Effects of Adipose-derived Stem Cells in the Treatment of Knee Osteoarthritis: A Case Report in Brazil's Unified Health System.

Osteoarthritis (OA) can incapacitate the individual to perform their activities of daily living due to pain. This is an important public health issue that worsens worldwide and in Brazil, since the population goes through an aging process, and has caused increased public spending on the monitoring and maintenance of treatments that can last for years and still not be resolutive. Thus, the search for innovative and effective therapies that can reduce costs becomes necessary. In this context, the present study reports the first application of cell therapy with adipose-derived stem cells in the treatment of cases of OA that are refractory to the conservative treatment, performed in the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The evaluation was performed with the application of the Visual Analog Scale (VAS), the Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities (WOMAC), specifics for OA evaluation, and also an analysis of the synovial fluid (inflammatory cytokines). The cell therapy improved the scores on the WOMAC, SF-36 and EVA, and reduced the inflammatory process. We observed a decrease of 0.73x in the TNF, of 0,71x in IL-1b, of 0,68x in IL-8, and of 0,70x in IL-10. For IL-6, an increase of 1,48x was observed. Therefore, this cell therapy can be considered promising in aiding the management of this disease, since it improved the patient's pain, decrease inflammatory markers, and enabled the return to activities of daily living, which resulted in an improvement in their quality of life.

The intra-articular injection of adipose-derived stem cells decreases pain and reduces inflammation in knee osteoarthritis, with or without the addition of platelet-rich plasma also improves functionality.

The increase of individuals with Osteoarthritis (OA) has generated an increase in public spending in the treatments, which are still not that effective. So, the purpose of this study was to analyze and compare four types of interventions: platelet-rich plasma (PRP), adipose-derived stem cells (ADSCs), ADSCs + PRP and the standard surgical video arthroscopy (All groups passed through standard arthroscopy before intervention). The evaluation was performed by applying the questionnaires Western Ontario McMaster Universities, Short Form Health Survey 36 and Visual Analog Pain Scale, also by analyzing the synovial fluid (inflammatory cytokines, enzymatic, colorimetric and viscosity analysis), this evaluation happened in two moments: before the surgical procedures and after 6 months of the interventions and also was made a comparison to standard arthroscopy. The questionnaires results showed a greater improvement in the scores of the domains analyzed in the ADSCs + PRP group, followed by the ADSCs and PRP group. In the evaluation of inflammatory cytokines, there was a significant reduction in the cytokine IL-1b only in the ADSCs + PRP group (46%) and ADSCs (31%), of IL-6 in the ADSCs + PRP group (72%), of IL-8 in the ADSCs + PRP group (50%) and ADSCs (31%), and TNF in the ADSCs + PRP group (46%). There was also a significant increase in the amount of total proteins (79%) in the control group and polymorphonuclear cells (47%) in the ADSCs + PRP group. Taking all the results into account, we infer that therapies with ADSCs + PRP and only ADSCs are safe and effective over 6 months for the improvement of pain, functional capacity and joint inflammation in volunteers with OA. It is also considered that the use of ADSCs + PRP, particularly, is a promising alternative to help manage this disease, due to the better results presented among the four propose interventions.

Effect of anti-inflammatory agents on the integration of autogenous bone graft and bovine bone devitalized matrix in rats.

PURPOSE: To study the repair of bone defect filled with autograft or bovine bone devitalized matrix in rats under anti-inflammatory action. METHODS: Two hundred and forty Wistar rats were distributed to two groups of 120 animals each. A 2mm-diameter defect was created in the femoral diaphysis. Animals of Group I had the bone defect filled with autograft and those of Group II, with bovine bone devitalized matrix. Animals of each group were redistributed to four subgroups according to the intramuscular administration of anti-inflammatory drug or saline solution: A - diclofenac sodium; B - dexamethasone; C - meloxicam; D - saline solution. Evaluation periods were 7, 14 and 30 days. Histological evaluation consisted of quantifying the inflammatory process, the bone neoformation, the collagen formation and the presence of macrophages. RESULTS: Animals of Group I did not show significant difference considering inflammatory reaction. Significant and progressive increase of bone neoformation was observed in both groups. The animals that received meloxicam and autograft showed less collagen formation at 14 and 30 days. The number of macrophages was higher in Group II than in Group I. The animals treated with dexamethasone and saline solution did not show statistically significant difference. CONCLUSIONS: Diclofenac sodium and meloxicam delayed bone graft repair and dexamethasone did not interfere in it.

Effect of anti-inflammatory agents on the integration of autogenous bone graft and bovine bone devitalized matrix in rats

PURPOSE: To study the repair of bone defect filled with autograft or bovine bone devitalized matrix in rats under anti-inflammatory action. METHODS: Two hundred and forty Wistar rats were distributed to two groups of 120 animals each. A 2mm-diameter defect was created in the femoral diaphysis. Animals of Group I had the bone defect filled with autograft and those of Group II, with bovine bone devitalized matrix. Animals of each group were redistributed to four subgroups according to the intramuscular administration of anti-inflammatory drug or saline solution: A - diclofenac sodium; B - dexamethasone; C - meloxicam; D - saline solution. Evaluation periods were 7, 14 and 30 days. Histological evaluation consisted of quantifying the inflammatory process, the bone neoformation, the collagen formation and the presence of macrophages. RESULTS: Animals of Group I did not show significant difference considering inflammatory reaction. Significant and progressive increase of bone neoformation was observed in both groups. The animals that received meloxicam and autograft showed less collagen formation at 14 and 30 days. The number of macrophages was higher in Group II than in Group I. The animals treated with dexamethasone and saline solution did not show statistically significant difference. CONCLUSIONS: Diclofenac sodium and meloxicam delayed bone graft repair and dexamethasone did not interfere in it.

OBJETIVO: Estudar o reparo do defeito ósseo preenchido com enxerto ósseo autógeno ou matriz óssea bovina desvitalizada sob ação de antiinflamatórios em ratos. MÉTODOS: 240 ratos Wistar, distribuídos em dois grupos de 120 animais. Confeccionou-se defeito de 2 mm de diâmetro na diáfise femoral. Os animais do Grupo I tiveram o defeito ósseo preenchido com enxerto ósseo autógeno e os do Grupo II com matriz óssea bovina desvitalizada. Cada grupo foi redistribuído em quatro subgrupos segundo a administração intramuscular de antiinflamatório ou solução salina: A - diclofenaco de sódio; B - dexametasona; C - meloxicam; D - solução salina. Os períodos de avaliação foram de 7, 14 e 30 dias. A avaliação histológica constou da quantificação do processo inflamatório, osso neoformado, formação de colágeno e macrófagos. RESULTADOS: Os animais do Grupo I não mostraram diferença significante em relação à reação inflamatória. Observou-se aumento significante e progressivo da neoformação óssea nos Grupos I e II. Os animais que receberam meloxicam e enxerto autógeno mostraram menor aporte de colágeno aos 14 e 30 dias de observação. Os macrófagos apresentaram-se em maior quantidade no Grupo II que no Grupo I. Os animais tratados com dexametasona e solução salina não demonstraram diferença estatisticamente significante entre os Grupos I e II. CONCLUSÕES: O diclofenaco de sódio e o meloxicam retardam a reparação do enxerto ósseo. A dexametasona não interfere na reparação do enxerto ósseo.

Efeito do alopurinol sobre a morfologia do testículo do rato submetido a isquemia, pela torção do cordão espermático seguida de reperfusão / Effect of allopurinol on rat testicles morfology, submited to ischaemia for spermatic cord torsion followed by reperfusion

OBJETIVO: Estudar o efeito do alopurinol no fenômeno de isquemia-reperfusão em testículos de ratos. MÉTODOS: Foram utilizados 80 ratos Wistar, adultos, distribuídos em 4 grupos: controle sem alopurinol, controle com alopurinol, torção do cordão espermático sem alopurinol e torção do cordão espermático com alopurinol. Os testículos foram retirados após 60 dias do ato operatório e processados para exame histológico à microscopia óptica, onde os túbulos seminíferos e as células espermatogênicas foram objeto de estudo. RESULTADOS: A comparação entre os grupos demonstrou que houve atrofia dos testículos que foram submetidos à torção, inclusive o grupo que recebeu o alopurinol. CONCLUSÃO: O alopurinol não protegeu as gônadas dos efeitos da isquemia reperfusão.

[Effect of allopurinol on rat testicles morphology, submitted to ischaemia for spermatic cord torsion followed by reperfusion]. / Efeito do alopurinol sobre a morfologia do testículo do rato submetido a isquemia, pela torção do cordão espermático seguida de reperfusão.

PURPOSE: In this investigation has been studied the effect of the allopurinol on the reperfusion injury phenomenon in testicles of rats. METHODS: Eighty adults Wistar rats were divided in 4 groups: sham without allopurinol, sham with allopurinol, right testicular torsion for one hour without allopurinol and right testicular torsion for one hour with allopurinol. Bilateral orchiectomy was performed 60 days of the experiment and the testis were processed for optical microscopy, and examined to asses the seminiferous ducts and the spermatogenic cells. RESULTS: There was significant atrophy and histological damage of the right testis. CONCLUSION: Allopurinol did not protected the testis against the effects of the reperfusion injury.

Estudo comparativo entre os fios de polidiaxanona e poliamida na tenorrafia de coelhos / Comparative study between polidioxanone and poliamide sutures in rabbit's tenorraphy

OBJETIVO: estabelecer comparaçäo entre as propriedades mecânicas das tenorrafias realizadas com poliamida (náilon) e polidioxanona (PDS). MÉTODOS: Foram utilizados 56 coelhos adultos, machos, Nova Zelândia, distribuídos em dois grupos e quatro subgrupos: GIA - tenorrafias com polidioxanona e avaliaçäo após duas semanas; GIB - tenorrafias com polidioxanona e avaliaçäo após quatro semanas; GIIA - tenorrafias com náilon e avaliaçäo após duas semanas; GIIB - tenorrafias com náilon e avaliaçäo após quatro semanas. Foram realizados ensaios de traçäo nas tenorrafias dos tendöes dos coelhos. RESULTADOS: na avaliaçäo aos quinze dias de pós-operatório, o náilon apresentou como resultados dos ensaios mecânicos, valores superiores que os do PDS para carga máxima, coeficiente de rigidez, deformaçäo, deformaçäo no limite de proporcionalidade, carga no limite de proporcionalidade, que foram as variáveis analisadas. CONCLUSAO: aos trinta dias de pós-operatório näo houve diferença significante entre o uso do náilon e o PDS.

Mal de Pott: tratamento clínico e cirúrgico / Pott's disease: clinical and surgical treatment

Foram analisados os prontuários de 22 pacientes atendidos no período de março de 1983 a março de 1993, diagnosticados como portadores de tuberculose vertebral. Destes, três foram excluídos, por näo terem retornado para controle ambulatorial. Todos os pacientes tratados fizeram uso de quimioterapia tríplice (rifampicina, isoniazida e pirazinamida) e colete gessado por período mínimo de seis meses. Apenas dois pacientes foram submetidos a tratamento cirúrgico associado à quimioterapia e imobilizaçao gessada. Os procedimentos cirúrgicos foram: a) drenagem cirúrgica do abscesso por via anterior (caso 15); b) drenagem do abscesso, descompressao medular e artrodese com enxerto ósseo de perônio e ilíaco em chips por via anterior (caso 11). Apesar da utilizaçäo de métodos conservadores na maioria dos casos (17 pacientes), o índice de bons resultados foi semelhante aos descritos na literatura, com a realizaçäo de procedimentos cirúrgicos. Essa constataçäo é de grande importância em nosso contexto, onde as condiçöes socioeconômicas dificultam os procedimentos invasivos.