Sodium Hyaluronate Solution Research Articles

Surgical treatment?s possibilities of late adhesive intestinal obstruction in children.

Objectives: To study the adhesions prevalence in the abdominal cavity and to determine the possibilities of surgical treatment of Late Adhesive Intestinal Obstruction (LAIO) in children. Materials and Methods: 73 children were operated on for LAIO. 35 children were in a comparison group (comprehensive treatment by traditional methods) and 38 children were in the main group. In the main group was used an anti-adhesive solution which containing sodium hyaluronate and decamethoxin to prevent recurrence of Adhesive Intestinal Obstruction (AIO). The following surgical interventions were performed: Adhesiolysis, adhesiolysis and resection of the small intestine, adhesiolysis and making of the ileostomy, elimination of the cause without total adhesiolysis, elimination of the cause without total adhesiolysis and with resection of the small intestine, elimination of the cause without total adhesiolysis and with making of ileostomy. The Adhesion Process (AP) in the abdominal cavity was evaluated by the type of adhesions and their projection on the anterior abdominal wall. Results: The most common causes of LAIO were adhesive conglomerates (32.88%), moorings (23.28%) and visceral-visceral adhesions (21.92%) in lesser extent visceral-parietal and omentalvisceral adhesions, accordingly 10.96% and 10.96%. In main group recurrent AIO was seen in 3 of 38 children (7.89%) and resolved conservatively. In comparison group recurrent AIO occurred in 7 of 35 children (20%). In comparison group, 4 of 7 children required relaparotomy. The method of cause eliminating was used at AIO without total adhesiolysis using sodium hyaluronate for the operated children. When children were observed between 1 and 7 years, recurrence of AIO was in 1 patient who resolved conservatively. Conclusion: Mesothelium damaging leads to the emergence of the primary AP of the abdominal cavity with spreading to the surrounding structures and projection on the areas of the anterior abdominal wall. In operations for LAIO in children, it is advisable to use the operation of the cause eliminating (separation or resection of the conglomerates, cutting of the mooring) without total adhesiolysis in combination with intraoperative use of sodium hyaluronate solution with decamethoxine. Keywords Late Adhesion Intestinal Obstruction (LAIO), Children.

Off-label use of 0.4 % sodium hyaluronate teardrops: a safe and effective solution for submucosal injection in gastric endoscopic submucosal dissection

[This corrects the article DOI: 10.1055/a-1265-6598.].

New Approach to Drug Delivery in Ophthalmological Practice: Development of Composite Ophthalmological Solution for Drug Loading of Soft Contact Lenses

Introduction. This article provides a tentative justification of use of soft contact lenses as a carrier of ophthalmological solutions to eye tissues.Aim. The aim of the research is to develop the composition of the ophthalmic transport system for the treatment of glaucoma. Also, the proposed manufacturing algorithms were proposed for drug loading ophthalmological solutions.Materials and methods. Preparation of sodium hyaluronate solution was carried out based on the methodology described in EP 7.0 [01/2011:1472] (Sodium hyaluronate).Results and discussion. The conducted investigation with the purpose to justify a concentration of sodium hyaluronate helped to determine its concentration that gives the viscosity level as close to the upper limit stated in Russian Pharmacopoeia as possible. Buffer solution was chosen with criteria to use as less components in ophthalmological solution as possible. Also, it was found out that the more components are added to the viscous solution, the more viscosity level is decreased. Thus, initial viscosity of solution containing sodium hyaluronate was 149.59 mm2/s, and after addition of active pharmaceutical substance it dropped down to 88.49 mm2/s and 81.36 mm2/s for model solution number 1 and 2, respectively. After addition of citric acid and disodium hydrophosphate, the viscosity of model solution was found to be 78.11 mm2/s and 75.28 mm2/s for model solution number 1 and 2, respectively.Conclusion. As a result of the studies, two alternative model compositions of an ophthalmic solution for the saturation of soft contact lenses for the treatment of glaucoma were proposed. The choice of active pharmaceutical substances, and excipients has been justified. Technological procedure of preparation of model solution was described and explained, where the most attention was paid on dissolving of sodium hyaluronate in purified water.

Development of Cell Delivery System for the Subretinal Space Using Biodegradable Nanosheets

Age-related macular degeneration (AMD) is a major ophthalmic disease that causes visual impairment and blindness, particularly in elderly people. The developing choroidal vessels invade Bruch’s membrane and disrupt the monolayer of retinal pigment epithelial (RPE) cells. Subsequently, degeneration of photoreceptors occurs. Hence, subretinal transplantation of RPE cells to the site of degeneration would offer an ideal treatment providing the transplanted cells could generate a monolayer, reconstruct the RPE–photoreceptor interface, and inhibit further development of choroidal vessels. Although transplantation of autologous peripheral RPE cells has been tested by injection of cell suspensions using a syringe needle, limited visual improvement result due to the low viability of the injected cells, and their restricted distribution and integration into the subretinal tissue.Recently, we investigated the use of biodegradable polymeric nanosheets as cell scaffolds [1,2]. Because this system enabled the easy manipulation of the cell/nanosheet constructs with a syringe needle, it raises the possibility of transplanting cell sheets into a narrow space, such as the subretinal space, in a minimally-invasive manner. So far, poly(lactic-co-glycolic acid) (PLGA) was used as the material for the nanosheets. However, this biodegradable polymer is relatively inflammatory because it produces lactic and glycolic acids as degradation intermediates and these acid dissociation constants are about 3.8. In this study, we fabricated biodegradable nanosheets using polycaprolactone (PCL) and collagen as low inflammatory materials and investigated a minimally invasive and effective method for cell transplantation into the subretinal space (Fig.1(a)).Micropatterned nanosheets consisting of PCL, collagen and Nile red were prepared by a combination of spin-coating and micro-contact printing technique (Fig.1(b)). The diameter and thickness of the nanosheets used for the following experiments were 200 μm and 200 nm, respectively. The cell/nanosheet constructs were prepared by culturing rat retinal pigment epithelial (RPE-J) cells on the micropatterned nanosheets in a monolayer. A hand-made glass capillary needle was as thick as a 27G medical needle, and the tip angle was 30 degrees. Also, it was coated with 2-methayloxyethyl phosphorylcholine (MPC) to prevent cells from attaching the inner surface of the needle. The cell/nanosheet constructs and a sodium hyaluronate solution with the medium were loaded into the capillary needle. Subsequently, the cell/nanosheet was injected into the subretinal space through the sclera of rat. Several days after implantation, the rats were euthanized, and the eyeballs were enucleated.The micropatterned nanosheet was shown in Fig.1(c). The nanosheets had sufficient strength and flexibility to be handled in water. The shape or diameter of the nanosheets could be varied by adjusting the microstructure of the PDMS stamp. Also, the thickness of the nanosheets could be controlled by changing the concentration of the solution. As shown in Fig.1b, the cells formed a monolayer on the nanosheet of PCL/collagen. Finally, we attempted to deliver the RPE-J cell/nanosheet constructs to the subretinal space of a rat eye in vivo. The hand-made glass capillary needle shape allowed the needle insertion along the retina through the sclera. The fluorescence of PCL/collagen nanosheet and cells could be observed in the eyeballs under excitation light. Also, as shown in Fig.1(e), it was confirmed that the cell/nanosheet construct was successively delivered into the subretinal space.We fabricated biodegradable nanosheets using PCL and collagen as low inflammatory materials. Also, we developed a minimally invasive and effective method for cell transplantation into the subretinal space using capillary needles and confirmed that cell/nanosheet was successfully delivered. This method holds great promise for transplantation of monolayer cells and for the development of local cell delivery systems. In order to further improve this method, we plan to evaluate the inflammatory properties of the nanosheets and the efficacy of the delivered cells.

Off-label use of 0.4 % sodium hyaluronate teardrops: a safe and effective solution for submucosal injection in gastric endoscopic submucosal dissection.

Background and study aims Submucosal (SM) injection is a critical step in endoscopic submucosal dissection (ESD). In Japan, use of viscous solutions such as sodium hyaluronate are recommended; the commercially product available is MucoUp (Seikagaku Co. and Boston Scientific Japan Co., Japan). Nevertheless, MucoUp is expensive and unavailable in many Western countries. For the past 8 years, we have been using low-cost sterile teardrops solution composed of 0.4 % sodium hyaluronate (Adaptis Fresh, Legrand Laboratory, Brazil). This solution is readily available in drugstores with a cost of approximately US$ 10.00 for each 10-cc bottle. The aim of this study was to present the clinical outcome with off-label sodium hyaluronate use for SM injection in gastric ESD. Patients and methods A single-center retrospective study of collected data investigating consecutive patients that underwent gastric ESD between 2012 and 2019. ESD was performed using 0.4 % sodium hyaluronate teardrop for SM injection and Flush Knife BT 2.5 (Fujifilm Co., Japan). The following data were analyzed: clinical-pathological features, en-bloc, R0 and curative resection rate, procedure duration, adverse events, and clinical outcome. Results ESD was performed with sodium hyaluronate for submucosal injection in 78 patients. The en-bloc resection rate and R0 resection rate were 96.1 % and 92.3 %, respectively. The curative resection rate for epithelial lesions was 83.8 %. Adverse events occurred in 5 cases (6.3 %): delayed bleeding (3.8 %, 3 cases) and perforation (2.5 %, 2 cases); all managed successfully by clipping and thermal coagulation. The mean volume of sodium hyaluronate solution used per patient was 10 cc (SD: ± 8 cc). During follow-up (mean: 17 months; SD: ± 14.5 months), two patients developed metachronous lesions (2.5 %). Conclusions Off-label use of teardrops with 0.4 % sodium hyaluronate for submucosal injection was demonstrated to be safe and able to provide an effective submucosal cushion that facilitates SM dissection in gastric ESD procedures.

An innovative next-generation endoscopic submucosal injection material with a 2-step injection system (with video)

Next-generation submucosal injection materials (SIMs) with higher performance and flexibility than the current SIMs (eg, 0.4% sodium hyaluronate solution [HA]) are expected to improve the outcomes of endoscopic submucosal dissection (ESD) but are difficult to develop. We developed a next-generation SIM by devising a 2-solution-type SIM comprising 2.0% calcium chloride solution (Ca) and 0.4% sodium alginate solution (SA) and evaluated its performance. Viscoelasticity, submucosal elevation height, and injection pressure of HA, SA, and the next-generation SIM were measured. Outcomes of ESDs on pseudo-lesions in exvivo porcine stomach/colon models were compared. The dramatic increase in SA viscoelasticity with the addition of Ca facilitated the formation of highly viscous submucosal cushions that can be controlled by endoscopists. The submucosal elevation height of the next-generation SIM was significantly higher than that of HA or SA with the same injection pressure. The ESD procedure time using the next-generation SIM was significantly shorter than that using HA or SA (14.2 ± 6.1 vs 29.2 ± 9.1 minutes, P= .0004, or 14.2 ± 6.1 vs 29.1 ± 5.9 minutes, P<.0001). Furthermore, the total injection volume for the next-generation SIM was considerably lower than that for HA or SA (7.0 ± 0.9 vs 17.2 ± 3.4 mL, P<.0001, or 7.0 ± 0.9 vs 16.2 ± 2.9 mL, P<.0001). We developed an ideal next-generation SIM that achieved high performance and high flexibility in exvivo models. Our findings warrant further investigations in a patient population.

Effects of Polymer Entanglement in Sodium Hyaluronate Solution on Elastic Instability in Abrupt Contraction-Expansion Micro Channels

In this study, the effects of polymer flexibility and entanglement on elastic instability were investigated by observing sodium hyaluronate (Hyaluronic Acid Sodium salt, Na-HA) solution in planar abrupt contraction-expansion microchannels. The rigidity of Na-HA in a solution is affected by ion concentration in the solution. Therefore, we prepared Na-HA water solution and Na-HA PBS solution with concentrations from 0.15 wt% to 0.45 wt%. The rheological properties were measured and analyzed to detect the Na-HA overlap and entanglement concentrations. The flow regimes of the Na-HA solutions in several planar abrupt contraction-expansion channels were characterized in terms of rheological properties, polymer flexibility and polymer entanglement.

Outcome of a 980-nm diode laser coagulation in women with radiation-induced hemorrhagic cystitis: a single-center retrospective study.

The purpose of this study was to evaluate the efficacy of a 980-nm diode laser coagulation in women with radiation-induced hemorrhagic cystitis (RHC). We conducted a retrospective study of 21 RHC patients treated with a 980-nm diode laser between July 2014 and December 2017 at our institution. Data was collected with regard to age, sex, lower urinary tract symptoms, use of transfusions, a drop in hemoglobin levels, indication of radiotherapy, median time between radiation therapy and presentation, previous treatments, operative time, mean energy used, number of coagulated areas, catheterization time, discharge time after treatment, hospital stay, and surgical outcome. All 21 patients were women with a median age of 52years (range 36-68years). Eighteen patients complained of frequency and urgency, four patients had dysuria, and one patient developed urinary retention. Radiation therapy was primarily indicated in the treatment of cervical cancer in 18 patients (85.7%) and endometrial cancer in three patients (14.3%). Nine patients (42.8%) received blood transfusion before surgery and three patients (14.3%) needed blood transfusion after the procedure. The mean decrease in hemoglobin prior to the procedure was 4.08 ± 2.04g/dL. The median length of time from completion of radiotherapy to the presentation of hematuria was 38months (range 8-65months). All patients had failed an adequate trial of conservative treatment which included adequate hydration, hemostatics, continuous bladder irrigation (CBI), and clot evacuation at the bedside. Eleven patients (52.4%) had previously been treated with endoscopic electrocoagulation; the mean number of procedures was 1.73 ± 0.78 (range 1-3 sessions). Six patients (28.6%) underwent HBO, and sodium hyaluronate solution irrigation was administered to 3 patients (14.3%). The mean number of HBO sessions was 26.3 ± 16.8 (range 8-50), and the mean number of sodium hyaluronate solution irrigation procedures was 4.33 ± 1.53 (range 3-6). All operations were successful. The mean operative time was 45.6 ± 12.3min, the mean number of coagulated areas was 11.7 ± 4.4, the mean energy used was 2.74 ± 1.14kJ, the mean catheterization time was 6.2 ± 0.9days, the mean discharge time after treatment was 6.8 ± 1.2days, and the average length of a hospital stay was 7.4 ± 1.3days. In 16 patients (76.2%), hematuria was completely resolved after one session of diode laser coagulation. Four patients (19.0%) underwent multiple sessions of laser treatment due to recurrent gross hematuria (three patients required two sessions and one patient required three sessions). Only one patient (4.8%) who had persistent gross hematuria after diode laser treatment (two sessions) underwent a radical cystectomy, which resolved the hematuria. The median hematuria-free interval of patients who had multiple procedures was 9months (range 1-13months). In total, 21 patients underwent 27 sessions of diode laser coagulation, and the median hematuria-free interval was 16months (range 1-45months) with a median follow-up of 25months (range 7-48months). Our study shows promising results for the management of patients with RHC; however, further evaluation with a larger cohort is required to confirm the efficacy of this treatment.

Cellulose nanofiber dispersion as a new submucosal injection material for endoscopic treatment: preliminary experimental study.

Background and aims Although various solutions have been tested for submucosal injections during endoscopic treatment, the ideal solution has not been established. We investigated the suitability of a cellulose nanofiber (CNF) dispersion with high viscosity and thixotropy as a potential submucosal injection material for endoscopic treatment. Methods We evaluated the catheter injectability and mucosa-elevating capacity of CNF dispersion compared with sodium hyaluronate (SH) solution, which has been reported to be a promising submucosal injection solution. The catheter injectability of CNF dispersion was examined under conditions equivalent to those used clinically in endoscopic treatment. The mucosa-elevating capacity of CNF dispersion was examined in porcine stomachs. Results There was no significant difference between the catheter injectability of 0.4 % CNF dispersion and 0.4 % SH solutions; however, 0.4 % CNF dispersion maintained significantly higher and longer elevation of the submucosal layer than 0.4 % SH solution. A clear separation of the mucosal layer from the underlying muscle layer was achieved by injecting 0.4 % CNF dispersion. Conclusion This preliminary study suggests that CNF dispersion could be an ideal submucosal injection material for endoscopic treatment because of its unique high thixotropy index.

Ondansetron buccal administration for paediatric use: A comparison between films and wafers.

The objective of this study was the development of different solid formulations, such as wafers and films, for buccal administration of ondansetron, a selective and potent antagonist of 5-hydroxytryptamine 3 receptors used in children for the treatment of nausea and vomiting. Wafers and films have been prepared drying an aqueous solution of pectin, hydroxypropyl methylcellulose, sodium hyaluronate, sodium carboxymethylcellulose, chitosan or gelatin, through lyophilization or oven. Formulations were characterized in terms of morphology, drug solid state and ability to hydrate, adhere to mucosa, release and favour the permeation of the drug through porcine esophageal epithelium, used as model of human buccal epithelium. The most promising formulations were tested for in vitro biocompatibility in human pulp fibroblasts. Films showed greater hydration and mucoadhesion abilities and allowed the release and the permeation of a greater amount of ondansetron with respect to wafers. Chitosan or hyaluronate provided films with the best mucoadhesion properties and good biocompatibility profile. Moreover, chitosan based film allowed to obtain the highest amount of permeated drug and could represent a novel child-appropriate dosage form able to combine the advantages of solid dosage form with the possibility to avoid the swallowing.

THE EFFECT OF GRAPHENE ADDITIVE ON THE TRIBOLOGICAL PROPERTIES OF BIONIC LUBRICANT COMPOSITIONS TESTED BY THE SRV METHOD

The aim of the study was to investigate the effect of the addition of graphene dispersion on anti-wear properties of bionic lubricant compositions based on aqueous sodium hyaluronate solutions. Tribological tests were carried out using a SRV tester, enabling the tests to be carried out in conditions of linear oscillating movement of the bullet-shield type association in which the ball was made of aluminium oxide and the disc was made of bearing steel 100Cr6. For research, a 0.5% solution of sodium hyaluronate in water (composition BSS2) was chosen, which was the base to which the graphene additive was introduced. During the main stage of work, three lubricant compositions were tested, i.e., as well as BSS2 solution, into which 0.05% m/m or 0.1% m/m graphene oxide was introduced, respectively. The study allowed the observation of a clear anti-wear effect associated with the introduction of graphene preparations into the hyaluronan base, manifested in a change in the trend of the graph of the coefficient of friction over time. In addition, a reduction in the volume wear of friction node components was found. Based on the analysis of tribological research results, it was found that the anti-wear effect of the lubricant on the friction elements of the steel-ceramic material combination increases with increasing the content of the graphene preparation in the lubricant composition.

Enhancement of the safety and efficacy of colorectal endoscopic submucosal dissection using a CO2 laser.

Endoscopic submucosal dissection (ESD) has been at the forefront of international attention as a less invasive treatment for early gastrointestinal cancer. Currently, ESD involves the use of an electrosurgical knife for mucosal incision and subsequent submucosal dissection. However, it has been reported that perforation occurs in approximately 5% of cases. To enhance tissue selectivity with this modality, we focused on applying a laser to ESD (laser ESD). A CO2 laser was chosen as the surgical knife because the saline or sodium hyaluronate solution injected into the submucosal layer during the current ESD procedure has a high absorption coefficient at the wavelength of the CO2 laser. Thus, the purpose of this study is to quantitatively clarify the safety and efficacy of laser ESD for the colon. First, we validated a porcine colon as a model of the human colon in terms of optical and thermal properties. Next, ex vivo experiments on the safety and efficacy of laser ESD were performed. In ex vivo experiments using extracted porcine colon tissue, an incision depth of 0.5-1.0mm was obtained without thermal damage to the muscle layer when the power density was set at 17, 22, or 28W/mm2. In addition, less thermal damage was observed in tissue incised with this method compared with electrosurgical knives. These results might be explained by the strong absorption of the CO2 laser by the saline injected into the submucosa. Therefore, laser ESD is expected to be a safer method for the treatment of early colon cancer.

Effects of flexibility and entanglement of sodium hyaluronate in solutions on the entry flow in micro abrupt contraction-expansion channels

In this study, the effects of polymer flexibility and entanglement on elastic instability were investigated by observing sodium hyaluronate (hyaluronic acid sodium salt, Na-HA) solution in planar abrupt contraction-expansion microchannels. As the rigidity of Na-HA depends on the ionic strength of a solvent, Na-HA was dissolved in water and phosphate buffered saline with concentrations from 0.15 wt. % to 0.45 wt. %. The rheological properties were measured and analyzed to detect the Na-HA overlap and entanglement concentrations. The flow regimes of the Na-HA solutions in several planar abrupt contraction-expansion channels were characterized in the Reynolds number and Weissenberg number space. The effects of the solvent, solution concentration, and channel geometry on the elastic corner vortex growth curve and flow regimes characterized by the Weissenberg number were analyzed. It was found that the entanglement of Na-HA in the solution is a more dominant factor affecting the flow regimes than the solution relaxation time and polymer rigidity.

Miniscleral lenses in the treatment of patients with dry eye syndrome (first own experience)

Background. Scleral lenses, due to their benefits, hold a specific position among all types of contact lenses. Some years ago, they began to be used successfully not only for the correction of complex types of refractive errors, when other types of correction failed to achieve satisfactory visual function and visual rehabilitation of patients, but also as a therapeutic system in the management of ocular surface disease.&#x0D; Purpose. To evaluate the efficacy of rigid gas permeable miniscleral contact lenses as a therapeutic system in the management of patients with dry eye syndrome by filling the space under the lens with a non-preserved sodium hyaluronate solution.&#x0D; Materials and methods. In the study, 7 patients (11 eyes) with keratectasias after corneal surgery and concomitant dry eye syndrome were included. In the treatment and rehabilitation of these patients, miniscleral contact lenses were used during daytime with additional filling of the space under the lens with a non-preserved sodium hyaluronate solution.&#x0D; Results. As a criterion of the effectiveness of miniscleral contact lens use for therapeutic purposes, along with a significant increase in visual function in patients with complex corneal pathology, the elimination of discomfort due to restoration of the corneal epithelium integrity and improvement of their quality of life is considered.

Сравнительный анализ эффективности лечения синдрома болезненного мочевого пузыря/интерстициального цистита внутрипузырными инстилляциями гиалуроната натрия изолированно и в сочетании с пероральным приемом хондроитин сульфата

It is established that intravesical sodium hyaluronate and chondroitin sulfate has high efficacy in patients with bladder pain syndrome/interstitial cystitis (BPS/IC). Currently, an oral form of chondroitin sulfate is also available. The aim of study was to compare the efficacy of intravesical hyaluronic acid monotherapy and long-term oral chondroitin sulfate in combination with intravesical therapy in patients with BPS/IC. A total of 59 patients with BPS/IC were randomized in two groups. In Group 1, 30 women (mean age 57.1 years) received viscoelastic solution of sodium hyaluronate 50 ml 1 time per week for 12 weeks as intravesical monotherapy. In Group 2 (n=29), patients were prescribed to complex therapy, which included the similar intravesical therapy combined with chondroitin sulfate in a dose 0.39 g, 2 capsules 3 times a day, also for 12 weeks. All patients completed visual analogue scale (VAS), interstitial cystitis symptom index (ISCI), interstitial cystitis problems index (ICPI) and voiding diary before and 1 week after the start of therapy. In all cases a cystoscopy and urodynamic study were performed in order to exclude other bladder pathologies. At baseline, a mean VAS score in both groups was 7 points, a mean ISCI score was 17 points in Group 1 and 18 points in Group 2 (p>0.1). The mean ICPI score in both groups was 15 points. A frequency of urination in Group 1 and 2 was 11.4 and 11.6 per day, respectively (p>0,1). A mean volume of urination was 138+/-24.6 and 131+/-18.6 , respectively. After 12 weeks of therapy there was significant improvement of VAS, ICSI and ICPI scores in both groups, as well as frequency and volume of urination, but in Group 2 an improvement in almost all parameters studied, except for the volume of urination, was more pronounced. The combined therapy of BPS/IC with intravesical hyaluronic acid and oral chondroitin sulfate provides significantly better results in comparison with intravesical hyaluronic acid as monotherapy.

Arthrocentesis associated with viscosupplementation in a case of anterior disc displacement and attachment in temporomandibular joint

Introduction: Temporomandibular disorders (TMD) are a group of conditions that cause pain and dysfunction in temporomandibular joint (TMJ), masticatory muscles, and/or associated structures. Signs and symptoms include pain, joint sounds and/or joint dysfunction [1,2]. The aim of this study is to report the clinical case of a patient with TMD, articular disc sounds, associated with arthralgia. who underwent arthrocentesis with biodynamic irrigation and subsequent viscosupplementation in order to reestablish ATM biomechanics and promote pain relief. Materials and methods: Detailed clinical evaluation and examination of magnetic resonance imaging demonstrated an anterior displacement with the attachment of the TMJ disc to the posterior wall of the articular tubercle. This was accompanied by joint sound and severe pain (VAS =7), difficulty in chewing, as well as decreased interincisal distance (28.06 mm), which lingered for more than 5 years. Treatment consisted of arthrocentesis under local anesthesia without sedation, with two needles technique, using a total volume of 200 mL of saline solution followed by synovial fluid replacement with 10 mL of 0.5% 1200 kDa molecular weight sodium hyaluronate solution (Viscoseal®) under joint manipulation. After this procedure, 1 mL of 1% 1000-2000 kDa molecular weight sodium hyaluronate solution (Osteonil®) (viscosupplementation) was performed. Oral pharmacological control with non-steroidal anti-inflammatory and analgesic was also included. Results: Immediate results to therapy consisted of a increased mouth opening with a interincisal distance of 45.09 mm, reduction in joint sound, and restoration of mandibular movements. Supervised home physiotherapy was established in order to maintain function and mouth opening. The exercises were performed for 20 seconds, 3 times a day. After two months, significant progress was observed with gain of 17.03 mm in the interincisal distance, absence of pain (VAS = 0) and great decrease in right articular sound. Discussion and conclusions: Specifically in this case, this minimally invasive approach has shown successful clinical outcomes for arthralgia and biomechanical control of the temporomandibular joint. However, in the future, a larger case-control study is necessary to ascertain its promising potentialities

Histological, Ultrastructural, and Physiological Evaluation of a Rat Model of Obstructive Sleep Apnea Syndrome.

BackgroundPatients with obstructive sleep apnea syndrome (OSAS) are at an increased risk of cardiovascular disease. The aims of this study were to develop a rat model of OSAS and to validate the use of the model by investigating respiratory and cardiovascular physiological parameters and morphological changes by light microscopy and electron microscopy.Material/MethodsSixty 3-month-old Sprague-Dawley rats were assigned to the model group (n=30) and the control group (n=30). The rats in the OSAS model group were injected with 0.1 ml sodium hyaluronate solution into the upper respiratory tract at the junction between the hard and soft palate. After one month, the model and normal rats were compared using tests of respiratory and cardiac function, and histology and electron microscopy of the lung and cardiac tissue.ResultsIn the rat model of OSAS, airway obstruction resulted in the collapse of the upper airway. Tests of respiratory function showed that the oxygen partial pressure, oxygen concentration, and oxygen saturation in the model group were significantly lower when compared with the control group. In the model group, histology of the heart showed cardiac myocyte disarray, and electron microscopy showed vacuolar degeneration and mitochondrial abnormalities. The rat model of upper airway occlusion showed pulmonary and cardiac changes that have been described in OSAS.ConclusionsA rat model of upper airway occlusion resulted in physiological and morphological changes in the lung and heart due to hypoxia, and may be used for future studies on OSAS.

Elastic Instability of Sodium Hyaluronate Solution

Elastic Instability of Sodium Hyaluronate Solution

Effects of a hydrocortisone plus sodium hyaluronate solution on wound healing and inflammatory biomarkers in corneal epithelial cells

Effects of a hydrocortisone plus sodium hyaluronate solution on wound healing and inflammatory biomarkers in corneal epithelial cells

Evaluation of tear meniscus by optical coherence tomography after different sodium hyaluronate eyedrops instillation.

To evaluate changes in tear meniscus dynamics using optical coherence tomography (OCT) after the instillation of different concentrations of sodium hyaluronate (SH) ophthalmic solutions. An experimental, double-masked, randomized study was performed. Twenty-three healthy subjects (16 women and seven men; mean age 23.57±2.56years) participated in this study. About 35μl of 0.1%, 0.2%, 0.3% SH ophthalmic solutions and saline solution was instilled in a randomly assigned eye. Tear meniscus measurements (height, depth and turbidity) were taken with OCT at 30seconds and 1, 3, 5, 10 and 20min after instillation. Subsequently, the Schirmer test and tear break-up time (TBUT) were evaluated. Tear meniscus depth and tear meniscus height showed a significant increase with all solutions compared to basal values: up to 3min for 0.1% SH, up to 5min for 0.2% and up to 10min for 0.3% SH ophthalmic solution. Tear meniscus turbidity was also increased at 30seconds for 0.1%, 0.2% and 0.3% SH artificial tears (p<0.05). This increase remained significant for up to 1min for 0.2% and 0.3% SH solutions (p<0.05). After 5min of saline and 0.1% SH instillation, the turbidity was lower than basal values (p<0.05). There was a significant increase in the TBUT for all solutions after instillation (p<0.05). No differences between the Schirmer pre- and postinstillation were found (p>0.05). Finally, the comfort was significantly improved for all ophthalmic solutions (p<0.05). Sodium hyaluronate (SH) ophthalmic solutions increase residence time in healthy subjects and are positively correlated with its concentration and therefore the viscosity.