐item Short Form Health Survey, and the modified North American Spine Society (NASS) Outcome Questionnaire were used. Results Forty‐seven participants (29 in the treatment group, 18 in the control group) were analyzed by an independent observer with a 92% follow‐up rate. Over 8 weeks of follow‐up, there were statistically significant improvements in participants who received intradiskal PRP with regards to pain (NRS Best Pain) (P = .02), function (FRI) (P = .03), and patient satisfaction (NASS Outcome Questionnaire) (P = .01) compared with controls. No adverse events of disk space infection, neurologic injury, or progressive herniation were reported following the injection of PRP. Conclusion Participants who received intradiskal PRP showed significant improvements in FRI, NRS Best Pain, and NASS patient satisfaction scores over 8 weeks compared with controls. Those who received PRP maintained significant improvements in FRI scores through at least 1 year of follow‐up. Although these results are promising, further studies are needed to define the subset of participants most likely to respond to biologic intradiskal treatment and the ideal cellular characteristics of the intradiskal PRP injectate.
Tập 8 Số 1 - Trang 1-10 - 2016
Assessment of cognition in early dementia Better tools for assessing cognitive impairment in the early stages of Alzheimer's disease (AD) are required to enable diagnosis of the disease before substantial neurodegeneration has taken place and to allow for detection of subtle changes in the early stages of progression of the disease. The National Institute on Aging and the Alzheimer's Association convened a meeting to discuss state‐of‐the art methods for cognitive assessment, including computerized batteries, as well as new approaches in the pipeline. Speakers described research using novel tests of object recognition, spatial navigation, attentional control, semantic memory, semantic interference, prospective memory, false memory, and executive function as among the tools that could provide earlier identification of individuals with AD. In addition to early detection, there is a need for assessments that reflect real‐world situations so as to better assess functional disability. It is especially important to develop assessment tools that are useful in ethnically, culturally, and linguistically diverse populations as well as in individuals with neurodegenerative disease other than AD.
Tập 7 Số 3 - 2011
Preparation of 3‐chloroacetylpyridine adenine dinucleotide: An alkylating analogue of NAD<sup>+</sup>
Tập 40 Số 1 - Trang 29-32 - 1974
Differential Plantaris‐Achilles Tendon Motion: A Sonographic and Cadaveric Investigation Abstract Background Differential motion between the plantaris and Achilles tendons has been hypothesized to contribute to pain in some patients presenting with Achilles tendinopathy. However, objective evidence of differential Achilles‐plantaris motion is currently lacking from the literature. Objective To determine whether differential, multidirectional motion exists between the plantaris tendon (PT) and Achilles tendon (AT) as documented by dynamic ultrasound (US) and postdissection examination in an unembalmed cadaveric model. Design Prospective, cadaveric laboratory investigation. Setting Procedural skills laboratory in a tertiary medical center. Subjects Twenty unembalmed knee‐ankle‐foot specimens (9 right, 11 left) obtained from 6 male and 10 female donors ages 55‐96 years (mean 80 years) with body mass indices of 14.1‐33.2 kg/m2 (mean 22.5 kg/m2 ). Methods A single, experienced operator used high‐resolution dynamic US to qualitatively document differential PT‐AT motion during passive ankle dorsiflexion‐plantarflexion. Specimens were then dissected and passive dorsiflexion‐plantarflexion was repeated while differential PT‐AT motion was visualized directly. Main Outcome Measurements Presence or absence of multidirectional differential PT‐AT motion. Results All 20 specimens exhibited smooth but variable amplitude multidirectional differential PT‐AT motion. Whereas US readily demonstrated medial‐lateral and anterior‐posterior PT motion relative to the AT, differential longitudinal motion was only appreciated on dissection and direct inspection. Many specimens exhibited partial or complete encasement of the PT between the gastrocnemius portion of the AT and the soleus aponeurosis. Conclusion Some degree of multidirectional differential PT‐AT motion appears to be a normal phenomenon, and PT motion can be evaluated sonographically in both the medial‐lateral and anterior‐posterior directions. The existence of normal differential PT‐AT motion suggests that alterations in PT motion or repetitive stress within the PT‐AT interval may produce symptoms in some patients presenting with Achilles region pain syndromes. The PT should be evaluated in all patients presenting with Achilles, plantaris, or calf pain syndromes. Future research would benefit from the development of a sonographic classification system for PT anatomy and motion with the goal of differentiating normal versus pathologic states and identifying risk factors for symptom development. Level of Evidence IV
Tập 9 Số 7 - Trang 691-698 - 2017