Mineral rich algae with pine bark improved pain, physical function and analgesic use in mild-knee joint osteoarthritis, compared to Glucosamine: A randomized controlled pilot trial.

INTRODUCTION: Osteoarthritis (OA) is characterised by synovial joint pain, functional disability and affects ∼13 % of people worldwide, of which ∼16-27 % report Knee-OA (KOA). Glucosamine (Glu) is the most widely used nutraceutical treatment for OA despite a lack of scientific consensus, therefore alternative nutraceutical treatments are required. The aim of this study was to investigate the effect of Lithothamnion species, seawater-derived magnesium and pine bark (Aq+) on pain, symptoms and improve physical function in symptomatic (sKOA), compared to Glu. METHODS: 358 participants were screened. In a double-blinded crossover pilot-trial, sKOA participant (n = 30) were randomly assigned to either the Glu group (2000 mg day-1) or Aq+ (3056 mg day-1) for 12 weeks (clinicaltrials.gov:NCT03106584). The Knee Injury and Osteoarthritis Outcome Score was used to assess subjective pain and symptoms. Timed-up-and-Go (TuG) and Six minute walking distance were used to assess functional change and analgesic use was recorded. RESULTS: Aq+ improved pain, with a large effect (P < 0.01, d' = 0.73, 95 %CI 0.201-1.265) and no change for Glu (d' = 0.38, P = 0.06). Only Aq+ improved pain (P < 0.05) for males (d' = 0.91, 95 %CI 0.162-1.667) and females (d' = 0.55, 95 %CI 0.210-1.299). In females, Aq+ improved TuG by -7.02 % (d' = 0.92, 95 %CI 1.699-0.141) while Glu worsened performance by 4.18 % (P = 0.04). Aq+ reduced analgesia by 71.6 %, compared to Glu (P = 0.02; d' = 0.82, 95 %CI 1.524-0.123). Aq+ was superior to Glu at improving pain, KOOS subscales, physical function and analgesia use in mild-sKOA. Given these data, Aq+ should be considered as a supplementary treatment for early-stage-KOA and may have the potential to reduce use of pain medication, although larger replication studies are required.

Gingipain enzymes from Porphyromonas gingivalis preferentially bind immobilized extracellular proteins: a mechanism favouring colonization?

BACKGROUND AND OBJECTIVE: Porphyromonas gingivalis, an anaerobic bacterium associated with adult periodontal disease, employs a number of pathogenic mechanisms, including protease/adhesin complexes (gingipains), fimbriae and hemagglutinins, to maintain attachment within colonized hosts. Here we examined the binding of gingipains and whole, live P. gingivalis cells to immobilized extracellular matrix proteins in the presence of soluble forms of the same proteins, to investigate whether this may constitute a colonization mechanism in the oral environment. MATERIAL AND METHODS: Binding of purified gingipain molecules and whole bacterial cells to immobilized matrix proteins was examined in the presence and absence of soluble competitors using enzyme-linked immunosorbent assays. RESULTS: Purified gingipains or whole, live bacteria preferentially bound immobilized forms of matrix proteins, even in the presence of soluble forms of the same proteins. Fimbriae appeared to be redundant for adhesion to immobilized proteins in the presence of the gingipains, indicating that the protease/adhesins and hemagglutinins may be more important for adhesion under these conditions. CONCLUSION: The data presented here provide evidence for a model of adhesion for P. gingivalis within the fluid environment of the oral cavity, where preferential binding of matrix-located proteins over soluble forms facilitates colonization of the host.

The gingipains from Porphyromonas gingivalis do not directly induce osteoclast differentiation in primary mouse bone marrow cultures.

BACKGROUND AND OBJECTIVE: Porphyromonas gingivalis is a major aetiological agent in the development of periodontitis, the major clinical hallmark of which is bone resorption. The cysteine proteases (gingipains) produced by P. gingivalis have a critical role in the pathogenesis of the disease, and previous studies on whole bacteria have implicated these enzymes in osteoclastogenesis, a process which serves to upregulate bone resorption. The effects of the gingipains from P. gingivalis on osteoclast differentiation were investigated here to determine whether the enzymes directly contribute to osteoclastogenesis and thus to bone resorption. MATERIAL AND METHODS: The effects of the gingipains on osteoclast differentiation were investigated in primary mouse bone marrow cultures. The cultures harvested from C57BL6/J mice were incubated in the presence of parathyroid hormone, a known osteoclastogenic factor, or active/inactivated forms of three gingipains. Osteoclast differentiation was quantified by counting the number of multinucleated cells positive for tartrate-resistant acid phosphatase, an enzyme marker for these cells. RESULTS: After 10 days of culture, the gingipains, either active or inactive, failed to stimulate osteoclast differentiation in comparison to the parathyroid hormone. CONCLUSION: The data presented here demonstrate that the gingipains do not induce osteoclast differentiation in this system, indicating that the bacterium uses other mechanisms to induce bone loss.

The correlation of disease activity and antibody titers in pemphigus.

Twenty cases of pemphigus extracted from the literature and 19 patients from UCLA with pemphigus were studied in detail regarding the possible correlation of pemphigus titer and disease activity. A statistically significant relationship between titer and disease activity, as well as change in titer and change in disease activity, was found. However, in spite of this relationship, serial titers were not found to be consistent enough to be used reliably as a guide to therapy or prognosis in pemphigus.

Tattoo removal using the alexandrite laser.

BACKGROUND: Until the recent development of the Q-switched lasers, it was not possible to remove tattoos without causing scarring, sometimes very disfiguring. Variations in wavelengths and pulse widths used may result in different clinical effectiveness or risks. The objective of this study was to determine the effectiveness of the alexandrite laser in removing professional and amateur tattoo pigment without adverse tissue response. RESULTS: We describe the clinical and histologic effects of the use of a new Q-switched laser for treatment of tattoos, the alexandrite laser (wavelength, 755 nm; pulse width, 100 nanoseconds). The results of treatment of 17 patients with professional tattoos and eight patients with amateur tattoos are analyzed. Greater than 95% removal of tattoo pigment averaged 8.9 treatment sessions. Transient hypopigmentation occurred in approximately 50% of patients, and transient textural surface changes occurred in 12%. CONCLUSIONS: The alexandrite laser is a safe and effective treatment modality for removal of black and blue-black tattoo pigment.

Cosmetic tattoo ink darkening. A complication of Q-switched and pulsed-laser treatment.

BACKGROUND: High-energy, short-pulse lasers, eg, Q-switched lasers, emitting visible and near-infrared light have recently been developed for removing tattoos, with little risk of scarring. The mechanisms of action, and possible adverse effects other than scarring and hypopigmentation, are not fully understood. OBSERVATIONS: We describe five cases of pulsed-laser-induced, immediate, irreversible darkening of cosmetic, white, flesh (skin-color), and pink-red colored tattoos. Irreversible ink darkening can be an insidious complication, because immediate whitening of the skin temporarily obscures the subsequently impressive color change. Among these cases, irreversible ink darkening occurred with Q-switched ruby (694 nm), Q-switched neodymium (Nd):YAG (1064 nm/532 nm), and pulsed green dye (510 nm) lasers. Attempts to remove the darkened ink with further laser treatment failed in two cases, and surgical excision was necessary. In the other three cases, subsequent laser treatments successfully removed the darkened ink. The red cosmetic tattoo ink used in one of the cases was placed in agar in vitro and was converted to a black compound immediately on Q-switched ruby laser exposure. Ferric oxide, a brown-red ingredient commonly used in cosmetic tattoos, was similarly tested and blackened in vitro by Q-switched ruby laser exposures. CONCLUSIONS: Although most tattoos are not darkened by laser treatment, short-pulsed lasers over a wide spectrum can cause immediate darkening of some tattoo inks. Patients should be warned of the potential for irreversible cosmetic tattoo darkening, and test-site exposures should be performed prior to treatment. In some cases, subsequent laser treatments may remove the blackened ink. The mechanism probably involves, at least for some tattoos, reduction of ferric oxide (Fe2O3, "rust") to ferrous oxide (FeO, jet black), but the chemical reaction that is involved remains unknown.

Pulsed carbon dioxide laser resurfacing of photo-aged facial skin.

BACKGROUND AND DESIGN: public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microsecond-domain pulsed CO2 laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO2 laser energy (10 600 nm, 3-mm collimated beam, <1- millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four ¿blinded¿ reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded. RESULTS: All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythemia and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar. CONCLUSIONS: Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO2 laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heat-induced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.

CO2 laser resurfacing.

The CO2 Laser offers a variety of unique features in resurfacing facial photodamage and acne scarring. These include hemostasis, efficient removal of the epidermis in a single pass, thermally induced tissue tightening, and safe, predictable tissue interaction. Knowledge of these mechanisms will result in the capability of using the CO2 laser effectively and safely whether the goal is superficial or deep treatment.

Laser resurfacing of rhytides.

A discussion of the pathologic findings found with aging and photodamage is used to formulate a rational preoperative regimen, treatment technique, and maintenance regimen. Details of laser treatment technique, anesthesia, and postoperative care are given. Possible contraindications are discussed, as are the pros and cons of early versus late treatment.

Laser treatment of erythematous/hypertrophic and pigmented scars in 26 patients.

Fifteen patients with erythematous/hypertrophic scars and 11 patients with postinflammatory hyperpigmentation were treated with a flashlamp pumped pulsed-dye laser at 585 nm or a flashlamp pulsed-dye laser at 510 nm. An average of 1.8 treatments resulted in an average improvement of 77 percent. Forty-seven percent of the patients had 100 percent improvement after one to three treatments. Eleven patients with postinflammatory hyperpigmentation were treated with the flashlamp pumped pulsed-dye laser at 510 nm with a pulse width of 300 ns. There was an average of 80 percent improvement with 1.45 treatments. Forty-five percent of the patients had 100 percent improvement after one or two treatments. The pathophysiology of postoperative scarring is reviewed. Theoretical reasons for the efficacy of laser treatment are detailed.

Preoperative anesthesia and postoperative considerations in laser resurfacing.

This article details patient selection, preoperative preparation, and postoperative considerations for conducting UltraPulse (Coherent Medical, Palo Alto, CA) CO2 laser resurfacing. The authors share their more than 3 years experience with more than 1,000 patients to help physicians perform this technique, choose optimal treatment parameters, and select appropriate patients for treatment. Methods to decrease postlaser adverse sequelae are discussed. Particular emphasis is placed on the minimization of postoperative infections. An extensive section on anesthesia techniques is also provided.

Weekly treatments with a burst-firing magnetic field alters behavior in the elevated plus maze after two sessions.

In a split-litter design, rats were either injected with 15 mg/kg of clomipramine or saline from postnatal Days 8 through 21. Other rats from the same litters were not injected. When the rats were 90 days of age, the rats were tested once per week for five weeks in an elevated plus maze that contained two open arms (no alls) and two walled arms. Following each test, they were exposed (total of 4 exposures) for 30 min. to a burst-firing magnetic field (1 microTesla) that has been shown to reduce depression in human beings. After two treatments, the rats exposed to the burst-firing fields spent about half the amount of time in the open arms compared to the sham-field exposed rats. The interaction between adult treatment and whether the rats had received the antidepressant before weaning was not significant statistically. These results suggest that at least two weekly sessions may be required before significant changes in behavior occur after weekly 30-min. exposures to these potentially "therapeutic" magnetic fields.

Laser hair transplantation. Tissue effects of laser parameters.

BACKGROUND: Micro- and minigrafting have become increasingly popular in hair transplantation over the past decade, resulting in larger numbers of grafts per session and lengthy, potentially technically difficult procedures. The advent of very high energy pulsed carbon dioxide lasers as surgical instruments has led to the investigation of their use in hair transplantation, as bloodless surgery with tissue removal by vaporization has obvious advantages as far as surgical speed is concerned. METHODS: A prospective study of eight patients comparing conventional micro- and minigrafting using 18- and 14-gauge needle punctures with dilators versus laser-vaporized donor sites with variation of laser parameters was conducted with monthly evaluation of healing and hair growth for 6 months. In addition, an in vitro histological study of laser vaporization recipient sites on excised scalp tissue was conducted to evaluate the residual thermal damage of various laser parameters. RESULTS: The conventional micro- and minigrafts healed faster and resulted in better hair growth than the laser vaporization sites. The donor sites were judged to be comparable as far as healing, but more time consuming with the laser. The operative time for the laser recipient sites was 50% of that of the conventional sites. CONCLUSIONS: The clinical results of laser hair transplantation are very dependent upon the laser parameters and technique used. Though operative time may be significantly reduced, the end result clinically is dependent on proper choices of pulse parameters and technique.

Treatment of inflamed hypertrophic scars using intralesional 5-FU.

BACKGROUND: Hypertrophic scars and keloids may complicate wound healing secondary to trauma or surgery. A variety of treatment regimens have been used with a range of success. OBJECTIVE: The purpose of this paper is to report the use of 5-fluorouracil (5-FU) intralesionally in treatment of inflamed hypertrophic scars, both as an individual agent as well as in conjunction with low-dose intralesional corticosteroids plus pulsed dye laser therapy. METHODS: The author's 9-year experience in the use of this agent in treating hypertrophic scars is summarized, and case reports are used to demonstrate its efficacy at 50 mg/cc as well as mixed with Kenalog (1 mg/cc) plus concomitant use of the pulsed dye laser. RESULTS: Frequent initial injections (once to thrice weekly) were found to be more efficacious with decreasing frequency (weekly to monthly) during a period of stabilization and resolution of the scars. The combination of 5-FU and Kenalog appeared to be more effective and less painful. The addition of the pulsed dye laser treatments simultaneous with injection therapy was found to be most effective. CONCLUSION: The use of 5-FU intralesionally for treatment of hypertrophic scars appears to be both effective and safe. Further study is warranted.