Mg Of Hyaluronic Acid Research Articles

Counteracting HPV Cervical and Anal Infection through Dietary Supplementation of EGCG, Folic Acid, Vitamin B12 and Hyaluronic Acid: Clinical Case Reports.

Background: Human papilloma virus (HPV) infection and the management of its persistence is still a great medical challenge. Recently, scientific evidence has supported the potential therapeutic effects of four combined natural molecules-epigallocatechin gallate (EGCG), folic acid, vitamin B12 and hyaluronic acid (HA)-in counteracting HPV DNA positivity and related cytological lesions. Methods: Each patient of these five clinical cases had persistent HPV positivity in the anogenital site and assumed a dietary supplement based on a combination of 200 mg of EGCG, 50 mg of HA, 1 mg of vitamin B12 and 400 mcg of folic acid (Pervistop®, Farmares s.r.l., Rome, Italy) at a dosage of 1 or 2 caps/day for 6 or 3 months, respectively, depending on clinical history. Results: After treatment, all the patients reported a negative HPV DNA test and improved cytological lesions, thus demonstrating the ability of these combined molecules to counteract both anal and cervical HPV infection and related manifestations. Conclusions: Overall, these data corroborate previous evidence about the effectiveness of such natural molecules in the management of HPV infection and its persistence. Naturally, further studies with a larger population and long-term follow-up will contribute to reinforce the positive effects of this dietary supplement in counteracting HPV infection.

The Effects of Dietary Supplementation with Collagen and Vitamin C and Their Combination with Hyaluronic Acid on Skin Density, Texture and Other Parameters: A Randomised, Double-Blind, Placebo-Controlled Trial.

Collagen dietary supplements are becoming increasingly popular as a means to reduce signs of skin ageing. The objective of this three-way, randomised, placebo-controlled, double-blind study was to examine and contrast the effects of dietary supplementation with a daily dose of 5 g hydrolysed collagen with 80 mg of vitamin C (CP product) and their combination with 30 mg of hyaluronic acid (CPHA product) over 16 weeks. Validated methods were utilised for the objective evaluation of skin parameters. In total, 87 subjects (women, 40-65 years) completed the entire trial, distributed across the groups as follows: placebo group (n = 29), CPHA group (n = 28), and CP group (n = 30). The results showed beneficial effects of both test products, with notable enhancements in dermis density, skin texture, and a reduction in the severity of wrinkles. In contrast, the administration of either of the products did not yield any significant impacts on skin elasticity or hydration. Observation of the investigated skin parameters did not show superior effects of the addition of hyaluronic acid (HA) to collagen. Therefore, the ability of supplementation with HA to improve the effects on investigated skin parameters beyond the supplementation of collagen alone cannot be confirmed.

Supportive local treatment of diseases of the distal colon of various inflammatory genesis in the outpatient department

Introduction. Currently, along with the improvement of the scheme of combined drug therapy with first-line anti-inflammatory drugs, important importance is attached to adjuvant topical methods of treating diseases of the distal colon of various inflammatory genesis.Aim. Evaluate the clinical efficacy of the drug on sodium hyaluronate as an adjuvant topical agent in the complex treatment of patients with diseases of the distal colon.Materials and methods. A comparative analysis of the results of drug treatment of 97 patients with diseases of the distal colon of various inflammatory genesis, which were divided into two groups, was carried out. In 46 (47.4%) patients of the I (control) group, standard drug therapy with basic anti-inflammatory drugs was performed; 51 (52.6%) patients – II (main) group, the standard program of drug treatment was supplemented with instillations into the rectum of the drug on sodium hyaluronate (0.8 mg of hyaluronic acid in 1 ml). The comparative assessment of the results of treatment took into account the severity of clinical, laboratory and endoscopic manifestations of the disease.Results. In patients of the main group, there was a significant reduction in the healing time of erosions and ulceration of the mucous membrane of the distal colon compared with patients in the control group (29.4 ± 5.7 days, respectively, versus 52.8 ± 6.2 days). Also, in patients of the main group, it was possible to achieve stable clinical and laboratory remission of the disease at an earlier time, restoration of patients’ ability to work, and improvement of their quality of life.Conclusion. The results obtained by us allow us to recommend the drug on sodium hyaluronate as an additional topical drug for the medical treatment of chronic diseases of the distal colon of various inflammatory genesis in outpatient settings.

Evaluation of single and multiple hyaluronic acid injections at different concentrations with high molecular weight in the treatment of knee osteoarthritis

BackgroundKnee osteoarthritis is severe progressive and most commonly diagnosed articular disease and its incidence is increasing around the world depending on age. This pathologic condition which limits daily activity of patients can be characterized by degeneration of cartilage and inflammation. Although non-steroidal anti-inflammatory (NSAII) agents and other analgesics are routinely used treatment options, the potential effects of intraarticular injections including hyaluronic acid (HA) have also been demonstrated by various studies. However, few studies compare the efficacy of a single high molecular weight (HMW) high dose and a triple HMW low dose. This study aimed to compare the efficacy of single high molecular weight (HMW) high dose (2 mL / 60 mg) and triple HMW low dose (2 mL /30 mg) intra-articular injection of HA in knee osteoarthritis (OA) patients by evaluating function and pain parameters during 12 months.MethodsThis is a single-center, retrospective clinical study that included and involved 128 patients. Group I (n=64) patients received triple 30 mg HA injections (SEMICAL®) with one-week intervals, while Group II (n=64) patients received a single 60 mg HA injection (SEMICAL®). Lequesne Index, WOMAC and VAS scores were recorded to assess pain and function during a 12-month period.ResultsThere was no significant difference in characteristics of patient demographics. Our finding indicate that WOMAC, VAS score, and Lequesne Index values during follow-up visits exhibited a decrease, signifying improvement in the clinical condition. Notably, scores were significantly more favorable with the 30 mg of HA injection compared to the 60 mg of HA injection.ConclusionThis study suggests that the triple low-dose injection of HMW HA is more effective in improving WOMAC, VAS scores and Lequesne Index values than a single high-dose injection.

May the Symptomatic Subtalar Joint Be Conservatively Treated With Intra-Articular Hyaluronic Acid Injections After a Calcaneus Fracture?

Subtalar pain following intra-articular calcaneus fractures may be associated with disability, pain, and a negative impact on the quality of life. Salvage procedures as subtalar fusion are associated with further consequences as stiffness, altered ankle biomechanics, and adjacent articular overloading with degenerative changes. The objective of the present study is to evaluate the short-term effects of viscosupplementation with intra-articular hyaluronic acid (HA) on function and pain, in patients with painful subtalar joint after calcaneus fracture. We searched for patients who underwent osteosynthesis of intra-articular calcaneus fracture between January 2011 and July 2015 and were diagnosed during the follow-up with pain and subtalar osteoarthritis. Between January and December of 2018, 13 patients (50 ± 10 years) accepted to participate in this study and received intra-articular HA injections. Three consecutive doses of 20 mg of HA were administered within a week interval, through anterolateral injections into the subtalar joint. We prospectively evaluated the function using the ankle/hindfoot American Orthopaedic Foot & Ankle Society score (AOFAS) and level of pain using the visual analog scale (VAS) before the intervention and 4, 12, and 24 weeks after the first injection. Hindfoot function improved with an increase of AOFAS from 55 ± 19 before the intervention to 88 ± 20 at the 24th week (P = .001). Similarly, we observed relief of pain during the 24 weeks following intra-articular hyaluronic acid injection, with a decrease in VAS from 8.3 ± 1.3 before treatment to 2.2 ± 3.0 at the 24th week (P = .001). For patients experiencing pain and dysfunction with subtalar osteoarthritis after intra-articular calcaneus fracture, viscosupplementation with intra-articular HA may be associated with improvement in function and pain in the short term. Furthermore, patients with higher grades of osteoarthritis may have limited benefit in pain relief and function improvement. IV, Case series.

Efficacy of antimicrobial intravesical treatment for uncomplicated recurrent urinary tract infections: a systematic review.

Intravesical antimicrobials (IVA) provide a localized modality of treatment for recurrent urinary tract infections (rUTIs). Owing to the sporadic use of these treatments, we conducted a systematic review on the efficacy of IVA in the management of uncomplicated rUTIs. A systematic review was conducted for all English language articles from inception to April 2021 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards with the following databases: PubMed, OVID Embase, Biomed Central, and Scopus. References were cross-examined for further articles. Risk of bias was assessed in the articles included using the Cochrane and Joanna Briggs Institute tools. The initial search resulting in 476 titles led to 15 full-text articles. Of the 13 in the final review (2 RCTs), 3 used gentamicin and 10 used hyaluronic acid IVA. These included 764 participants, mostly women, with a mean age range of 27-80 (median: 53.1). There was a reduction in UTI frequency in 12 out of 13 studies, with 10 studies showing a statistically significant decrease. Dosages of 80mg of gentamicin per instillation and both 40mg and 800mg of hyaluronic acid per instillation were found to be effective in reducing the frequency of UTIs in most studies. Eleven participants reported gentamicin-resistant infections after IVA treatment. Despite high levels of bias in selected categories, the 13 studies were designated to be of high quality for inclusion. The IVAs gentamicin and hyaluronic acid with chondroitin sulphate demonstrated efficacy in the management of uncomplicated rUTIs, mostly in women.

Development of Novel Nano Hyaluronic Acid Carrier for Diagnosis and Therapy of Atherosclerosis

For an efficient atherosclerosis diagnosis and treatment, we have a persistent requirement of developing a carrier that can precisely carry agents into the pathological location. Herein we examined the ability of hyaluronic acid nanoparticles (HA NPs) as a carrier for the active aiming of atherosclerosis. To prepare HA NPs, 100 mg of Hyaluronic acid was added to 20 ml of formamide, and 61 mg of EDC followed by adding 36.4 mg of NHS in order to activate –COOH functionalities of HA. The resultant mixture was then added with 33.16 mg of aminated 5b-cholanic acid in 40 ml of DMF under contentious stirring at standard temperature conditions for about 12 h, followed by purification and lyophilization. The prepared NPs were examined to study their use in the treatment of atherosclerosis. The prepared HA NPs were studied by using different characterization techniques. By in vitro cellular acceptance investigation, it was exposed that the HA NPs were taken up selectively by over expressing the cells CD44 or stabilin-2. Conversely, the cellular acceptance of HA NPs was noticed to be decreased extremely by pretreating the cells with surplus quantity of free HA, indicating that the HA NPs was taken up by the receptor intervened endocytosis. In conclusion, HA NPs were prepared and confirmed by using different characterization techniques. Also, the prepared HA NPs possesses high ability to be a carrier for the atherosclerosis diagnosis and treatment.

Treatment of Temporomandibular Joint Arthritis with Triamcinolone Acetonide and Hyaluronic Acid Injection: An Observational Study.

Temporomandibular joint (TMJ) arthritis is a common cause of orofacial pain with distressing symptoms. The patients most commonly females are often anxious and worried due to the typical gritty sound produced during chewing moments. In other cases there is pain followed by decreased mouth opening. Currently the treatment is not standardised though the clinicians are treating these disorders either by oral medications; splintage or by injections. Though local injection of Triamcinolone acetonide and Hyaluronic acid is an innovative therapy yet it is elusive of much research. The main aim of the present study is to evaluate the efficacy of with Triamcinolone acetonide and Hyaluronic acid in treating temporomandibular joint arthritis. The present study is a prospective non randomized clinical trial of 100 patients in a tertiary referral centre. The patients diagnosed with temporomandibular joint arthritis were treated with local infiltration of 40mg triamcinolone acetonide along with 20mg of hyaluronic acid; one injection every week for 4weeks. The pre-treatment and post-treatment data was compared using student paired t test and Mann-Whitney U test. Majority of the patients showed relief in symptoms like pain (87/96) and clicking sounds (81/88) and the difference was statistically significant (p < 0.05). Though other symptoms like restrictive mouth opening; discomfort on lateral and medial movement were also relieved in 9/15 patients and 21/23 patients respectively however the difference was not statistically significant. We highly recommend the use of Triamcinolone acetonide and hyaluronic acid injection in TMJ arthritis as it helps in relieving pain and clicking of sound in majority of the patients. The treatment is an out-patient department procedure with almost no side effects in most of the patients. The cost effectiveness of the treatment is another benefit.

Therapeutic effect of Intra-Tympanic Dexamethasone-Hyaluronic Acid Combination in Sudden Sensorineural Hearing Loss.

Hearing loss is fairly a common disorder which is usually treated with corticosteroids via systemic administration and/or intra-tympanic injection. This study aimed to compare the effectiveness of intra-tympanic injections of dexamethasone with its combination with hyaluronic acid in patients with sudden sensorineural hearing loss. In this clinical trial, 40 patients were randomly assigned to two groups; in the first group, 20 patients received 2.4 mg intra-tympanic dexamethasone, while in the second group patients received injections of 2.4 mg of dexamethasone plus 2 mg of hyaluronic acid in combination. Patients in both groups were injected every other day to a total of three injections. The hearing status of patients was evaluated by pure tone audiometry (bone conduction threshold) before and 2 weeks after the intervention. Assessment of hearing threshold before and after treatment in the two groups showed a significant difference between hearing thresholds at frequencies of 4,000 to 8,000 Hz (P<0.001). The difference at other frequencies was not meaningful; however, in general, we found a better therapeutic effect in patients who received the combination of dexamethasone and hyaluronic acid. A combination of dexamethasone and hyaluronic acid in patients with sudden sensorineural hearing loss may be more effective than dexamethasone alone. Because hyaluronic acid lacks certain side effects, and also makes it possible to reduce the steroid dose, we recommend the use of this combination in the treatment of patients with sudden sensorineural hearing loss.

Efficacy and safety of adalimumab by intra-articular injection for moderate to severe knee osteoarthritis: An open-label randomized controlled trial.

ObjectiveTo evaluate the efficacy and safety of adalimumab (ADA) versus hyaluronic acid (HA) by intra-articular injection for moderate to severe knee osteoarthritis.MethodsFifty-six consecutive patients with moderate to severe knee osteoarthritis were randomly allocated to either the ADA group or HA group. On day 0, patients in the ADA group received 10 mg of ADA by intra-articular injection, while those in the HA group received 25 mg of HA. All patients received celecoxib at 200 mg/day for 4 weeks. The pain visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Patient Global Assessment (PGA), and Physician Global Assessment (PhGA) scores were assessed.ResultsAt baseline, the pain VAS, WOMAC, PGA, and PhGA scores were similar between the two groups. The decrease in the pain VAS score, WOMAC pain score, WOMAC physical function score, and WOMAC total score from baseline to week 4 were greater in the ADA than HA group. A greater decrease in the PGA and PhGA scores from baseline to week 4 was noted in the ADA than HA group. No difference in adverse events was observed between the two groups.ConclusionADA by intra-articular injection was effective and tolerated for moderate to severe knee osteoarthritis.

Acute and late vaginal toxicity after adjuvant high-dose-rate vaginal brachytherapy in patients with intermediate risk endometrial cancer: is local therapy with hyaluronic acid of clinical benefit?

PurposeThe aim of the present study was to evaluate the effectiveness of hyaluronic acid (HA) in the prevention of acute and late vaginal toxicities after high-dose-rate (HDR) vaginal brachytherapy (BT).Material and methodsBetween January 2011 and January 2015, we retrospectively analyzed 126 patients with endometrial cancer who underwent extrafascial hysterectomy with or without lymphadenectomy and adjuvant HDR-vaginal BT +/– adjuvant chemotherapy. The total dose prescription was 21 Gy in 3 fractions (one fraction for week). Vaginal ovules containing 5 mg of HA were given for whole duration of vaginal BT and for the two following weeks. Acute and late toxicities were evaluated according to CTCAE vs 4.02.ResultsAccording to the revised FIGO 2009 classification, most tumors were in stage IA (30.9%) and in stage IB (57.9%). Thirty-three patients (26.2%) received adjuvant chemotherapy before vaginal BT. Five-year disease-free survival (DFS) and five-year overall survival (OS) were 88% and 93%, respectively. The most common grade 1-2 acute toxicities were vaginal inflammation (18 patients, 14.3%) and dyspareunia (7 patients, 5.5%). Two patients (1.6%) had more than one toxicity. Late toxicity occurred in 20 patients (15.9%). Grade 1-2 late toxicities were fibrosis (14 patients, 11.1%) and telangiectasias (7 patients, 5.5%). Six patients (4.8%) had more than one late toxicity. No grade 3 or higher acute or late toxicities were observed.ConclusionsThese results appear to suggest that the local therapy with HA is of clinical benefit for intermediate risk endometrial cancer patients who receive adjuvant HDR-vaginal BT after surgery. A randomized trial comparing HA treatment vs. no local treatment in this clinical setting is warranted to further evaluate the efficacy of HA in preventing vaginal BT-related vaginal toxicity.

Antiaging, photoprotective, and brightening activity in biorevitalization: a new solution for aging skin.

BackgroundAge-related changes in the dermis can be considered the result of intrinsic factors and the consequence of environmental damage, mainly due to ultraviolet (UV) radiation from the sun (responsible for skin photoaging). The great versatility of the mesotherapy “biorevitalization” lies in the synergy between different biological effects of the active injected substances, which treats the skin in a more complete way. Several studies about biorevitalization efficacy showed good results. To date, however, objective results supported by instrumental evaluation are very sparse.PurposeThis study evaluated the efficacy of an injectable solution (32 mg of hyaluronic acid plus an antiaging antioxidant complex consisting of vitamins, minerals, and amino acids) in the treatment of skin aging and photoaging.MethodsA total of 64 female volunteers (37–60 years) underwent four sessions of biorevitalization at 3-week intervals, involving multiple injections in the face (external corner of the eye and cheek), neck, décolletage, and back of the hands. The esthetic result was assessed at baseline and after 6, 9, and 12 weeks, and was established through the use of clinical and instrumental evaluations, supported by photographic documentation. Additionally, a phototest was performed to assess the effect of biorevitalization treatment on UVB-induced erythema.ResultsInstrumental assessment showed, as early as after the second biorevitalizing treatment, the antiaging efficacy of the tested product; there was a clinical and statistically significant improvement of profilometric parameters, skin brightness, pigmentation, and deep skin hydration. The study product induced a statistically significant decrease of the visual score of the UVB-induced erythema compared with baseline, which was statistically different from placebo.ConclusionThe study confirmed the well-known efficacy of biorevitalization in skin rejuvenation. The positive difference between deep and superficial skin hydration registered at the end of the trial suggested improved skin moisture retention of the stratum corneum. Furthermore, the obtained results suggest that the injected product could intervene at different moments of the skin pigmentation process by activating an intrinsic photoprotective mechanism and improving skin pigmentation quality. It may be that these processes employ common mechanisms in which antioxidants could play a pivotal role. This last hypothesis deserves further investigation.

Simultaneous Bilateral Knee Injection of Methylprednisolone Acetate and the Hypothalamic-Pituitary Adrenal Axis

ObjectiveThe objective of this study was to evaluate the effect of simultaneous bilateral intra-articular injection (IAI) of methylprednisolone acetate (MPA) on the hypothalamic-pituitary-adrenal axis in patients with knee osteoarthritis.MethodsNonselected patients...

IJU this issue

Is inflammation related to any diseases? I asked this question when I read the Review and Original Articles in this issue. Carcinogenesis as a result of inflammation has been noted in stomach cancer in relation to Helicobacter pylori, liver cancer as a result of hepatitis virus, and, in the urological field, squamous bladder cancer linked to schistosomiasis. The Review Article by Nakai and Nonomura (Osaka, Japan) described the inflammation in normal prostate and prostate cancer tissues in relation to the initiation of prostate cancer. Proliferative inflammatory atrophy (PIA) is known to be associated with acute or chronic inflammation in the peripheral zone where prostate cancer predominantly develops. PIA might link inflammation and cancer. In an epidemiological view, a fat-rich diet is a risk factor of prostate cancer. Grilled meats produce heterocyclic amine and polycyclic aromatic hydrocarbons. These compounds induce inflammation of prostate tissues. Xenobiotics have received attention because of their estrogenic effects that might cause hypospadias and other congenital abnormalities. The role of estrogen in the initiation and the progression of prostate cancer will be further investigated. Does inflammation accelerate cancer progression? Patients with advanced cancer are associated with high fever and/or inflammatory reactions. Is inflammation the cause or the result of cancer progression? C-reactive protein (CRP) is widely used as a biomarker to monitor whole-body inflammation. Saito and Kihara (Tokyo, Japan) reviewed the role of CRP in urological cancers. CRP is a valuable prognosis factor that can be used in ordinary practice. CRP is generally produced by hepatocytes through the stimulation of cytokines including interleukin (IL)-6 and IL-1β. These cytokines play an important role, because they work as autocrine and/or paracrine growth factors in the cancer microenvironment. Therefore, CRP is not the cause of cancer progression, but the result of cytokines produced by cancer or immunological cells. Then, how are theses cytokines produced? For example, IL-6 is induced by the activation of transcription factors including NF-κB. However, the mechanism underlying NF-κB activation is diverse. Further investigation should be focused on why the inflammatory reaction is common in predicting the poor prognosis of all malignancies. A cancer microenvironment composed of cancer and mesenchymal cells can be conceived as an inflammatory environment where hematological cells target or help cancer cells. Choi et al. (Ansan, Korea) have shown CD74 expression in the microenvironment. CD74 is part of a receptor complex for macrophage migration inhibitory factor (MIF). They found that CD74 expression is increased in high-grade invasive bladder cancer. This implicates the immunological escape of cancer cells. Indeed, CD74 expression was correlated with the absence of tumor-infiltrating inflammatory cells and the presence of tumor-associated inflammatory cells. Milatuzumab is a humanized anti-CD74 antibody being evaluated for hematological malignancies. This study might have opened the gate for molecular-targeted therapy for invasive bladder cancer where no such agents are available at present. How do we treat inflammation? The answer depends on the disease that induced inflammation. Interstitial cystitis (IC) is a refractory inflammatory disease, the cause of which is unknown. Wada et al. (Hokkaido, Japan) have shown the effect of intrathecal administration of E-series prostaglandin 1 (EP1) receptor antagonist in a cyclophosphamide-induced cystitis rat model. EP-1 receptor antagonist is promising for future therapy. Another treatment strategy for IC comes from focusing on the defective urothelial lining in the bladder. The pathogenesis of IC involves the mucin glycosaminoglycan layer of the urothelium. Hyaluronic acid (HA) is a relevant component. Lai et al. (Taipei, Taiwan) showed the result of a comparative randomized trial to determine the optimization of the regimens, namely, four weekly intravesical instillations of 40 mg of HA followed by monthly instillations or 12 intravesical instillations every 2 weeks. Both groups had no differences in showing a significant improvement in symptom scores and Quality of Life Index. None declared.

Intravesical hyaluronic acid for interstitial cystitis/painful bladder syndrome: A comparative randomized assessment of different regimens

To compare the clinical effectiveness of different regimens of intravesical hyaluronic acid instillation for patients with interstitial cystitis/painful bladder syndrome. A total of 60 patients (age 16-77 years) diagnosed with interstitial cystitis/painful bladder syndrome were enrolled in this prospective, randomized study. A total of 30 patients were assigned to receive four weekly intravesical instillations of 40 mg of hyaluronic acid followed by five monthly instillations (hyaluronic acid-9 group). Another 30 patients received 12 intravesical instillations of 40 mg hyaluronic acid every 2 weeks (hyaluronic acid-12 group). Symptomatic changes after hyaluronic acid treatments were assessed using Interstitial Cystitis Symptom and Problem Indexes, pain visual analog scale, functional bladder capacity, frequency and nocturia in voiding diary, maximum flow rate, voided volume, postvoid residual volume, and Quality of Life Index at 1, 3 and 6 months. Of the 60 patients, 59 were evaluable at the end of the study. The Interstitial Cystitis Symptom Index, Interstitial Cystitis Problem Index and total score, pain visual analog scale, functional bladder capacity, maximum flow rate, and Quality of Life Index improved significantly after 6 months in both groups. The frequency and voided volume improved significantly only in the hyaluronic acid-12 group. However, patients with moderate and marked improvement were clinically similar in both groups. The measured variables did not differ between the two groups over the course of the study. No significant difference was noted in the therapeutic effect between two hyaluronic acid instillation regimens for treatment of interstitial cystitis/painful bladder syndrome patients. Both groups showed significant improvement in symptom scores and Quality of Life Index.

Oral Administration of Polymer Hyaluronic Acid Alleviates Symptoms of Knee Osteoarthritis: A Double-Blind, Placebo-Controlled Study over a 12-Month Period

This study was conducted to investigate the efficacy of oral hyaluronic acid (HA) administration for osteoarthritis (OA) in knee joints. Sixty osteoarthritic subjects (Kellgren-Lawrence grade 2 or 3) were randomly assigned to the HA or placebo group. The subjects in the HA group were given 200 mg of HA once a day everyday for 12 months, while the subjects in the placebo group were given placebo. The subjects in both groups were requested to conduct quadriceps strengthening exercise everyday as part of the treatment. The subjects' symptoms were evaluated by the Japanese Knee Osteoarthritis Measure (JKOM) score. The symptoms of the subjects as determined by the JKOM score improved with time in both the HA and placebo groups. This improvement tended to be more obvious with the HA group, and this trend was more obvious with the subjects aged 70 years or less. For these relatively younger subjects, the JKOM score was significantly better than the one for the placebo group at the 2nd and 4th months after the initiation of administration. Oral administration of HA may improve the symptoms of knee OA in patients aged 70 years or younger when combined with the quadriceps strengthening exercise.

541 THE IMPACT OF INTRA-ARTICULAR HYALURONIC ACID ON GAIT VARIABILITY IN KNEE OSTEOARTHRITIS PATIENTS

Purpose: Our objective was to collect pilot data on the effect of intraarticular hyaluronic acid (HA) treatment on the gait variability of knee osteoarthritis (OA) patients. The degenerative knee changes, pain, and loss of function associated with knee OA can lead to a less stable walking pattern, increasing the risk for falling. Gait variability, specifically high stride time (StrTM), single support time (SSTM), and base of support (BSup) variability, has been shown to predict falls, and is associated with mobility decline and disability. Intra-articular HA knee injections are used to control pain in knee OA patients; however, evidence on the effect of HA on spatio-temporal gait performance is limited. We hypothesized that knee OA patients treated with HA would experience greater reductions in pain and gait variability than matched controls receiving placebo injections (P). Methods: Thirty older adults with mild to moderate radiographically diagnosed knee OA were equally randomized to receive 3 consecutive weekly knee injections of 2 ml HA (20 mg of HA) or 1.2 ml P (0.001 mg of HA). Fast gait characteristics were determined with a 10 metre electronic walkway (GAITRite System), and clinical outcomes of knee pain, stiffness, and physical function were assessed using the WOMAC OA Index. Gait variability was determined by calculating the coefficient of variation (CoV) for each of StrTM, SSTM, and BSupp. Treatment effects were determined by comparing baseline outcomes to those three (3m) and six months (6m) post-treatment, using repeated measures ANCOVA, controlling for baseline fear of falling. Results: The participants were [Mx (SD)] 72.44 (6.11) years old and all lived within the community. The StrTM, SSTM, and BSup CoV of the HA group remained relatively unchanged throughout the study, while these same measures of gait variability increased for the P group, with the greatest increases observed at 6m. However, there were no significant differences between the HA and P groups regarding the CoV for StrTM [Mean difference (95%CI)] [0.25 (0.70; 0.20)], SSTM [0.48 (1.35; 0.39)], or BSup [0.87 (6.77; 5.03)]. The HA group experienced greater reduction in WOMAC scores than the P group, however, there were no significant differences between the HA and P groups regarding the WOMAC subsections of pain [2.27 (4.75; 0.22)], stiffness [0.80 (1.78; 0.18)], and physical function [6.63 (14.35; 1.10)]. Conclusions: The results of this small sample study demonstrate that gait variability in knee OA patients was not reduced with intra-articular HA treatment. However, the trends observed in the results indicate that when compared to intra-articular P, intra-articular HA may maintain gait function in knee OA patients by preventing further increases in gait variability, particularly in StrTM and SSTM variability. Since gait disturbances are important risk factors for falling, these preliminary results provide rationale for further investigation in a larger trial assessing the effect of intra-articular HA on gait variability, and in reducing the risk of falling and mobility decline in the elder knee OA population.

The effect of vaginally administered genistein in comparison with hyaluronic acid on atrophic epithelium in postmenopause

The quality of life in postmenopause is seriously affected by the symptoms related to vaginal atrophy. To evaluate in a 3-month, prospective, randomized, double blind, study whether vaginal suppositories containing genistein might improve genital symptoms, colposcopical and cytologic findings or modify DNA cytometric features in postmenopausal women affected by vaginal atrophy, in comparison with vaginal suppositories containing hyaluronic acid (HA). A total of 62 postmenopausal women were randomly assigned to receive intravaginally 97 μg of genistein (group A, n = 31) or 5 mg of HA (group B, n = 31) daily for 15 days continuously/month for 3 months. Vaginal and cervical smear, colposcopy, vaginal biopsy were performed before and at the end of the study. Maturation value (MV) was calculated. Flow cytometric analysis of DNA ploidy (DI) and S-phase fraction (SPF) were performed. After 90 days of study, a significant improvement was obtained in genital symptoms, colposcopy scores and MV (p < 0.001) in both groups; the improvement obtained by genistein was more effective especially regarding genital score (p value between groups 0.001). No significant change was found in SPF value and DI. Both treatments improved genital symptoms, colposcopical features and MV, although genistein was more effective on genital score. Both treatments did not significantly influence flow cytometry parameters, although genistein showed slight decrease in DI, with a normalization of the aneuploid content present in some cases that could represent an additional application of intravaginal phytoestrogen therapy, providing an alternative therapy of vaginal atrophy in postmenopausal patients. The results of this investigation should be considered preliminary and need to be verified in larger, prospective studies.

Evaluation of the effects of a supplementary diet containing chicken comb extract on symptoms and cartilage metabolism in patients with knee osteoarthritis

We aimed to investigate whether a supplementary diet containing chicken comb extract (CCE) rich in hyaluronic acid (HA) has an effect on pain and other symptoms, as well as cartilage type II collagen (CII) metabolism in patients with knee osteoarthritis (OA). A randomized double-blind placebo-controlled study was conducted in 43 subjects with knee OA (Kellgren/Lawrence grade, mainly 1-2) comprising 22 patients receiving concurrent exercise therapy (ET) and 21 without ET (referred as ET-receivers and ET-unreceivers, respectively). Subjects were randomized to a CCE-containing diet (active diet) group administered a dose of 1,800 mg/day (containing 630 mg of CCE and approximately 60 mg of HA) and a placebo group, and the intervention was continued for 16 weeks. Symptomatic efficacy was evaluated based on the Japanese Orthopaedic Association clinical trials response criteria (JOA response criteria) and Visual analog scales (VAS) before (baseline) and during the intervention. To further examine its effect on CII metabolism, the levels of two degradation biomarkers (CTX-II and C2C) and one synthesis biomarker (CPII) were measured using urine or serum samples. Nineteen subjects (10 ET-receivers and 9 ET-unreceivers) in the active diet group and 21 subjects (10 ET-receivers and 11 ET-unreceivers) in the placebo group were finally included in the study. Compared to the baseline, subscale scores of the JOA response criteria, i.e., 'pain/walking function', 'pain/step-up and -down function' and 'aggregate total symptoms' were more intensely improved in the active diet group than in the placebo group. Moreover, subgroup analyses of ET-receivers and ET-unreceivers indicated that significant improvements were restricted to ET-receivers of the active diet group. Furthermore, VAS assessment indicated that the 'pain on pressing' subscale was significantly improved in ET-receivers of the active diet group. In addition, analysis of CII biomarkers revealed that serum C2C and CPII levels, but not the urinary CTX-II level, were increased in the active diet group. Notably, both urinary CTX-II/serum CPII and serum C2C/serum CPII ratios were reduced in the active diet group (particularly ET-unreceivers), suggesting that CII synthesis was relatively increased compared to CII degradation in the active diet group. Finally, no diet-related side effects were observed. The CCE-containing diet is likely to be effective in relieving symptoms in patients with knee OA. In addition, it has the potential to improve the balance of CII degradation/synthesis in knee OA.

Hyaluronic acid interaction with chitosan-conjugated magnetite particles and its purification

The polyelectrolyte complex (PEC) effect between hyaluronic acid (HA) and chitosan was explored to recover HA from fermentation broth. Chitosan was conjugated with the magnetic nanoparticles by co-precipitation method to facilitate its recovery. The magnetic chitosan particles (chitosan–magnetite) have an average size about 5 μm and point of zero charge (PZC) around 6.5. pH lower than PZC favored the HA capture. About 39 mg of HA was captured per gram of particles at pH 6. Nearly quantitative release of captured HA was achieved at pH 8. Although HA could not be directly isolated from Streptococcus zoopedemics fermentation broth by manipulating pH between 6 and 8, HA free of contaminant protein could be purified from the crude ethanol precipitate using chitosan–magnetite.