Hyaluronate Group Research Articles

Effects of 0.2% Hyaluronic Acid Gel-Impregnated Dental Floss on Clinical Gingival Parameters: A Randomised Clinical Trial.

Gingivitis is a common inflammatory lesion caused by the build-up of oral biofilm and is an essential precursor to periodontitis. For its treatment, oral hygiene habits, such as dental flossing, must be improved, and adjunctive materials, such as hyaluronic acid, may be used to reduce plaque formation and gingival inflammation. This study aimed to assess the effects of 0.2% hyaluronic acid gel-impregnated dental floss on the clinical periodontal markers of patients with gingivitis. This clinical study adopted a split-mouth, randomised controlled trial design. After clinical data were assessed at baseline, and supragingival scaling was performed, bilateral gingivitis regions were randomly allocated to either the hyaluronic acid gel-impregnated floss group or just the floss group using a computer-generated randomisation table. Clinical parameters were recorded at 1, 2 and 4 weeks after treatment. Over the 4-week trial period, all patients showed significant improvements in all clinical periodontal markers. The 1-week plaque index, 4-week gingival index and 4-week papillary bleeding index were significantly lower in the test group than in the control group (p < 0.05). The use of hyaluronic acid-impregnated dental floss has resulted in more significant improvements in clinical periodontal parameters compared to dental floss alone. For ease of use, ready-made products with this innovative formulation may be produced. ClinicalTrials.gov identifier: NCT06307041.

Assessing the Influence of Hyaluronan Dressing on Wound Healing on Split-Thickness Skin Graft Donor Sites Using a Three-Dimensional Scanner.

Objectives: The topical application of hyaluronic acid after injury may accelerate the wound healing process. We aimed to retrospectively investigate whether the topical application of hyaluronic acid on standardized wounds after split-thickness skin graft removal on the thigh would accelerate wound healing and improve scarring outcomes. Additionally, we aimed to evaluate the usefulness of three-dimensional (3D) scanning to assess scars. Methods: The wound healing process of a hyaluronan group (n = 20) and a control (n = 21) were analyzed and evaluated using 3D scans at 7 and 14 days and 1, 3, and 6 months post-operatively. Scar evaluations by the patients were conducted 6 months post-operatively using the patient and observer scar assessment scale and the Manchester scar scale. Experts evaluated the scars after 6 months using a modified version of both scales. Results: On days 7 and 14, significantly larger areas of the wound surface were closed in the hyaluronan group compared to the control group (p < 0.05). After 1 month, significantly more crusted areas remained in the control group than in the hyaluronan group (p < 0.05). At the 6-month self-assessments, the hyaluronan group evaluated their scars as being significantly better compared to the control group. Conclusions: The topical application of hyaluronic acid in combination with polyurethane foam as a wound dressing after split skin removal accelerated the wound healing rate and positively influenced scar appearance after 6 months. Three-dimensional scanning is useful for evaluating and documenting the wound healing process.

The Toll-like receptor 4 antagonist TAK-242 in combination with sodium hyaluronate alleviates postoperative abdominal adhesion in a mouse model

Postoperative abdominal adhesion is one of the most common complications after abdominal surgery. The Toll-like receptor 4 (TLR4) signaling pathway is one of the most common inflammation-related pathways, and it has been demonstrated that TLR4 is highly expressed in adhesive tissues; however, the function of TLR4 in adhesion formation has not yet been studied. In the present study, the expression of TLR4 was first detected by immunohistochemical (IHC) and double-immunofluorescence staining in 40 mice, which were randomly divided into four groups, and sacrificed at 1, 3, 5 and 7 days after surgery. Subsequently, another 40 mice were randomly divided into five groups; with the exception of the sham group, the other groups were modeled and treated with saline that contained DMSO, sodium hyaluronate (HA), TAK-242 or TAK-242 + HA (applied to damaged peritoneal wounds). A total of 7 days after surgery, the mice were sacrificed and specimens were collected. Inflammation was detected by hematoxylin and eosin staining, and ELISA of transforming growth factor- β1 (TGF-β1) and interleukin-6 (IL-6); collagen deposition was examined by Masson staining and IHC staining of α-SMA; and reactive oxygen species (ROS) were detected by ROS staining and malondialdehyde (MDA) assay. The results revealed that TLR4 was highly expressed in the adhesive tissues at 3, 5 and 7 days after surgery. In addition, TAK-242 + HA treatment could reduce abdominal adhesion formation, exhibiting lower Nair’s score and inflammation scores, lower TGF-β1 and IL-6 levels, and lower collagen thickness and α-SMA levels compared with those in the control group. In addition, the TAK-242 + HA group had lower levels of ROS and MDA compared with those in the control group. The present study revealed that TLR4 was highly expressed in the process of adhesion formation and its inhibitor, TAK-242, combined with HA, could reduce adhesion formation by reducing inflammation and ROS, and alleviating collagen deposition.

Use of Tear Substitutes to enhance the Image Quality of the Optic Nerve and Retina by Optical Coherence Tomography

&amp;lt;i&amp;gt;Background &amp; Objectives&amp;lt;/i&amp;gt;: Dry eye disease (DED) has become very prevalent, with the increased usage of internet and video terminals. The present study was carried out to compare the efficacy of tear substitutes in enhancing the signal strength of measurements of optic nerve head, retinal nerve fiber layer and macula by Optical coherence tomography (OCT), and resultant change in image quality. Thus proving the role of artificial tear substitutes in increasing the diagnostic accuracy of Optical coherence tomography (OCT) measurements. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: A double blinded randomized control trial was performed on one hundred and fifty patients needing optical coherence tomography. They were randomly allocated into three groups to receive any one of the three tear substitutes Group 1 –Sodium hyaluronate (Molecular Weight M Wt 799.6g/mol) Group 2 – Poly ethylene glycol (Molecular Weight M Wt 400g/mol), Group -3 Hydroxy Propyl Methyl cellulose (Molecular Weight M Wt 1261.4 g/mol); Measurement of signal strength for optic nerve head, retinal nerve fiber thickness RNFL and sub foveal thickness SFT was done before and after instillation of tear substitutes. Data was analyzed using the Statistical Package for Social Sciences SPSS 22 version software. P value &amp;lt;0.05 was considered statistically significant. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The groups were comparable with respect to mean age and gender distribution. The mean signal strength (SS) of Optic Nerve Head (ONH) evaluation improved in all the groups in both eyes. The increase was the highest in Group II in both eyes. The increase in retinal nerve fiber layer thickness [RNFL] was seen in both eyes in all the groups. Improvement in macular evaluation sub foveal thickness (SFT) was seen in Group II of both eyes and group III in the Left eye. &amp;lt;i&amp;gt;Interpretation and Conclusion&amp;lt;/i&amp;gt;: All tear substitutes improved the quality of the image but the improvement varied with regard to the parameters measured, thus proving artificial tear application is an essential for Optical coherence tomography OCT measurements in persons prone to dry eye This reduces the scope for error due to bad images and thereby the possibility of misdiagnosis of ophthalmic disease.

The effect of intense pulsed light combined with topical 0.05% Cyclosporin A eyedrops in the treatment of Sjögren’s syndrome related dry eye

ABSTRACT Objectives This study aimed to assess the effectiveness and safety of intense pulsed light (IPL) therapy plus topical 0.05% cyclosporine A (CsA) eye drops to treat Sjögren’s Syndrome-related dry eyes (SS-DE). Research design and methods In this prospective, randomized trial included, 60 individuals with SS-DE symptoms were randomized to receive topical eye drops containing either 0.1% sodium hyaluronate (Group S) or 0.05% CsA (Group C) plus IPL therapy. Before the first treatment (baseline), and at 12, 16, and 20 weeks after treatment commencement, we assessed the best corrected visual acuity (BCVA), the Ocular Surface Disease Index (OSDI) score, the Schirmer I test (SIT), noninvasive tear breakup time (NBUT), corneal fluorescein staining (CFS), meibomian gland (MG) dropout, lid margin abnormality, MG expressibility, and meibum quality. Results Both groups showed significant improvements in the OSDI, NBUT, CFS, MG expressibility, and meibum quality (all p < 0.05). Group C showed a greater increase in OSDI, NBUT, MG expressibility, and meibum quality (all p < 0.05). Moreover, SIT and lid margin abnormalities significantly improved in Group C (both p < 0.05), but not in Group S. Conclusion Treatment with 0.05% CsA eyedrops plus IPL therapy could significantly reduce the issues and physical discomfort of patients with SS-DE. Clinical Trial Registered on 20 July 2021, with the registration number ChiCTR2100049059.

Effect of umbilical cord blood-mononuclear cells on knee osteoarthritis in rabbits

BackgroundTo investigate the effect and underlying mechanism of umbilical cord blood-mononuclear cells (UCB-MNCs) in treating knee osteoarthritis (KOA) in rabbits.MethodsA rabbit KOA model was prepared by anterior cruciate ligament transection (ACLT). Fifty New Zealand white rabbits were randomly divided into the control group, model group, sodium hyaluronate (SH) group, platelet-rich plasma (PRP) group and UCB-MNC group. Knee injections were performed once a week for five consecutive weeks. The gross view of the knee joint, morphology of knee cartilage and structural changes in the knee joint were observed on CT scans, and graded by the Lequesne MG behavioral score and the Mankin score. TNF-α and IL-1β levels in the synovial fluid of the knee were measured by the enzyme-linked immunosorbent assay (ELISA). Expression levels of MMP-13 and COL-II in the knee cartilage were detected by Western blotting and qRT-PCR.ResultsThe Lequesne MG behavioral score and the Mankin score were significantly higher in the model group than those in the control group (P < 0.05). Rabbits in the SH, PRP and UCB-MNC groups had sequentially lower scores than those in the model group. Imaging features of KOA were more pronounced in the model group than in the remaining groups. CB-MNC significantly relieved KOA, compared to SH and PRP. Significantly higher levels of TNF-α and IL-1β in the synovial fluid of the knee, and up-regulated MMP-13 and down-regulated COL-II in the knee cartilage were detected in the model group than in the control group. These changes were significantly reversed by the treatment with SH, PRP and UCB-MNCs, especially UCB-MNCs.ConclusionInjections of UCB-MNCs into knees protect the articular cartilage and hinder the progression of KOA in rabbits by improving the local microenvironment at knee joints.

Clinical Efficacy of 2% Rebamipide in Patients With Video Display Terminal-Associated Dry Eye Disease: A Prospective, Randomized, Double-Blinded Study.

To compare the effects of 2% rebamipide clear solution and 0.1% sodium hyaluronate eye drops in patients with visual display terminal (VDT)-related dry eye disease (DED). Prospective, randomized, double-blinded Study. This was a prospective, double-blind, and randomized controlled study. Patients with VDT-related DED were randomly allocated to a 2% rebamipide (REB) group or a 0.1% sodium hyaluronate (HYA) group (4 times/day for 4 weeks). The ocular surface disease index (OSDI), dry eye questionnaire-5 (DEQ-5), Placido disk-tear film analyzer, fluorescein-stained tear break-up time (FBUT), ocular surface staining score, and Schirmer 1 test were examined before and after the instillation of drug. A total of 56 eyes of 28 patients (28 eyes of 14 patients in each group) were included. There were no significant differences in the baseline data. The OSDI, DEQ-5, FBUT, and conjunctival erosion scores improved significantly in both groups after treatment. In the REB group, corneal staining and bulbar nasal redness scores also improved significantly after treatment ( P <0.001 and 0.036, respectively), whereas no significant differences were found in these parameters in the HYA group ( P =0.326 and 0.118, respectively). The REB group showed a significantly larger decrease in the corneal staining score than the HYA group ( P =0.016). No adverse reactions were observed. A 2% rebamipide clear solution effectively improved the symptoms and signs in patients with VDT-related DED and was superior to 0.1% sodium hyaluronate ophthalmic solution in improving corneal epithelial damage, making it a safe and effective treatment option for VDT-related DED.

Effects of Platelet-Rich Plasma Combined with Physical Therapy on IL-1β, TGF-β1, and MMP-3 in Patients with Knee Osteoarthritis.

The occurrence of osteoarthritis in the knee joint is regulated by a complex network, and there is currently no specific therapeutic drug available. Functional exercises and treatments targeting inflammatory factors have shown the potential to alleviate knee osteoarthritis to some extent. Therefore, the aim of this study was to assess the intra-articular injection (IAI) of autologous platelet-rich plasma (PRP) combined with physical therapy (PT) in treating knee osteoarthritis. A total of 128 patients with knee osteoarthritis were included in the study, including 64 males and 64 females. A total of 128 patients were divided into sodium hyaluronate group (HA group), PRP group, PRP + PT group, and PT group, with 32 cases in each group. Visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Japanese Orthopaedic Association (JOA) were employed to evaluate the recovery of patients from pain and osteoarthritis. Color Doppler ultrasound imaging technology was utilized to assess joint effusion, synovial membrane thickness, and articular cartilage thickness in patients with knee osteoarthritis. Enzyme-linked immunosorbent assay (ELISA) was employed to detect the levels of interleukin-1β (IL-1β), transforming growth factor-β1 (TGF-β1), and matrix metallopeptidase 3 (MMP-3) in the synovial fluid. Compared to the HA group, the PT group, PRP group, and PRP combined with PT (PRP + PT) group all showed reduced VAS and WOMAC scores, increased JOA scores, decreased joint effusion, synovial membrane thickness, and articular cartilage thickness in the knee joint. Additionally, levels of IL-1β and MMP-3 in the synovial fluid decreased, while TGF-β1 levels increased (P < 0.05). Compared with the PT group, the VAS and WOMAC scores of the knee joint in the PRP group decreased, JOA scores increased, joint effusion, synovial thickness, and articular cartilage thickness decreased, but there was no statistically significant difference (P > 0.05), and the PRP + PT group showed decreased VAS and WOMAC scores, increased JOA scores, reduced joint effusion, synovial membrane thickness, and articular cartilage thickness in the knee joint. Moreover, levels of IL-1β and MMP-3 in the synovial fluid decreased, while TGF-β1 levels increased (P < 0.05). No severe adverse reactions were observed in any of the four groups, but the pain rate in the PRP + TP group was significantly lower than PT group, PRP group, and PRP + PT group (P < 0.05). The efficacy of intra-articular injection of PRP combined with exercise therapy in the treatment of knee osteoarthritis is superior to that of single interventions such as simple interventions of HA, PRP injection, and PT. Furthermore, intra-articular injection of PRP combined with exercise therapy demonstrates enhanced effectiveness in improving the inflammatory levels associated with knee osteoarthritis and facilitating the rehabilitation process.

Intra-articular injection of hyaluronic acid after arthroscopic surgery fails to provide additional benefit for symptomatic degenerative arthropathy patients: a systematic review and meta-analysis of randomized controlled trials.

This study aimed to provide the evidence of the role of addition hyaluronic acid immediate after arthroscopy in pain relief and functional recovery. A multiple databases search of the PubMed, the Cochrane Library, and Embase was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to identify randomized controlled trials that evaluate the effect the hyaluronic acid compared with placebo addition immediately after arthroscopy for degenerative arthropathy. Data related to postoperative pain using the visual analog scale, and functional scores, were extracted and analyzed using the RevMan software. A total of five randomized controlled trials were included in this study. All patients showed significant pain relief after surgery at 2 weeks and 2 months, but no statistically significant differences between the hyaluronic group and control group were observed at 2 weeks and 2 months, respectively. This meta-analysis did not find a difference of WOMAC score between the two groups at 2 weeks (MD: 3.07; 95% CI: -0.66 to 6.81; I2 =39%; P = 0.11) and 2 months (MD: 5.47; 95% CI: -0.69 to 11.62; I2 =57%; P = 0.08), respectively. For patients with symptomatic degenerative arthropathy, adding hyaluronic acid immediately after arthroscopic surgery did not appear to provide patients with more pain relief and better functional recovery.

Use of hyaluronic acid matrix in dorsal augmentation rhinoplasty

ABSTRACT Augmentation rhinoplasty sometimes is required for patients with saddle nose deformity caused by failed rhinoplasty or facial trauma; finding appropriate grafting material remains a significant problem for this procedure. We investigated hyaluronic acid matrix as an allograft for dorsal augmentation rhinoplasty in a rabbit model. We performed an osteotomy on the nasal bones of eight rabbits. Four animals were sham operated as the control group and four were administered a mixture of saline-gelled hyaluronic acid matrix and sliced cartilage. Ultrasonography and three-dimensional reconstruction tomography were performed at the end of the experimental period. After sacrifice of the animals, nasal tissues were examined for histopathology, and both collagen scores and number of capillaries were compared between the two groups. Increased collagen and capillaries were apparent in the hyaluronic acid matrix group compared to controls. The median collagen score was significantly greater for the hyaluronic acid matrix group than for the control group. Although the number of capillaries for the hyaluronic acid matrix group was greater than for the control group, the difference was not statistically significant. Three weeks is sufficient for adhesion of ends of fractures in clinical practice; however, we found no ossification at this time in either group. A hyaluronic acid matrix may be a useful alternative supplement for dorsal augmentation rhinoplasty. Development of collagen was commensurate with membranous ossification; however, assessment of complete ossification requires a longer experimental period.

Using Type I Collagen Gel to Prevent Postoperative Intrauterine Adhesion: A Multicenter Retrospective Study.

We evaluated the clinical outcomes of using type 1 collagen gel after therapeutic resectoscopy; overall, 150 women aged > 20 who planned to undergo therapeutic resectoscopy were enrolled. The patients were randomly assigned to either of the anti-adhesive treatment groups: the type 1 collagen gel (Collabarrier®) (study group; N = 75) or the sodium hyaluronate and sodium carboxymethylcellulose gel group (control group; N = 75) after resectoscopy. One month after applying anti-adhesive materials, postoperative intrauterine adhesions were evaluated using second-look hysteroscopy; the incidence rate of postoperative intrauterine adhesions examined through second-look hysteroscopy showed no significant differences between the groups. There were no statistical differences between the frequency and mean scores of the type and intensity of adhesions in both groups. Finally, no significant differences in adverse events, serious adverse events, adverse device effects, and serious adverse device effects were noted between the two groups; type 1 collagen gel can be effectively and safely used in intrauterine surgery to minimize postoperative adhesions, thereby eventually decreasing the prevalence of infertility, secondary amenorrhea, and recurrent pregnancy loss in reproductive women.

Combination therapy with 3% diquafosol tetrasodium ophthalmic solution and sodium hyaluronate: an effective therapy for patients with dry eye after femtosecond laser-assisted in situ keratomileusis.

To assess the effect of combination therapy with 3% diquafosol tetrasodium (DQS) and sodium hyaluronate (HA) for dry eye after femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Prospective nonrandomized comparative trial. The prospective study included 80 eyes of 40 patients who underwent FS-LASIK with or without preoperative dry eye. Patients were divided into a combination group and a HA group according to their willingness and the doctor's advice. The combination group was treated with DQS six times a day and HA four times a day, and the HA group was treated with HA four times a day after FS-LASIK. Ocular surface disease index (OSDI), ocular symptom score, vision-related score, environmental score, tear meniscus height (TMH), first non-invasive tear breakup time (NIBUT-First), average non-invasive tear breakup time (NIBUT-Ave), tear breakup time (TBUT), Schirmer I test (SIT), corneal fluorescein staining score (CFS), bulbar redness score, limbal redness score, lipid layer grade (LLG), meiboscore, lid margin abnormality, corneal sensitivity, and corneal nerve parameters were examined before surgery and at 1 week and 1 month after surgery. Surface regularity index (SRI) was also examined before surgery and at 1 month postoperatively. OSDI score (p = 0.024) and vision-related score (p = 0.026) were significantly lower in the combination group than in the HA group at 1 month after FS-LASIK, especially in patients with preoperative dry eye symptoms. The increasements of CFS (p = 0.018), bulbar redness score (p = 0.021), and limbal redness score (p = 0.009) were significantly lower in the combination group than in the HA group at 1 week after FS-LASIK. But other ocular surface parameters showed no difference between both groups at 1 week and 1 month after FS-LASIK. LLG was significantly higher in the combination group than in the HA group at 1 week (p = 0.004) and 1 month (p < 0.001) after surgery, especially in patients with high meiboscore. Additional DQS significantly improved corneal sensitivity in patients without preoperative dry eye symptoms at 1 month after FS-LASIK (p = 0.041). The combination therapy with DQS and HA significantly relieved subjective symptoms, improved ocular surface status, and had the potential to promote corneal nerve growth in patients after FS-LASIK.

Leuprolide Acetate, a GnRH Agonist, Holds Up Neurodegeneration in an Experimental Glaucoma Model

Glaucoma is the main cause of irreversible blindness worldwide. In short, it is a multifactorial progressive optic neuropathy that correlates with retinal ganglion cell death, optic nerve head disturbances, and visual field disorders. Leuprolide acetate have recently been reported to have neurotrophic properties, the aim of this work was to determine whether it´s systemic administration holds up the neurodegenerative process in an experimental glaucoma model. Wistar rats divided into three groups were included: 1) a control group, 2) a hyaluronic acid-induced glaucoma group, and 3) a hyaluronic acid-induced glaucoma group treated with intramuscular leuprolide acetate. The eye electrical responses to light were recorded by simultaneous full-field electroretinography, and the eyes were processed for histological study. The results showed an improvement in the electrical activity, a recovery of fibers from the optic nerve as well as a reduction of the reactive astrogliosis in the leuprolide acetate treated group. In short, leuprolide acetate is a new potential alternative treatment in glaucoma, as it holds up the neurodegenerative process.

AICAR attenuates postoperative abdominal adhesion formation by inhibiting oxidative stress and promoting mesothelial cell repair.

Postoperative abdominal adhesion is one of most common complications after abdominal operations. 5-aminoimidazole-4-carboxyamide ribonucleoside (AICAR) is an adenosine 5'-monophosphate activated protein kinase (AMPK) pathway agonist that inhibits inflammation, reduces cell fibrosis and cellular reactive oxygen species (ROS) injury, promotes autophagy and mitochondrial function. This study aimed to explore the mechanism of AICAR in inhibiting adhesion formation. Forty rats were randomly divided into five groups. All of the rats except the sham group received cecal abrasion to establish an adhesion model. The rats in the sodium hyaluronate group were treated with 2 mL sodium hyaluronate before closing the peritoneal cavity. The AICAR 1 and 2 groups were treated with 100 mg/kg and 200 mg/kg AICAR, respectively. Seven days after the operation, all of the rats were euthanized, and the adhesion condition was evaluated by Nair's system. Inflammation was assessed by Eosin-hematoxylin (HE) staining and transforming growth factor-β (TGF-β1) detection. Oxidative stress effect was determined by ROS, nitric oxide (NO) level, superoxide dismutase (SOD), catalase, glutathione peroxidase (Gpx) and malondialdehyde (MDA) levels in adhesion tissue. Then, Sirius red picric acid staining was used to detect the fiber thickness. Immunohistochemical staining of cytokeratin-19 (CK-19), alpha-smooth muscle actin (α-SMA) and nuclear factor erythroid 2-related factor 2 (Nrf2) was also performed. Finally, HMrSV5 cells were treated with TGF-β1 and AICAR, the mRNA expression of E-cadherin, α-SMA and vimentin was assessed by q-PCR and cellular immunofluorescent staining. The rats in the AICAR-treated group had fewer adhesion formation incidences and a reduced Nair's score. The inflammation was determined by HE staining and TGF-β1 concentration. The ROS, SOD, Catalase, Gpx, MDA levels and fiber thickness were decreased by AICAR treatments compared to the control. However, the NO production, Nrf2 levels and peritoneal mesothelial cell integrity were promoted after AICAR treatments. In vitro work, AICAR treatments reduced E-cadherin, α-SMA and vimentin mRNA level compared to that in the TGF-β1 group. AICAR can inhibit postoperative adhesion formation by reducing inflammation, decreasing oxidative stress response and promoting peritoneal mesothelial cell repair.

Outcomes of Conservative Management of Fingertip Injury in Paediatric Population

In infants and children, the fingertip injuries occur frequently by accident which result causing infliction which ranges from a little cut to a fracture and also the finger amputation thus requires an immediate treatment intervention to avoid deformities. Different therapeutic approaches have been used involving surgical or conservative treatment. The conservative treatment is considered to be superior choice for management of these injuries so this research was designed to evaluate the functional and aesthetic outcomes of conservative approaches for treating fingertip injuries. Methods: This research consists of 30 children admitted to Ziaudin Hospital, Karachi with Allen's type II and III of fingertip injuries divided into three groups based on the treatment approach including Platelet Gel treatment group (group I), Fucidic acid treatment group (group II), Hyaluronic acid treatment group (group III). Results: All the conservative treatment approaches showed promising improvement regarding the range of motion, healing time, aesthetic and sensory outcome, complications, and subjective satisfaction. However, the platelet gel group exhibits significantly short healing time (p=0.003) in comparison to Fucidic acid and Hyaluronic acid treatment group Conclusion: It was concluded that conservative treatment is one of the effective approach in management of fingertip injuries in paediatric population providing better functional, sensory and aesthetic outcomes. Keywords: Fingertip injuries, Conservative treatment, Outcomes

ANALYSIS OF POST MSICS IOP RISE WITH 2%HPMC AND 1% SODIUM HYALURONATE OVDs - a comparative study

Background. Elevated IOP is the most frequent postoperative complication after cataract surgery and consequences of raised IOP lead to sight threatening problem. Intraocular pressure spikes of 30 mm HG or higher in the early period after cataract surgery causes pain, corneal epithelial edema, and damage to optic disc. The main cause of postoperative IOP increase is that the viscoelastic agent remains in the eye, which causes a mechanical obstruction of trabecular meshwork . To compare theAims and objectives. effect of two OVDs (2% HPMC and 1% Sodium Hyaluronate) on Intraocular pressure after MSICS. This is a prospectiveStudy design. observational study of 8 months duration in a tertiary hospital of Eastern India. 100 consecutive patients above the age 50 years havingMethods. age related cataract planned for elective cataract surgery will be included in this study. 50 consecutive patients were assigned to receive Hydroxypropyl methylcellulose(2%) and remaining 50 patients were assigned to receive Sodium hyaluronate (1%) during surgery. The IOP was measured 6 hours,24 hours and 1 week after surgery and the ndings were noted. After the study period the collected data was analyzed by standard statistical tools. .Mean IOP increased by 4.08 mm of Hg in the group receiving 2% HPMC and by 8.2 mm of Hg in patientsResults receiving 1% Sodium Hyaluronate. In both HPMC and Sodium Hyaluronate group the rise of the IOP in 6 hour post operative period was found to be signicantly higher (p&lt;0.05) than the pre operative IOP value. But the post operative 6 hour mean IOP rise was 4.32 mmHg more in the Sodium Hyaluronate group(8.2mm Hg) than the HPMC group (4.08 mmHg) . 24 hours and 1 week post-operatively the rise in mean IOP was found to be not signicantly different from each other. These ndings indicate that 1% Sodium Hyaluronate causes a signicantlyConclusion : higher IOP rise than 2% HPMC in the early post operative period.But 24 hours and 1 week post-operatively the rise in mean IOP was insignicant in both the group.

Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis compared with intra-articular hyaluronan injections based on trial data

BackgroundEffective symptom control in painful knee osteoarthritis (OA) may improve patient quality of life. In a randomised crossover trial (NCT03381248), COOLIEF* cooled radiofrequency ablation (CRFA) reduced pain and stiffness and improved physical function and quality of life compared with intra-articular hyaluronan (HA) injections. The present study aimed to establish the cost effectiveness of CRFA versus intra-articular HA injections for treating moderate-to-severe OA knee pain from a US Medicare perspective.MethodsWe conducted a cost-effectiveness analysis using utility data (EQ-5D) from the randomised crossover trial of CRFA versus intra-articular HA injections, which had follow-ups at 1, 3, 6, and 12 months. Patients in the HA group with unsatisfactory outcomes (e.g., continued pain) at 6 months could cross over to CRFA. Economic analysis outcomes included quality-adjusted life-years (QALYs), costs, and cost effectiveness (cost per QALY gained). Base-case analyses were modelled on a 6-month time horizon (to trial crossover). Due to limited trial data in the HA arm beyond 6 months, scenarios explored potential outcomes to 12 months if: 1) Utility with HA persisted for a further 6 months; 2) A second HA injection was received at 6 months and achieved the same utility change for the second 6 months. In both scenarios, the CRFA arm used trial data for patients who received CRFA from baseline to 12 months. Alternative costing scenarios were also explored.ResultsCRFA resulted in an incremental QALY gain of 0.020 at an incremental cost of US$1707, equating to an incremental cost-effectiveness ratio (ICER) of US$84,392 per QALY over 6 months, versus intra-articular HA injections. Extending the analysis to 12 months and assuming persistence in utility in the HA arm resulted in a larger utility gain for CRFA (0.056 QALYs) and a lower ICER of US$30,275 per QALY. If patients received a second HA injection, the incremental benefit of CRFA out to 12 months was reduced (QALY gain 0.043) but was offset by the costs of the second HA injection (incremental cost US$832). This resulted in an ICER of US$19,316 per QALY.ConclusionsCRFA is a cost-effective treatment option for patients with OA-related knee pain considering the typical US threshold of US$100,000/QALY.

Comparison of Effectiveness and Safety of a Botulinum Toxin Monotherapy and a Combination Therapy with Hyaluronic Acid Filler for Improving Glabellar Frown.

Among numerous cosmetic procedures for face rejuvenation performed all over the world, botulinum toxin type A (BoNT-A) for wrinkles is one of the most widely practiced procedures. However, for severe frowns, the application of botulinum toxin is often insufficient. In this study, the effects of hyaluronic acid filler combination therapy and the BoNT-A alone were evaluated. Forty subjects with 2 or higher points (moderate to severe) of a facial wrinkle scale (FWS) when frowning in the glabellar area were assigned to 2 group: Botulinum toxin type A monotherapy group and a combination regimen of the toxin and hyaluronic acid filler group. Subjects visited outpatient department every 4 weeks until 28 weeks after the injection, and the assessment of the efficacy using FWS, subject satisfaction at both resting and maximum frowning and safety analysis were performed. Subjects of both group was administered 18U of BoNT-A and the subjects of the combination group received additional 0.45mL of hyaluronic acid filler regimen. Both at rest and maximum frown, the combination group scored lower FWS than the toxin and showed significance in the week-20 and week-28. And at final visit, subject satisfaction score of the combination was higher than that of toxin group. For patients with moderate to severe glabellar frown, the combined administration of BoNT-A and hyaluronic acid filler could be a considerable treatment for improving wrinkles. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anti-scarring effect of sodium hyaluronate at filtration pathway after filtering surgery in rabbits.

To investigate the anti-scarring effect of sodium hyaluronate (HA) at filtration pathway after filtering surgery in a rabbit model. Fifteen healthy adult New Zealand white rabbits were selected for trabeculectomy in both eyes. The right eyes were used as HA group with 0.1 mL HA injected into the anterior chamber at the end of the operation; the left eyes were used with 0.1 mL sodium lactate Ringer's solution (RS) injected into the anterior chamber as RS group. Intraocular pressure (IOP), filtering blebs morphology, inflammatory reaction and complications were observed at the 7, 60, and 90d after surgery. One day after surgery, the IOP of HA and RS groups were 12.75±1.92 and 10.50±1.59 mm Hg (P=0.005). At the 7th day postoperative, the filtering blebs of each group were functional type and TGF-β expression was significantly difference in both groups (0.10±0.01 vs 0.14±0.02, P=0.024). After 60d of the operation, all filtering blebs were scarring and alpha-smooth muscle actin (α-SMA) expression was significantly difference in both groups (0.40±0.04 vs 0.35±0.02, P=0.032). α-SMA positive cells were mainly distributed in the junction of conjunctiva and sclera and around the blood vessels. The collagen volume fraction (CVF) of HA and RS group was (75.49±7.01)% and (79.93±5.35)% (P=0.044). On the 90th day after the operation, CVF was (82.57±5.19)% and (88.08±1.75)% in HA and RS groups (P=0.036). There was no α-SMA positive cell in HA group, while a few positive cells were observed in RS group (P=0.000). HA has effect of anti-scar and anti-inflammation on filtration pathway after filtering surgery within 3mo by inhibiting fibroblast proliferation and collagen deposition.

Effectiveness of intra-articular hyaluronic acid versus corticosteroids in knee osteoarthritis: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis (OA) is the largest cause of disability worldwide and the most common cause of knee discomfort. OA is a chronic, progressive joint disease marked by articular cartilage deterioration and secondary hyperosteogeny. OA affects 35 percent of those over the age of 65 and produces considerable pain in the knee joint. The patient with OA not only suffers from chronic pain, stiffness, and reduced movement, physical and/or mental co-morbidity, but also has a direct impact on their quality of life.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 72 patients with symptomatic osteoarthritis of unilateral knee joint (pain &amp;gt;3 months) were included in the present study. They were randomly divided into two groups; group A (n=36) included patients who were given intra-articular injection hyaluronic acid and group B (n=36) included those who were given intra-articular corticosteroid injection. All the data was compared both within the group as well as with one another at different follow up time.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was no significant difference in the basic demographic distribution in both groups. Female sex predilection was seen in the present study. In patients receiving hyaluronic acid (HA), mean baseline visual analog scale (VAS) score was noted to be 7.45±1.4. Then at 2 weeks, 6 weeks, 3 months and 6 months follow up the mean VAS score was 3.4±1.3, 2.78±1.1, 3.71±1.4 and 3.90±1.2; p&amp;lt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Steroids provide an acute symptomatic relief but their benefits are short lasting. On the other hand, HA provides long lasting therapeutic pain relief.&lt;/p&gt;