First-in-man intraglandular implantation of stromal vascular fraction … – Dove Medical Press

Back to Browse Journals International Medical Case Reports Journal Volume 10

Case report

Case reports

Video abstract presented by Kristin Comella.

Views: 12

Kristin Comella,1 Walter Bell2

1US Stem Cell, Inc, Sunrise, FL, USA; 2South African Stem Cell Institute, Parys, South Africa

Background: Stromal vascular fraction (SVF) is a mixture of cells which can be isolated from a mini-lipoaspirate of fat tissue. Platelet-rich plasma (PRP) is a mixture of growth factors and other nutrients which can be obtained from peripheral blood. Adipose-derived stem/stromal cells (ADSCs) can be isolated from fat tissue and expanded in culture. The SVF includes a variety of different cells such as ADSCs, pericytes, endothelial/progenitor cells, and a mix of different growth factors. The adipocytes (fat cells) can be removed via centrifugation. Here, we describe the rationale and, to our knowledge, the first clinical implementation of SVF and PRP followed by repeat dosing of culture-expanded ADSCs into a patient with severe xerostomia postirradiation. Methods: Approximately 120 mLs of adipose tissue was removed via mini-lipoaspirate procedure under local anesthetic. The SVF was prepared from half of the fat and resuspended in PRP. The mixture was delivered via ultrasound directly into the submandibular and parotid glands on both the right and left sides. The remaining 60 mLs of fat was processed to culture-expand ADSCs. The patient received seven follow-up injections of the ADSCs plus PRP at 5, 8, 16, 18, 23, 28, and 31 months postliposuction. The subject was monitored over a period of 31 months for safety (adverse events), glandular size via ultrasound and saliva production. Results: Throughout the 31-month monitoring period, no safety events such as infection or severe adverse events were reported. The patient demonstrated an increase in gland size as measured by ultrasound which corresponded to increased saliva production. Conclusion: Overall, the patient reported improved quality of life and willingness to continue treatments. The strong safety profile and preliminary efficacy results warrant larger studies to determine if this is a feasible treatment plan for patients postradiation.

Keywords: adipose tissue, ADSCs, cell therapy, MSCs, PRP, stem cells, SVF, xerostomia

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First-in-man intraglandular implantation of stromal vascular fraction ... - Dove Medical Press

Sabathia on DL because of knee; Montgomery back – Daily Astorian

Yankees left-hander CC Sabathia was put on the 10-day disabled list because of right knee inflammation and left-hander Jordan Montgomery was recalled from Triple-A Scranton/Wilkes-Barre

The Associated Press

FILE - In this Aug. 1, 2017, file photo, New York Yankees starting pitcher CC Sabathia winds up during the first inning of the team's baseball game against the Detroit Tigers, at Yankee Stadium in New York. Sabatthia was put on the 10-day disabled list because of right knee inflammation and left-hander Jordan Montgomery was recalled from Triple-A Scranton/Wilkes-Barre. (AP Photo/Kathy Willens. File)

NEW YORK (AP) Forced to leave a start this week because of knee pain, CC Sabathia initially thought his career might be over. Now, the 37-year-old left-hander hopes to miss just one turn for the New York Yankees.

Sabathia was put on the 10-day disabled list Friday because of right knee inflammation, and rookie left-hander Jordan Montgomery was recalled from Triple-A Scranton/Wilkes-Barre to make Sabathia's start in Sunday night's series finale against Boston. Sabathia's DL trip was retroactive to Wednesday, a day after he allowed four runs in three innings at Toronto.

"When it first happened initially, I was freaking out," Sabathia said. "I was in a lot of pain and I felt like I was letting the team down."

Sabathia calmed down after he spoke with his wife, Amber, and an MRI showed no additional damage. He had cortisone and platelet rich plasma injections on Wednesday and felt well enough to play catch Thursday.

Sabathia hopes to throw a bullpen session Sunday, then get ready to return.

"I think it's going to be a question mark until he throws the bullpen," Yankees manager Joe Girardi said.

Sabathia originally was to have maintenance injections at regular intervals.

"We didn't because I felt great, so we didn't want to like kind of mess with it," he said.

Sabathia is 9-5 with a 4.05 ERA in 19 starts, including 14 scoreless innings in two wins against Boston. He pitches with a brace because of the knee, which was repaired with surgery in July 2014 and last October. He had not had pain injections since the last operation.

A knee replacement may be necessary when his playing days are over. He wants to be able to play golf and bowl.

Montgomery, 7-6 with a 4.05 ERA in 21 starts, was optioned to Scranton on Sunday, the consequence of the late-July acquisitions of Sonny Gray and Jaime Garcia. Montgomery never left town and threw a bullpen session Thursday at the Class A Staten Island Yankees.

Second baseman Starlin Castro, sidelined since July 21 by a strained right hamstring, and first baseman Greg Bird, who hasn't played since May 1 because of a right ankle injury that needed surgery last month, are likely to start minor league injury rehabilitation assignments next week.

"I'm just excited to play," Bird said.

New York also activated infielder Tyler Austin from the 10-day disabled list and optioned him to Triple-A. Austin had been sidelined since late June by a strained right hamstring and hit .217 (5 for 23) during a seven-game rehab assignment with the RailRiders.

___

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Sabathia on DL because of knee; Montgomery back - Daily Astorian

Felix Hernandez, Hisashi Iwakuma remain hopeful of return to the Mariners’ rotation – Seattle Times

Both pitchers hope to help the Mariners in the final month of the season if not sooner.

Regardless of their performances prior to theirrespective injuries that landed them on the disabled list, the possible return of either Felix Hernandez or Hisashi Iwakuma or both to the Mariners rotation would be welcome addition. Its a unitthat has been hampered by injuries, lack of production and turnover. They would also be helpful in Seattles push for a spot in the postseason.

To be clear, neitherpitcher is returning in the coming days. And its not unfair to have a less than optimistic prognosis that neither would pitch again this season.

But they bothbelieve they will return.

Hernandez went on the disabledlist onSaturday for the second time this season with bursitis in his shoulder. He was placed on the disabled list on April 26 following a start in Detroit. He wouldnt return until June 22.

The last time it was in the back of my shoulder, he said. This time its in the front. They say its the same bursitis. Im not a doctor. I just tell them what I feel.

And he feels likethis discomfort isntnearly as bad as the first time.

They said three to four weeks, but I dont think so, he said. I can probably come back earlier. I just have to be careful not to rush it because of what could happen.They said its more inflamed than last time, but I feel better than last time. I dont understand it.

Hernandez recalled the days leading up to this DL appearance.

I felt fine before the last start in Texas, he said. The day I pitched in Texas I felt good. The next day I felt a little something in my shoulder. But I was fine before that. I was actually feeling really good.

That something in the shoulder didnt feel any better when he tried to play catch.

The next day in Texas, I was like, what is going on with my shoulder?' he said. I told them I cant throw a bullpen.

After examinations and tests from Dr. Edward Khalfayan, he received a platelet rich plasma (PRP) injection into the shoulder to speed up the healing process.

Im just hoping everything is good, he said. Im doing my treatment and waiting a few more days to see if I can play catch.

Hernandez is known to be a bit dour when hes on the disabled list and is not a fan of discussing his health. But he was in a good mood on Thursday with the team back in town. That wasnt the case when the injury first occurred.

I was so pissed, he said. Im still pissed. Im trying to calm myselfdown and, you know, smile to hide what I feel inside. Im just focused on getting healthy and help this team get to the promised land.

There was a belief that Iwakuma wouldnt return this season after experiencing multiple setbacks in his return from the shoulder inflammation that landed him on the DL on May 10. And he still may not. But hes going to keep working to do so. While the Mariners were on the road, Iwakuma threw three shorter bullpen sessions a major step back to being ready.

The plan is for him to throw an extended bullpen on Friday. If hecomes out of that healthy, Iwakuma would throw a simulated game next week. If that went well, he would head out on a rehab stint of at least two to three starts. If those went well, he might return to the rotation. Obviously, thats a lot of ifs that must go right to see him return.

It is tough to be be honest, he said through interpreter Antony Suzuki. It is whatit is. Its been a long process.But you have to go through your steps and go in the right directionand hopefully I will come back soon. The team is playing very well and you do have a strong feeling of wanting to help right now.

After receiving some injections and getting shutdown from his throwing program for a week in July, Iwakuma hasnt had any issues.

Better arm speed, better arm action, getting my mechanics and my deliveryto where I want to where its stress free on the shoulder, he said. As long as my mechanics are good, as long as Im not flying open, I dont feel anything. But when I do start flying open, I do feel tightness. Thats what Im working on right now.

Also

Mitch Haniger (facial laceration) participated in the pregame workout on Thursday, including taking batting practice on the field. He could go on a rehab assignment by next week. It could be a prolonged stint for Haniger, who was struggling before getting in the face by a95 mph fastball from Mets pitcher Jacob deGromm. With the Sept. 1 roster expansion looming, the Mariners could wait to activateHaniger from the DL, which would allow them to avoid another roster move to make room for him.

Veteran catcher Tuffy Gosewisch was outrighted to Class AAA Tacoma on Thursday. Gosewisch was designated for assignment on August 6 to make room on the 40-man roster for reliever Ryan Garton, who was acquired in a trade from the Rays.

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Felix Hernandez, Hisashi Iwakuma remain hopeful of return to the Mariners' rotation - Seattle Times

Should You Think Twice About Cortisone? – HuffPost

Corticosteroid - or more commonly called cortisone - injections are routinely performed in medical offices throughout the world. Injections for the knee have been described as far back as 1897, but it really wasnt until the 1960s that knee injections of steroids became widely available. Over the last 50 yeas, thousands of papers have been dedicated to corticosteroid injections of the knees but not many of them can stand up to rigorous scientific analysis. Furthermore, the use of steroid injections have been extrapolated to other joints and tendons in the body, but the truth is, the value and effect of injections in these areas may be even less understood and scientifically proven.

If we were to zoom down into cells we would see complex shaped protein molecules that acct as landing sites, or receptors for steroids. When a steroid chemical binds to one of these receptors they can affect hormone or gene expression. As scientists, we know that corticosteroids have both anti-inflammatory and immunologic effects, but their mechanism of action are complex and not completely understood. There are a handful of studies of cortisone injections in the knee for arthritis which show fleeting effects of pain relief, but its unclear exactly how or why this commonly used medication actually helps.

Typical arthritis is a gradual loss of cartilage from the ends of the bones. You can see the pearly white cartilage if you ever pick up a chicken bone and look at its end. This cartilage helps to absorb and distribute pressure within our joints. Over the years from injuries or wear and tear, and also likely from genetics, cartilage in the knee can become thinner and thinner until the bones of the knee are touching each other. This increase stress on the cartilage-less bone can cause pain and some inflammation, but arthritis really isnt an inflammatory condition, so it doesnt make complete sense why a corticosteroid can help. There is no doubt that it can provide some relief, usually just a few weeks, but if you ask doctors, patient responses are variable. Some patients swear by their annual or semi-annual injection cortisone injections while others will tell you they maybe only had one or two days of relief and then the pain came back. Unfortunately, this unpredictable response is even less predictable when it comes to treating non-arthritis conditions of the knee such as tears of the ligaments, tendons, or other structures.

When it comes to corticosteroid injections, especially in the world of orthopedics, you will find surgeons who inject everyone, only older patients or specific diagnoses, or sometimes nobody at all. Those surgeons who inject everyone have several beliefs among which include that cortisone is rather harmless, it is effective, and if it doesnt work then there is always surgery. Those who avoid it altogether point to the potential risks and instead lead patients towards less-studied, but possibly superior alternatives such as Platelet-Rich-Plasma (PRP) or stem cells. These are promising options, but the verdict is still out on their long-term efficacy and unlike cortisone, they are not covered by insurance and run anywhere from 500 to 2,000 dollars an injection. In addition, injections that mimic the lubrication fluid of the knee have been shown to be more effective and longer lasting than cortisone, but due to some conflicting earlier studies, many national medical specialty groups cannot fully recommend them and insurances are starting to approve them less often for the knee, and wont even consider it for other joints in the body. Some doctors adopt the belief that there may be a risk to the cartilage with cortisone and therefore will limit their injections only to those who already have evidence of arthritis with the belief that the die has already been cast when it comes to the status of the cartilage in the knee.

Geography of patient demand may also play a role. For example, a surgeon in the Midwest may see a farmer who only wants to come to the doctor for a knee injection once or twice a year and has no interest in traveling to get an MRI or weekly Physical Therapy visits. Or in Southern California, a 49 year-old semi-professional volleyball player may want an injection before an upcoming tournament since that is what he or she has been doing for years and is convinced their performance is not limited by pain because of the effects of the injection. Injection patterns also vary from the private practice to the academic setting where financial considerations and reimbursements differ. In private practice, increased overhead and decreased reimbursement from insurance companies may force physicians to rely on cortisone injections as a significant source of revenue, which is further bolstered with the use of ultrasound that helps the surgeon locate more specifically where the injection is going.

When we look at the basic science studies of corticosteroids in the laboratory, we know that cortisone injections have an effect on the health of cartilage. There is a time- and dose-dependent effect of corticosteroids. Beneficial effects of corticosteroids occur at low doses and short exposure times where there may actually be increased cell growth and recovery from damage. However, at higher doses and longer exposure times, corticosteroids can be associated with cartilage damage. The scientific evidence in treating other conditions of the body which are commonly injected is even less convincing. Perhaps the two most injected areas of the body that have the least supporting evidence are the rotator cuff of the shoulder and the tendons of the elbow. Just to clarify, as muscles insert into bones, they become thick tendons as opposed to the meaty substance of the muscles so they can make bone and joints move. This is in contrast to ligaments which are thick bands that simply connect one bone to another without moving anything.

The rotator cuff is a group of tendons that help rotate you shoulder internally and externally and also help you to start raising your arm out at the side. When these tendons become injured or over-used they can become inflamed and the covering over them called the bursa can also get inflamed leading to a condition called bursitis or inflammation aka itis of the bursa. In order to reduce this inflammation, doctors often inject cortisone into the bursa of the shoulder. Unfortunately, the overall effects of injection in the tendons arent fully understood and recent studies of the effects of cortisone on rotator cuff tendons in rats have shown decreases in tendon strength after only a single injection. Repeated corticosteroid injections are especially worse.

When it comes to cortisone injections for inflammation of the tendons on the outside of the elbow, a condition commonly referred to as tennis elbow, the results are also mixed. There is no doubt that patients can experience relief with corticosteroid injections, but some controversy has been raised due to the fact that some studies have shown that patients who received cortisone shots had a much lower rate of full recovery than those who did nothing or who underwent physical therapy. They also had a higher risk of relapse than people who adopted a more conservative approach. That being said, many patients are too busy and active to adopt a more complacent wait-and-see approach and are seeking a more immediate solution to their pain by visiting their doctor. To them, simply being told to wait it out after making an appointment and paying a copay seems like a waste of time.

To complicate matters, many studies show that the pain affecting these tendons or bursa, i.e. the "itis", may not actuallybe inflammation. Tennis elbow for example actually shows less evidence of inflammation and more evidence of blood vessel invasion and tissue degeneration and disarray. So the question then becomes why do these injections work? Some scientists think there is an effect on the nerve receptors involved in creating the pain in the sore tendons. They act to change the biology of pain in the short term. This why corticosteroid injections may be actually helpful for the acute inflammatory-type pain but don't actually do anything to cure the disease. In some cases like rotator cuff bursitis where the tendons are pinched under the top of a forward leaning shoulder blade, physical therapy to re-train the shoulder blade to get it out of the way as the arm is raised is really the long-term solution to the problem and the role of the injection may be to help the patient find short-term pain relief to be able to do the therapy.

As a profession, orthopedics and other medical specialties are continuing to reappraise what we have been doing for decades to see if the evidence actually shows what we are doing is helping the patient, or if what we are doing is only useful in the short-term with other therapies perhaps better in the long-term. That is why there is a quest underway for better and longer-lasting therapies but as medical professionals and scientists, we must be careful to continue to self-reflect and see what the evidence of efficacy actually tells us.

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Should You Think Twice About Cortisone? - HuffPost

For Redskins Coach Jay Gruden, in some cases, less is more – The … – Washington Post

RICHMOND Here at Camp Svelte, the Washington Redskins boast many fitness feats. Trent Williams, the star left tackle, went (somewhat) vegan and lost his jolly cushioning. Junior Galette, the snakebit linebacker, dropped 24 pounds after recovering from two Achilles tendon tears that robbed him of the past two seasons. Rob Kelley, the running back wrongfully nicknamed Fat Rob as a child, now looks like he ought to go by Non-Fat Rob.

In the background stands Coach Jay Gruden, celebrating his players commitment and flashing an aw-shucks grin when hes asked about his own transformation. Gruden is quietly disappearing, too. You see it in the cheekbones resurfacing on his face. You see it in the absence of his tummy, which must have been shipped to the Bermuda Triangle.

At the end of last season, Gruden weighed 241 pounds. On Monday, he reported proudly that hes down to 218. Its the lightest he has been since 1991, when he was a 24-year-old, 215-pound quarterback starting his Arena Football League career with the Tampa Bay Storm.

You want to know how I did it? Gruden said, smiling. Youre going to have to pay extra for that, man. Youre going to have to YouTube my video, and its going to cost you $39.95.

[After Redskins chaos and Super Bowl collapse, Kyle Shanahan is ready to fix the 49ers]

Gruden will get to the how later. Its the why that matters most to him.

While his players alter their bodies to compete in a game full of world-class athletes, Gruden has a more relatable motivation. He was aching because of the extra weight on his 6-foot-2 frame. He blood pressure was high. He was a little embarrassed. He turned 50 in March, and he was tired of making excuses. He needed to do something or risk slipping from husky to obese.

I just didnt feel healthy, Gruden said. I hit 50 years old, and maybe it was part midlife crisis. I dont know. Who knows? You start looking around, and people are walking the streets, and you see people that are your age, and they look better and younger and healthier. And youre like, [Expletive], I shouldnt be this big.

Two years ago, CBS Sports radio host Scott Ferrall called Gruden a fat ass on the air. After learning of the cheap shot, Gruden referenced it during his next news conference. The comical coach tried to have fun with it, but the words bothered him.

I really dislike the guy that called me a fat ass, Gruden said then with a laugh. That really ticked me off. I dont mind you critiquing my coaching style, but to make fun of my weight, thats unfair. Im only 225.

As he recalled the exchange last week, Gruden was still upset.

Ive never considered myself, like, fat, he said. I know Im thick and a little heavy at times.

(Lee Powell/The Washington Post)

A more persuasive comment came at the end of last season. Anthony Lanier, a young defensive end who needs to add weight and strength to realize his potential, was honest with Gruden.

Man, Coach, youre too big right now, Lanier said.

The coach and player made a bet. Gruden vowed to lose as much weight, if not more, than Lanier gained. Gruden won. Hes down 23 pounds. Lanier is up 22.

But hes not paying me, Gruden said, jokingly cursing at the player. I told him Ill take the money when he gets his next contract.

[If Colin Kaepernick played basketball, the NBA would embrace him]

Gruden wont charge $39.95 for his weight-loss secrets because he didnt really do anything special. Over the past few months, he has paid more attention to what hes eating and begun exercising. Thats it, basically. He started by supplementing his breakfast with a shot of apple cider vinegar in the morning. That helped him lose four pounds in the first week or so. Since then, he has been committed to a balanced diet and regular exercise. He has been amazed at the results.

I did it because I was sore all over, Gruden said. My joints were sore. My ankle, my knee. Ive had shoulder issues. And Ive used that as an excuse for not working out or exercising. Then I lost an initial four pounds. I felt a lot better, and then I kept going. I started eating better, watching portion control, not eating late at night. And then the more I lost, the better my joints felt, so I was able to exercise more. Its amazing.

For years, Gruden thought football multiple injuries, multiple surgeries was to blame for his aches. He would wake up some mornings and struggle to walk to the bathroom because his Achilles tendon was sore. He had platelet-rich plasma injections in his knees. He took anti-inflammatory medication to get through the daily grind of coaching. But now that he is almost back to his playing weight, he feels good.

It sounds easy, but in a reality all too familiar to many people (myself included), its easier to remain unaware and mindlessly punish your body by indulging in the wrong foods and save the workouts for another day. Despite being a former high-level athlete, Gruden succumbed to bad habits.

Food is always available at the teams practice facility in Ashburn, and Gruden munched often. His job is active for about two hours of practice, but the bulk of his day is spent in meetings and sitting in rooms watching film late into the night.

The choices that you have at lunch and dinner are pretty big at our place, Gruden said. I would go out and have a sensible lunch, and then wed always have pizza there, and Id take a couple of pieces of pizza, and Id take a cookie upstairs.

Now I just have a small plate and I get the hell out of there, as much as I want to eat the pizza because its so damn good.

During training camp, Gruden used to bike 3 miles from the hotel in Richmond to the teams site. This year, he started walking every morning. Then he advanced to jogging and walking. On Monday, he ran the entire way for the first time. Earlier in camp, he played quarterback and danced in the pocket for the entirety of a long pass rush drill. Hes not a coach who has to stand back and evaluate anymore.

Last year, I couldnt do any of that, Gruden said. I didnt do any of that hardly because I was sore. Last year, I couldnt even walk from the hotel to work. I never even tried walking it. Now I ran the whole way, and I didnt stop. Thats how good my joints feel.

Gruden looked away and said softly, Lets hope I dont put it back on because its easy to put back on.

Acknowledging the threat is the first step to resistance. Besides, at Camp Svelte, there is ample peer pressure to keep Skinny Gruden or, better yet, Healthy Gruden motivated.

For more by Jerry Brewer, visit washingtonpost.com/brewer.

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For Redskins Coach Jay Gruden, in some cases, less is more - The ... - Washington Post

Thunder journal: Focus turns to Alex Abrines’ health entering EuroBasket – NewsOK.com

Oklahoma City's Alex Abrines tires to defend a shot by Houston's James Harden during the NBA playoffs in April. Abrines is getting ready to play in a tournament in Europe. [PHOTO BY SARAH PHIPPS, THE OKLAHOMAN]

When Thunder players gathered last week on the West Coast for workouts, Alex Abrines was noticeably missing.

Abrines did not attend the Russell Westbrook-coordinated workouts in Santa Monica, California. It was always Abrines' plan to start his summer attending friends' weddings and traveling home to Spain before preparing for FIBA EuroBasket 2017. Since Friday, Abrines has been in the Spanish National Team training camp for EuroBasket, the 24-team European tournament which starts Aug. 31.

Spain, the reigning European champion, will play in seven exhibition games before its Eurobasket group-play opener against Serbia and Montenegro on Sept. 1 in Romania. Its first exhibition is Aug. 8 against Belgium in Tenerife, Spain.

What will be critical to watch is the health of Abrines following platelet rich plasma injections in his right knee in May. Abrines missed three games toward the end of the regular season with a left knee sprain, and has a history of knee soreness. He missed a game for Spain in last summer's Olympics with left knee discomfort and battled a bout of right knee tendonitis when playing for Barcelona in 2013.

Abrines told The Oklahoman in June that with extended rest he hopes he won't have to repeat the treatment for years.

It'd been four or five years since the last one, Abrines said in June. This year, we did the right thing, stopping for two weeks, then rehabbing a little bit, starting slowly. I think it's going to get better, and we don't have repeat it for the next three years at least (knocks on table).

Abrines remained relatively healthy in his first NBA season, playing in 68 of a possible 82 games while leading the Thunder in 3-point percentage (38.1 percent).

Collison likes the George gamble

While the trade of Jimmy Butler from Chicago to Minnesota or the potential of Kyrie Irving getting traded out of Cleveland can compete, the move for Paul George made by the Thunder is the biggest trade of the offseason.

It's also the biggest what if? of the summer. George can become a free agent in 2018, while players such as Butler and Irving each have two years left on their contracts. George's affinity for his native Los Angeles is well-documented, as is the Lakers having nearly $40 million in salary coming off its payroll next summer.

Just by keeping the current roster together, the Thunder is assured a Western Conference contender this season, but beyond?

Thunder veteran Nick Collison said no matter the risk factor of the George trade, he likes the move. And so does the rest of the Thunder.

You love that the front office is trying to do that to win, Collison said. As players, we're just thinking about the season, and I understand there's other decisions that have to be made for the future of the franchise, but it's the move they decided to make. I think as players, we're excited about it.

Sam's job is to put the players here. Billy's job is to coach the team. The players' job is to be ready to play. The direction that they want to go is up to them, but as a player I think you love it when they add a guy like that if you feel like it's gonna make the team better, which I do.

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Thunder journal: Focus turns to Alex Abrines' health entering EuroBasket - NewsOK.com

Healing Osteoarthritis with Stem Cells – Anti Aging News

1079 0 Posted on Aug 03, 2017, 7 a.m.

Stem cell therapies provide an alternative to pain relievers and total joint replacement for those suffering from osteoarthritis.

Osteoarthritis plagues millions of older adults throughout the world. It is the most common type of degenerative joint disease. Commonly referred to as OA, osteoarthritis is an inevitability for many people. It occurs as the rubber-like cartilage that protects the ends of human bones gradually breaks down. It eventually leads to a situation where bones rub against one another as little, if any, cartilage remains. OA can occur in any of the body's joints. However, it is more common in the hips, knees, spine and hands.

OA sounds like a particularly gruesome condition with painful bone-on-bone contact yet hope is available. Patients currently use physical therapy, pain relievers, cortisone injections and even surgery. Scientists have recently pinpointed stem cells as a possible catalyst for OA healing.

How the Human Body Might be Able to Heal Itself

Emory Orthopaedics and Spine Center physicians made waves five years ago when they launched regenerative stem cell therapy. This is a form of treatment for OA as well as related joint maladies. It makes use of the patient's stem cells to remedy damaged tissues, minimize pain and hasten the healing process. Stem cells are taken from the patient's body with a needle. These stem cells are derived from abdominal fat and/or the hip's bone marrow. They are then placed in a centrifuge and spun in a rapid manner to generate a concentrate. This process isolates the stem cells. These cells are injected right back into the patient's compromised joint minutes later. This reapplication of stem cells catalyzes the healing process.

The use of stem cells takes about an hour and a half. The best part is it involves minimal comfort and produces few side effects for the vast majority of patients. The stem cells are taken from the patient himself in order to decrease the odds of rejection. This method of treatment has proven quite effective, helping patients enjoy a substantial improvement in joint health in as little as one month.

Stem Cells: The Darling of Regenerative Medicine

The medical community is quickly determining stem cells enhance the healing process better than other treatments. The predecessor was platelet-rich plasma for the treatment of OA and joint damage. This method debuted nearly a decade ago. Stem cell therapy launched in 2012 and has proven incredibly effective. Stem cells are highly specialized cells that can replicate themselves and potentially differentiate into different cell types for varying functions within the body.

Though there are numerous different stem cell types, those that help promote ligament, tendon and cartilage healing are referred to as mesenchymal stem cells. The human body has a substantial amount of these cells available to repair damaged tissues. Though there is minimal evidence that adding a concentration of such cells can replace joint cartilage that has been lost, they serve as important signaling cells that promote the transmission of proteins like cytokines. These are molecular harbingers that mitigate cartilage degeneration and control pain.

Advancements in stem cells might eventually make it theoptimal means of repair for cartilage cells. Such cells aredamaged due to everyday wear and tear, sports participation, obesity, andgenetics. As of now, stem cells have proven quite effective in reducing the stiffness and pain tied to OA. It is an excellent alternative to total joint replacement surgery and pain relievers.

The FDA's Take on Stem Cells

Certain medical professionals consider stem cells to be an experimental treatment. The FDA is now attempting to determine how the number of stem cell therapies should be regulated. Unfortunately, many types of insurance do not cover stem cell treatments. Stay tuned for more developments.

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Healing Osteoarthritis with Stem Cells - Anti Aging News

Platelet-Rich Plasma Injections – Hedley Orthopaedic Institute

Platelet-rich plasma therapy also referred to as PRP injection is an exciting branch of sports medicine that allows athletes to heal and recover from chronic pain and/or injuries of the tendons, muscles, ligaments, cartilage, nerves, and more. The treatment is safe, non-surgical, and doesnt even use drugs. With PRP injections, the patients own blood platelets are the healing agent.

At Hedley Orthopaedic Institute, sports medicine physicians can help you get back in the game with fast-acting, highly effective platelet-rich plasma therapy. Learn more below about this revolutionary alternative to steroid injections and surgery.

The idea behind PRP therapy is relatively simple on the surface, but a working knowledge of your bodys natural repair functions can make PRP easy to understand

Everyone knows that blood platelets help stop a cut. But researchers now know that these platelets do more than coagulate and stop blood flow; they also release growth factors, which draw special regenerative cells (progenitor cells) to the site of the injury. Platelet-rich plasma therapy maximizes this platelet/progenitor cell relationship.

During your appointment at Hedley Orthopaedic Institute, your physician will perform a basic blood draw. The blood is placed in a centrifuge that separates the platelets and plasma from the red blood cells. After about 15 minutes, the platelet-rich plasma is removed from the centrifuge. Using ultrasound guidance, your physician will place a needle into the damaged area of your body that requires treatment, and inject the platelet-rich plasma into the injury site. The high concentration of platelets is loaded with growth factors, which expedites the healing and recovery process. This entire procedure is done in-office and takes about an hour to complete.

After you receive a PRP injection, you will be asked to return to Hedley Orthopaedic Institute for a follow-up appointment six to eight weeks later. Your sports medicine physician will evaluate your injury to see how effective PRP therapy has been. While some patients may be fully or nearly recovered, most patients will return for two or three more treatments. Injections are usually spaced eight to 12 weeks apart.

Platelet-rich plasma therapy offers many benefits. Athletes are especially interested in this treatment option, as it can help speed up the recovery process and get them back to the game.

Platelet-rich plasma therapy can be used to treat:

For more information about platelet-rich plasma injections and other regenerative medicine services, contact us. Sports medicine services available in Phoenix, Tempe, and Mesa.

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Platelet-Rich Plasma Injections - Hedley Orthopaedic Institute

Alternative treatments for knee arthritis – Palm Beach Post

Question: Ive been told that I need a knee replacement. Are there other options?

Answer: If youve been told that you need a knee replacement, it is likely that you have advanced arthritis. There are various conservative options that must be considered before having joint replacement surgery. Some of the initial treatments include non-steroidal anti-inflammatory medication, physical therapy, cortisone, and visco-supplementation injections.

Emerging treatments include PRP (platelet rich plasma), stem cell therapy, as well as A2M (Alpha 2 Macroglobulin). These are newer options which bring much promise for the right candidate, but still have emerging data about their potential level of efficacy.

Should none of these provide adequate pain relief, there is the option of a genicular rhizotomy/radiofrequency ablation. This is where the nerves around the knee are treated to reduce or eliminate the perception of pain.

Some patients may benefit from a procedure called subchondroplasty, which reinforces the underlying, overstressed bone. Studies have shown that this can significantly delay or decrease the chances of having a knee replacement if done on the right patient.

If all else fails, it is possible in the appropriate patient to undergo a robotic-assisted partial knee replacement with a minimally invasive approach. This procedure resurfaces only the worn portion of the knee.

Dr. Noble specializes in non-operative treatment and innovative surgical techniques for the treatment of knee and hip arthritis. He completed a total joint replacement fellowship at the Harvard School of Medicine, Brigham and Womens Hospital, and Orthopaedic residency at the Medical College

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Palm Beach Orthopaedic Institute

Four locations: Jupiter, Palm Beach Gardens, Wellington, West Palm Beach

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Alternative treatments for knee arthritis - Palm Beach Post

Mariners shut down Hisashi Iwakuma’s throwing program – The Seattle Times

Hisashi Iwakuma received injections into his ailing right shoulder and won't throw for at least a week. He's been out since early May.

Hisashi Iwakumas return to the mound for the Mariners is looking less and less likely with each setback in his recovery from shoulder inflammation.

The veteran right-hander experienced more discomfort in his right shoulder following a bullpen session this past weekend in Anaheim. After meeting with team orthopedist Dr. Edward Khalfayan on Monday, Iwakuma has been shut down from throwing for at least a week. Iwakuma confirmed that he received a cortisone injection and a platelet rich plasma injection in his shoulder to help calmthe inflammation and speed up the recovery.

Its not feeling well yet, Iwakuma said through interpreter Antony Suzuki. Its just inflammation in my shoulder in general.

It was yet another setback in his recovery from an injury that placed him on the disabled list on May 17.

Its a lot longer than I was expecting, he said of the recovery. Its very disappointing and frustrating. But it is what it is and you just have to take it day by day.

Iwakumalast pitched in a game on May 3, throwing five innings against the Angels. After that outing, he felt discomfort in the shoulder during his midweek throwing routine. Hes made six starts this season, posting an 0-2 record with a 4.35 ERA.

This isnt the first time Iwakuma has dealt with shoulder injuries in his career. Its been an issue dating back to his time pitching in Japan. Hes had multiple disabled list stints with the Mariners because of shoulder issues and concerns over the shoulders healthduring his physical with the Dodgers led to them to scuttle athree-year contract as a free agentafter the 2015 season.

Given the nature of the injury and having to start his throwing program from the basics in a week at the earliest, a conservative expectation for his return to the rotation barring any setbacks would be in mid-August.

You just have to be patient with the situation, he said. You have to believe that things are going to get better and take it one day a time with rehab and treatment and any kind of training I can do in the weight room, just keeping my body shape.

Some people within the Mariners organization think he might not pitch again for Seattle this season, which isnt an unfair assessmentof thesituation. The Mariners are certainly at the point where theyve stopped expecting him to return and contribute. Unlike with Drew Smyly, who is scheduled to undergo season-ending Tommy John surgery in the coming days, there is no immediate closure for the situation.

Iwakuma will continue to rehab and try to return and help the Mariners in the final month of the season.If he is able to return and help, it will be a bonus.

Asked if hes confident that it will get better, Iwakuma replied: Yes, of course.

The injuries this season have insured that Iwakumas optionfor 2018 wont vest. If he had reached a total of 324 innings pitched combined from 2016 and 2017, Iwakumas option for $15 million in 2018 would have kicked in. But hes thrown just 230 innings (199 in 2017, 31 this season).

Still, this only furthers the idea that general manager Jerry Dipoto needs to add starting pitching help for this season and possibly next season at the trade deadline. After the starting rotation of James Paxton, Felix Hernandez, Ariel Miranda, Sam Gaviglio and Andrew Moore, only Christian Bergman and Chase De Jong remain in Class AAA Tacoma as options for depth.

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Mariners shut down Hisashi Iwakuma's throwing program - The Seattle Times