Hyaluronic Acid Preparations Research Articles

Comparison of Two Hyaluronic Acid Preparations for the Treatment of Rizoarthrosis

Osteoarthritis of the trapeziometacarpal joint (TOA) or rizoarthrosis is a pathology particularly prevalent in post-menopausal women. It can be symptomatic, with associated pain, or asymptomatic, and in this latter case it is diagnosed by radiographical examination. TOA, when symptomatic, strongly affects quality of life. The treatment of TOA involves both pharmacological and non-pharmacological treatment (including local application of heat, ultrasound and splints). The major treatments, recommended by the European League Against Rheumatism consists of corticosteroids for pain control and hyaluronic acid (HA) for amelioration of functional capacity. The present study aimed at comparing the efficacy and tolerance of intra articular injections of two HA preparations, high-low molecular weight HA (HL) (Sinovial® HL) and high molecular weight HA (HMW) (Sinovial® Mini), in patients with TOA. The observational and retrospective study involved overall 125 subjects, ageing from 45 to 85 years, who had clinical symptoms of TOA lasting at least 6 months. The patients received HL (66 subjects) or HMW (59 subjects) in two injections at baseline and after 15 days. The subjects were followed for 6 months, and the outcome measurements included pain control (through VAS scale) functional hand capacity, using the Duruoz Hand Index (DHI) and the change of the duration of morning stiffness, using the Italian version of the Health Assessment Questionnaire (HAQ). HL was found superior to HMW in all the three parameters examined, with a quicker and stronger pain relief, recovery of hand function as well as in self-assessment by the subjects. Both treatments were associated with very modest side effects. In conclusion, our data show the efficacy of HL and HMW for the treatment of TOA and the superiority of HL to HMW. Although these data are observational and retrospective, they pose the basis for future prospective studies focused on the use of HL and HMW in TOA.

Local injection therapy with hyaluronic acid preparations: in focus of rheumatologists and orthopedic traumatologists

Hyaluronic acid (HA) is an effective and safe medication for local injection therapy (LIT) widely used in the treatment of osteoarthritis (OA) of large joints. The therapeutic effect of HA is determined both by the replacement of the lubricating function of natural hyaluronate (viscosupplementation), which leads to an improvement in the biomechanical parameters of the joint, and by the biological effects that unfold when interacting with cellular receptors (CD44, RHAMM, etc.), resulting in an anti-inflammatory, anti-nociceptive and anabolic effect of HA. HA therapy has a reliable evidence base. According to a number of clinical studies and meta-analyses, LIT with HA – reduces pain intensity by 28–54 % and improves the function of the affected joint by 9–32 % compared to baseline over a 12-24 week observation period. Repeated administration of HA can delay the need for orthopedic surgery. HA extremely rarely causes serious adverse events and can also be prescribed to patients with concomitant diseases. The use of HA for the treatment of OA is included in Russian and several foreign clinical guidelines (in particular OARSI and ESCEO). A new direction in LIT for OA is therapy with combined (hybrid) HA preparations containing high molecular weight (HMW) and low molecular weight (LMW) fractions. A new HA preparation has appeared in our country, which is a stabilized, highly purified hydrogel containing 80 % HMW HA (molecular weight – 30,000 kDa) with transverse "crosslinking" BDDE (innovative ECHATM technology) and 20 % "uncluttered" linear HA (molecular weight – 1500 kDa). This product is characterized by favorable rheological parameters, which guarantee a long-term improvement in the biomechanics of the affected joint and a rapid onset of biological effects, reduction in pain and inflammation and activation of the synthesis of natural hyaluronate.

Isolated ocular sarcoidosis

A rare clinical case of a patient with isolated sarcoidosis of the eyes is presented. Sarcoidosis is a polyethological disease, the morphological feature of which is the formation of epithelioid cell granulomas in various organs and tissues, which is accompanied by a violation of their structure and function. Both congenital and adaptive immune systems are involved in the pathogenesis of sarcoidosis, with damage to lymph nodes, lungs, skin, organ of vision, etc. Risk factors for the development of sarcoidosis have not been definitively established. Environmental factors and genetic predisposition play a crucial role in the development of the disease. The above clinical observation demonstrates the polymorphism of the clinical picture of isolated ocular sarcoidosis. In addition to standard ophthalmic examination methods, the genetic method of reverse transcription and quantitative polymerase chain reaction (RT-PCR, English qRT-PCR) was also used to determine the expression profile of signature microRNAs as potential diagnostic markers of sarcoidosis of the organ of vision.An increase in the expression level of hsa-miR-455-3p, hsa-miR-4663, hsamiR68063p, hsa-miR-450b-5p, hsa-miR-6716-3p, hsa-miR-5000-5p, hsa-miR150-5p can be considered as potential diagnostic biomarkers of sarcoid lesion of eye structures. With sarcoidosis, the involvement of the lacrimal gland is possible. In the presented clinical observation, this was indicated by the results of a functional examination, sonographic signs: revealed multiple linear tubular hyperechoic structures and a decrease in blood flow velocity in the ocular and lacrimal arteries, as well as an increase in the expression activity of hsa-miR150-5p (p < 0.05). In order to prevent possible damage to the ocular surface due to the development of lacrimal gland dysfunction, it is advisable to prescribe local tear replacement therapy with hyaluronic acid preparations. Such effective drugs include tear substitutes of the Optinol® line: “Optinol® Express Moisture” and “Optinol® Deep Moisture”.

Oral preparation of hyaluronic acid, chondroitin sulfate, N-acetylglucosamine, and vitamin C improves sexual and urinary symptoms in participants with recurrent urinary tract infections: a randomized crossover trial.

Intravesical instillation of hyaluronic acid (HA) has been associated with reduced sexual dysfunction in participants with recurrent urinary tract infections (rUTIs), but the efficacy of an oral treatment has never been investigated. To investigate the efficacy of an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C in improving sexual and urinary symptoms in a cohort of reproductive-age participants with rUTI. In a monocentric randomized crossover pilot trial, participants with rUTI who were referred to our institute between March 2022 and April 2023 were randomized 1:1 in 2 groups: intervention vs control. All participants had an oral preparation of cranberry, D-mannose, propolis extract, turmeric, and Boswellia twice a day for 3 months. The intervention group also included an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C once a day for 3 months. Crossover of treatment occurred at 3 months for an additional 3 months. At baseline and 3 and 6 months, participants were evaluated clinically and with the International Prostate Symptom Score (IPSS) and Female Sexual Function Index (FSFI). Descriptive statistics and logistic regression models tested the impact of the intervention on urinary and sexual symptoms at each follow-up assessment. Improvement in sexual and urinary symptoms as measured by the FSFI and IPSS. Overall, 27 (54%) participants had an FSFI score <26.5 at enrollment. At 3 months, FSFI scores were higher in the intervention group vs control (P < .001), but IPSS scores were lower (P = .03). After crossover of treatment, FSFI and IPSS scores remained stable in the intervention group. However, after crossover, the control group showed a significant improvement in IPSS and FSFI scores (all P < .01) vs the 3-month assessment. At last follow-up, urinary and sexual symptoms were comparable between groups. In logistic regression analyses, the intervention group was associated with early improvement in sexual symptoms (odds ratio, 3.9; P = .04) and urinary symptoms (odds ratio, 5.1; P = .01) after accounting for clinical confounders. Combination treatment with HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C is effective if started immediately or even after a few months from symptoms in participants with rUTI. The main limitation is the lack of long-term follow-up. The oral formulation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C could be an effective therapy against urinary and sexual distress in participants with rUTI (NCT06268483; ClinicalTrials.gov).

Application of Hyaluronic Acid Preparations in Orthopedics and Dentistry

The article is a comparative analysis of hyaluronic acid preparations widely used in clinical practice. An analysis of modern literature on the use of “synovial fluid prostheses” for patients with osteoarthritis is presented. The advantages of using intra-articular injections of hyaluronic acid preparations are shown. According to indications and in compliance with technical conditions the use of products containing hyaluronic acid and its salts for intra-articular injections can improve the functional state of the joints. The article also describes the use of hyaluronic acid in dentistry for diseases of the temporomandibular joint, inflammatory diseases of the oral cavity, including diseases of periodontal tissue, tooth extraction, osteotomies, etc.

The evolution of artificial tears based on hyaluronic acid

In recent years, there has been growing interest in the use of tear substitutes, based on natural polysaccharides in the treatment of dry eye syndrome, the leader of which is hyaluronic acid (HA). It has sufficient biocompatibility, non-immunogenicity, high viscoelasticity, hydrophilic, mucus-adhesive and good moisturizing properties. At the same time, in order to improve artificial tear preparations, there is a need to improve the mechanical and rheological properties of HA, its hygroscopicity, swelling in an aqueous environment and reducing the rate of biodegradation. One of the ways to solve this problem was the chemical modification of HA, by cross-linking its chains with two or more covalent bonds, with the participation of various polyfunctional molecules: urea, HA-cysteine ethyl ester, polyfunctional diepoxides, glutaraldehyde, carbodiimide, and many others. At the same time, the rigidity of the three-dimensional polymer network increases, increasing its resistance to enzymatic decomposition at the site of burial. Cross-linked HA has a higher viscosity compared to native hyaluronic acid due to the binding of its chains, which determines longer retention on the corneal epithelium and naturally makes it possible to reduce the frequency of drug instillations. Convincing data were obtained on the effectiveness of the resulting cross-linked hydrogel with non-Newtonian properties in vitro – on cultures of corneal epithelial cells and in vivo – on models of mechanical trauma and chemical burns of the cornea, as well as in animals with torpid corneal ulcers. The clinical effectiveness of cross-linked hyaluronic acid in the treatment of patients with dry eye syndrome of varying severity, including those due to Sjögren’s syndrome, has also been established. The higher effectiveness of cross-linked HA compared to native HA preparations has been convincingly proven. Taking into account the available information, an official drug has been developed based on cross-linked 0.2% hyaluronic acid Ocutears® Hydro+ (Santen).

Сравнение эффективности внутрисуставного введения препаратов гиалуроновой кислоты с разной кратностью введения после артроскопических операций на коленном суставе

This study was conducted to evaluate the efficacy of various hyaluronic acid (HA) preparations in patients with knee joint injuries in the postoperative period after knee arthroscopy. Ninety patients with grade I–II gonarthrosis and concomitant meniscus damage who underwent knee arthroscopy were included in the study. Patients were divided into three groups of 30 patients: in the 1st group no HA preparations were administered, in the 2nd group threefold administration of HA with the concentration of 1.6% was performed with the volume of 2 ml, in the 3rd group a single injection of HA with the concentration of 2.2% mixed with mannitol was performed with the total volume of 5 ml. After 1, 6 and 12 months, the dynamics of the mean score on the visual analog scale (VAS) of pain, WOMAC index and Leken's algo-functional index were evaluated. According to the results of observation after 6 and 12 months, the most pronounced dynamics of pain syndrome intensity reduction was observed in groups 2 and 3, where HA preparations were administered after knee arthroscopy. No statistically significant differences in the efficacy of the compared HA preparations were found. According to the results of observation after 6 and 12 months, the most pronounced dynamics of pain syndrome intensity reduction was observed in groups 2 and 3, where HA preparations were used after knee arthroscopy. No statistically significant differences in the efficacy of the compared HA preparations were revealed. HA administration after arthroscopic lavage causes persistent regression of pain syndrome and improvement of functional status of the knee joint.

ИСПОЛЬЗОВАНИЕ ПРЕПАРАТОВ ГИАЛУРОНОВОЙ КИСЛОТЫ ДЛЯ СТИМУЛЯЦИИ РЕГЕНЕРАЦИИ ПРИ РАЗВИТИИ ТРОФИЧЕСКИХ НАРУШЕНИЙ У ПАЦИЕНТОВ С ХРОНИЧЕСКИМИ ОБЛИТЕРИРУЮЩИМИ ЗАБОЛЕВАНИЯМИ АРТЕРИЙ НИЖНИХ КОНЕЧНОСТЕЙ

Trophic ulcers as a result of chronic vascular diseases of the lower extremities are an urgent and complex task of surgical treatment. Local treatment of the ulcer is an important role after revascularization. Hyaluronic acid (HA) preparations are among the most promising in this regard. HA provides increased tissue resistance to ischemia, suppression of the inflammatory response, stimulation and acceleration of tissue regeneration. HA ensures the formation of a temporary matrix in a fresh wound, facilitates the diffusion of nutrients and cleans the wound from products of cellular metabolism. Secondly, it takes an active part in the proliferation and migration of keratinocytes, which make up the bulk of the epidermis. Due to the insignificant use of HA in local therapy of trophic disorders of chronic vascular diseases of the lower extremities, it is interesting to further study the effect as part of complex and pathogenetically oriented treatment in patients of this group.

Реконструктивная локальная инъекционная терапия

The article discusses the treatment of osteoarthritis (OA) as the most common joint disease. The recommendations from professional associations for the patient management in OA using hyaluronic acid (HA) preparations differ somewhat depending on the affected joint, although they generally indicate positive effects of their use. Studies have shown the HA participation in the phagocytosis reduction, as well as in lowering the levels of prostaglandins, fibronectin, cAMP and a number of other anti-inflammatory effects. There is also a hypothesis that HA can prevent the release of arachidonic acid, block nociceptors and reduce the bradykinin formation, as well as it has chondroprotective properties. At the same time, total joint replacement is considered optimal (which has proven itself to be an effective and safe type of surgery) during the OA progression, the preservation of severe pain and loss of joint function, and the inefficacy of conservative treatment. The authors draw attention to the most common complication that occurs during total joint replacement — contralateral limb pain, and explain the mechanisms of its progression. They also present their case follow-ups of patients after total joint replacement with the development of synovitis in the contralateral hip joint and synovitis in combination with ligamentitis in the contralateral knee joint. Besides, the article highlights the clinical picture patterns and the methods of reconstructive local injection therapy with HA. KEYWORDS: osteoarthritis, knee joint, hip joint, hyaluronic acid, total joint replacement, contralateral limb pain, intra-articular injection, periarticular injection. FOR CITATION: Filatova Yu.S., Solovyov I.N., Solovyov E.I. Reconstructive local injection therapy. Russian Medical Inquiry. 2024;8(4):208– 214 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-4.

Connective Tissue Dysplasia As A Predictor Of Premature Skin Aging

Background — One of the manifestations of connective tissue dysplasia (CTD) is premature skin aging. The latter can have different etiological factors. The objective of our study was to investigate the effect of predictors of premature skin aging, especially CTD, on the severity of involutional changes in the skin, as well as to develop the approach for the management of patients with premature aging. Material and Methods — We included in our study 78 women 35-45 years of age with no substantial anti-aging treatment procedures in their anamneses. We considered genealogical and cosmetological anamneses, and life history (including somatic pathology), physical examination; determined prevailing type of facial skin aging; identified predictors of CTD, assessed psychoemotional state of the patient, and performed sonography of the skin and biochemical examination of patient serum. At a clinical stage, we conducted a randomized comparative study of biorevitalizant efficacy in patients with normal and premature patterns of skin aging. Results — Our study established the role of CTD in assessing the risk of premature skin aging. In addition to the presence of CTD, the importance of identifying isolated phenotypic manifestations of CTD (such as arachnodactyly, hypermobility syndrome, low relative weight of the patient, and skin manifestations of CTD) was shown. Other predictors were also analyzed; their identification can help assessing the risk of premature skin aging. Among them, somatic pathology (varicose veins, herniated discs, visceroptosis, autonomic vascular dystonia) and physical examination data (such as pallor of the facial skin, swelling, skin hyperelasticity) were noted. When assessing the clinical efficacy of biorevitalization, the greatest satisfaction of patients with premature skin aging regarding its results was characteristic for the group of patients after 7% collagen treatment. The clinical efficacy according to sonography and histological examination in patients with premature skin aging was significantly higher after the use of collagen or a complex hyaluronic acid (HA) preparation, compared with native HA. Patients with premature skin aging exhibited high level of anxiety and/or depression, which in turn increased the risk of underestimating the outcome of procedures. Conclusion — The presented study confirmed the role of CTD in assessing the risk of premature skin aging. Predictors were revealed (somatic pathology, type of facial aging, physical examination data of the patient, etc.) that could be used to assess the risk of premature skin aging. In patients with premature aging, preparation with native HA (as a biorevitalizant) had a low clinical efficacy comparable to using placebo. A collagen-based preparation and a complex HA-based preparation exhibited high clinical efficacy. Also, patients with premature aging of the skin had a higher score of anxiety and depression, while patients with high levels of anxiety and depression were more likely to underestimate the satisfaction with the results of their aesthetic treatment.

Influence of local administration of autologous platelet-rich plasma on the level of expression of matrix metalloproteinases in experimental tendinopathy

Purpose: To evaluate the expression of matrix metalloproteinases in the calcaneal tendon tissue under conditions of experimental tendinopathy and under the influence of local administration of autologous platelet-rich plasma.&#x0D; Material and methods: The study was conducted on 20 mature Wistar rats divided into 5 groups. In all groups, experimental modeling of tendinopathy of the calcaneal tendon was performed by intra- and near-tendon injection of 0.5 ml of a 10 % suspension of sterile talc. Further, autologous platelet-rich plasma (PRP), hyaluronic acid preparation Rusvisk (Russia) or their sequential combination was injected into the area of tendinopathy. The results of the study were evaluated after 10 weeks; autopsy preparations prepared for immunohistochemical analysis were studied using light microscopy and morphometry.&#x0D; Results: Histological signs characteristic of tendinopathy were identified: disorganization of collagen structures, mucoid and lipoid degeneration, neovascularization, lymphoid-histiocytic infiltration. Injection of PRP into the area of simulated tendinopathy, hyaluronic acid, or their sequential combination led to changes in the immunohistochemical pattern of the tissue. As a result, there was a decrease in the expression of immunoreactive material in the cytoplasm of tenocytes and cells of the inflammatory infiltrate, compared with the picture observed in micropreparations in animals with tendinopathy, which were not subjected to any manipulations.&#x0D; Conclusion: The introduction of PRP into the area of the calcaneal tendon under conditions of experimental tendinopathy reduces the level of expression of matrix metalloproteinases and, thereby, preserves the structure of the tendon tissue, demonstrating tendoprotective properties.

Osteoarthritis of the hip joints: possibilities of local therapy

Osteoarthritis of the hip joints is one of the most common pathology of the musculoskeletal system. The issues of its therapy are discussed in all clinical recommendations and recently more and more attention has been paid to the introduction of hyaluronic acid preparations. In the Russian recommendations for the treatment of coxarthrosis, this recommendation has a high level of credibility and evidence and is based on a significant number of studies confirming the safety and effectiveness of this therapy in the long term. The article provides data from some studies, as well as the conclusions of the European Consensus Group on intra-articular administration of hyaluronic acid, which prescribes indications and contraindications for the introduction of drugs into the hip joints. The issue of choosing a specific drug among a variety of forms is also discussed and a clinical example of the administration of hyaluronic acid to a patient with osteoarthritis of the hip joints under ultrasound control is considered. A detailed technique of drug administration is described. When considering this clinical example, the good tolerability of the drug, the accuracy of the administration of the drug, as well as the long-term results of the safety and effectiveness of therapy in the form of pain reduction and the absence of the need for NSAIDs are demonstrated.

THE MODERN DATA ABOUT THE ANATOMY OF A DANGEROUS TRIANGLE OF THE FACE

The anatomical structures of the facial skin are susceptible to various damage and can be affected when the integrity of the skin is violated, both at home and during invasive procedures or surgical interventions. In such cases, there is a danger of rapid spread of infection, mainly through the blood flow through the valve-less vessels of the face and head, which can lead to damage to the brain, organ of vision and other structures. The so-called danger zones of the face are especially vulnerable - areas of the skin, damage to which is more likely to lead to serious consequences. To prevent the development of complications, a deep understanding of the anatomical structure of these areas of the face is necessary. The purpose of the review is to summarize modern notions about the most dangerous traumatic injuries, various surgical and cosmetic interventions of the anatomical areas in the face, their possible infection, consequences and complications. Traumatization of blood vessels and nerves in dangerous areas of the face, as well as infection of wounds in this area can cause death. The skin of dangerous anatomical areas of the face (the surface of the nasal area, lip area, nasolabial triangle and other areas) is thin and closely connected to the underlying muscles. These areas contain a large number of blood vessels that anastomose with each other, as well as lymphatic vessels and nerve plexuses. An analysis of the frequency of diseases and injuries in these areas shows that currently they are caused by other reasons than what was observed in previous decades, and are more associated with cosmetic procedures of uncontrolled injections of botulinum toxin type A and (or) hyaluronic acid preparations. These methods of rejuvenating the appearance and correcting facial structures are becoming increasingly popular and more dangerous for the anatomically determined reasons mentioned above. All of the above is relevant in the study of facial anatomy by both students and specialists.

High molecular weight hyaluronic acid drastically reduces chemotherapy-induced mucositis and apoptotic cell death

Oral and intestinal mucositis (OIM) are debilitating inflammatory diseases initiated by oxidative stress, resulting in epithelial cell death and are frequently observed in cancer patients undergoing chemo-radiotherapy. There are currently few preventative strategies for this debilitating condition. Therefore, the development of a safe and effective mucositis mitigating strategy is an unmet medical need. Hyaluronic acid (HA) preparations have been tentatively used in oral mucositis. However, the protective effects of HA in chemotherapy-induced mucositis and their underlying mechanisms remain to be fully elucidated. This study aimed to assess these mechanisms using multiple formulations of enriched HA (Mucosamin®), cross-linked (xl-), and non-crosslinked high molecular weight HA (H-MW-HA) in an oxidative stress-induced model of human oral mucosal injury in vitro and an in vivo murine model of 5-flurouracil (5-FU)-induced oral/intestinal mucositis. All tested HA formulations protected against oxidative stress-induced damage in vitro without inducing cytotoxicity, with H-MW-HA also significantly reducing ROS production. Daily supplementation with H-MW-HA in vivo drastically reduced the severity of 5-FU-induced OIM, prevented apoptotic damage and reduced COX-2 enzyme activity in both the oral and intestinal epithelium. In 5-FU-injected mice, HA supplementation also significantly reduced serum levels of IL-6 and the chemokine CXCL1/KC, while the serum antioxidant activity of superoxide dismutase was elevated. Our data suggest that H-MW-HA attenuates 5-FU-induced OIM, at least partly, by impeding apoptosis, inhibiting of oxidative stress and suppressing inflammatory cytokines. This study supports the development of H-MW-HA preparations for preventing OIM in patients receiving chemotherapy.

Preparation and optimization of hyaluronic acid decorated irinotecan-loaded poly(lactic-co-glycolic acid) nanoparticles by microfluidics for cancer therapy applications

Polymer-based nanoparticles have been largely investigated in the cancer therapy field for their features to generate colloidal delivery systems of hydrophobic drugs to improve drug stability, specific delivery and reduce toxicity. In particular, nanoparticles surface functionalized with hyaluronic acid have been widely employed for their active tumor-targeting efficiency. Furthermore, the control of the physicochemical properties as well as high drug encapsulation efficiency, yield and batch-to-batch reproducibility of nanoparticles obtained by means of microfluidics, pave the way to overcome the drawbacks related to the fabrication of NPs obtained via traditional bulk methods and consequently increase cancer cell killing effect. For these reasons, we here investigated the effects of process parameters on the preparation and optimization of poly(lactic-co-glycolic acid)-poloxamers nanoparticle formulations (PLGA/PF68+PF127 NPs) decorated with HA (HA-based NPs) by using microfluidics for intravenous delivery of a model chemotherapeutic agent, irinotecan (IRIN). The study on the aggregation behavior and morphology of NPs were investigated by Dynamic Light Scattering (DLS), Electrophoretic Light Scattering (ELS), Transmission Electron Microscopy (TEM) and Differential Scanning Calorimetry (DSC). Our results revealed that by increasing the polymer weight fractions of organic and water phases the size, the NP yield, and the drug encapsulation efficiency of NPs are increased. Furthermore, by increasing the flow rate ratios from 0.05 to 0.3, a raise of dH from ∼85.6 to ∼176.4, for PLGA/PP NPs, and from ∼101.6 to ∼283.3 for HA/PLGA/PP is detected. The optimized HA-based NP formulation showed a spherical morphology, with a core-shell structure, small hydrodynamic diameter (dH∼120 nm), uniform size distribution (PDI<0.06) and high: i) drug loading (DL∼22.7%), ii) drug encapsulation efficiency (DEE∼87.8%) and iii) yield (92.4%). Moreover, the in vitro IRIN kinetic release and stability of IRIN-loaded HA-based NPs were evaluated showing the complete release in 15 days. Thus, this study highlighted a microfluidic method to fabricate IRIN-loaded HA-based NPs without any chemical modifications to provide novel understanding of the effect of process parameters, by varying the polymer weight fractions of both organic and water phases and flow rate ratio, on the physicochemical properties and consequently on nanoparticle formulation qualities for cancer therapy applications.

Anatomy, molecular structures, and hyaluronic acid - Gelatin injectable hydrogels as a therapeutic alternative for hyaline cartilage recovery: A review.

Cartilage damage caused by trauma or osteoarthritis is a common joint disease that can increase the social and economic burden in society. Due to its avascular characteristics, the poor migration ability of chondrocytes, and a low number of progenitor cells, the self-healing ability of cartilage defects has been significantly limited. Hydrogels have been developed into one of the most suitable biomaterials for the regeneration of cartilage because of its characteristics such as high-water absorption, biodegradation, porosity, and biocompatibility similar to natural extracellular matrix. Therefore, the present review article presents a conceptual framework that summarizes the anatomical, molecular structure and biochemical properties of hyaline cartilage located in long bones: articular cartilage and growth plate. Moreover, the importance of preparation and application of hyaluronic acid - gelatin hydrogels for cartilage tissue engineering are included. Hydrogels possess benefits of stimulating the production of Agc1, Col2α1-IIa, and SOX9, molecules important for the synthesis and composition of the extracellular matrix of cartilage. Accordingly, they are believed to be promising biomaterials of therapeutic alternatives to treat cartilage damage.

Retrospective Cohort Trial of the Effectiveness of Plasma Surgery for Benign Prostatic Hyperplasia of Large and Giant Sizes

Background. Over the past 10 years, the incidence of benign prostatic hyperplasia (BPH) over 80 cm3 has increased 34 times. With indications for surgical treatment, transurethral methods are increasingly used today with the use of laser or plasma techniques for resection and enucleation of the prostate. The article presents a comparative analysis of the results of plasma transurethral enucleation of the prostate (P-TUEP) and open prostatectomy, methods of surgical and drug prevention of dysuric complications, which indicates the primacy of the choice of P-TUEP in large and giant BPH surgery. Aims to prove the effectiveness of the use of plasma surgical methods and the scheme of complex medical postoperative prevention of late dysuric and cicatricial complications in the treatment of benign prostatic hyperplasia of large and giant sizes. Methods. The design of a retrospective cohort trial included several stages conducted at the urological center of the clinical hospital RZD-Medicine, Nizhny Novgorod in 20082019. The object of the study were patients with a confirmed diagnosis of large BPH (over 80 cm3) and giant (over 250 cm3) size, divided into the main and control groups according to the methods of surgical intervention and postoperative prevention of dysuric complications. The selection of patients was carried out by the method of paired design with an equal number of observations and maximum comparability of the initial parameters. Data analysis was carried out using the methods of parametric and nonparametric statistics, multivariate statistical analysis. Results. Comparison of the results of P-TUEP (n = 122) and open prostatectomy (n = 122) in groups of patients with large and giant BPH showed the possibility of reducing intraoperative blood loss by 1.5 times, the duration of bladder catheterization by 3.8 times, the frequency of early postoperative complications by 1.7 times and the duration of hospitalization by 2.9 times, which significantly saves hospital costs. Modification of the initial stage of P-TUEP, which consists in creating access to the prostate using new anatomical landmarks to maximize the preservation of the anterior fibrostromal complex, reduces the risk of trauma to the external urethral sphincter, which was proven by a three-fold decrease in the frequency of stress incontinence after surgery. In order to prevent late dysuric and cicatricial complications of P-TUEP, a scheme of complex medical postoperative prophylaxis with the use of a hyaluronic acid preparation was developed. It has been histologically and clinically confirmed that instillations of a hyaluronic acid solution into the bladder in combination with standard postoperative therapy make it possible to accelerate reparative processes by 24 times and get rid of irritative symptoms at 612 postoperative weeks, depending on the volume of removed BPH. Conclusion. The validity of the use, clinical and economic efficiency, high safety profile and the primacy of the choice of P-TUEP in surgery of large and giant BPH, including its modified technique and a comprehensive scheme of drug prevention of late complications, have been proven.

Combined therapy for contractures of the hand joints

Aim to study the effectiveness of the combined treatment of contractures of proximal interphalangeal joint.&#x0D; Material and methods. The study included 30 patients with a diagnosis of post-traumatic mixed contracture of the proximal interphalangeal joint. The patients were divided into 3 groups. In the first group, the patients were administered a combined treatment, including the arthrolysis of the joint, the imposition of a dynamic distraction apparatus, the injection of hyaluronic acid preparations and platelet-rich plasma. The second group of patients underwent the arthrolysis of the joint and the application of the apparatus. The third group underwent only arthrolysis.&#x0D; Results. The results of the study indicated the effectiveness of all three methods of treatment. However, in the first group where the combined treatment was used, the registered improvement in the angles of joint function and a decrease in pain were significant, which ultimately led to better functional indices of the hand and a shorter treatment period.

Hyaluronic Acid Hydrogel Containing Resveratrol-Loaded Chitosan Nanoparticles as an Adjuvant in Atopic Dermatitis Treatment.

Atopic dermatitis (AD) is a common disease-causing skin inflammation, redness, and irritation, which can eventually result in infection that drastically impacts patient quality of life. Resveratrol (Res) is a natural phytochemical famed for its excellent anti-inflammatory and antioxidant activities. However, it is poorly bioavailable. Thus, a drug delivery system is needed to enhance in vivo bioactivity. Herein, we report the preparation of hyaluronic acid (HA) hydrogels containing resveratrol-loaded chitosan (CS) nanoparticles, their physicochemical analysis, and their potential therapeutic effects in the treatment of AD. Positively charged CS nanoparticles prepared by tripolyphosphate (TPP) gelation showed sizes ranging from 120 to around 500 nm and Res encapsulation efficiency as high as 80%. Embedding the nanoparticles in HA retarded their hydrolytic degradation and also slowed resveratrol release. Resveratrol released from nanoparticle-loaded hydrogel counteracted the oxidative damage induced by ROS generation in TNF-α/INF-γ-treated human keratinocytes (HaCaT) used as an AD in vitro model. Moreover, pre-treatment with Res@gel reduced secretion and gene expression of proinflammatory cytokines in HaCaT cells. The physicochemical analysis and in vitro assay confirmed that the formulated hydrogel could be considered an efficient and sustained resveratrol delivery vector in AD treatment.

The Comparative Study of the Administration of the Combination Preparation of Isoflavones and Hyaluronic Acid in Menopausal Women for the Treatment of the Symptoms of Menopause, Urogenital Atrophy and Oteoporosis in Relation to Existing Hormone Replacement Therapies.

Menopause is characterized by a series of symptoms and effects from the various systems and organs, for which, the decline in estrogen production from the ovaries is considered responsible. The aim of this study was to make comparative study of the administration of the combination preparation of isoflavones and hyaluronic acid in menopausal women for the treatment of the symptoms of menopause, urogenital atrophy and osteoporosis in relation to existing hormone replacement therapies. In this five-year, double-blind, placebo-controlled clinical study, a total of 274 postmenopausal women were enrolled and classified into three groups. Participants in group A, were 96 women who did not receive Hormone Replacement Therapy (HRT), in the second group, 92 received daily treatment with tibolone (2.5 mg) as monotherapy, and in the third group, 86 received treatment with a pharmaceutical formulation of hyaluronic acid 120 mg and isoflavones. MF11RCE 80 mg. In the postmenopausal women of our study, a significant reduction of postmenopausal symptoms was found in both groups B and C of participants who received hormone replacement preparations compared to group A who did not receive HRT. Furthermore, no difference in efficacy was observed between the administered preparations of isoflavones and tibolone. The combination of isoflavones and hyaluronic acid has the same efficacy as tibolone in menopausal symptoms.