It may be uncomfortable at first, but doing exercises to strengthen your quadriceps after you've had knee replacement surgery due to osteoarthritis is critical to your recovery. In fact, it can boost the function of your new knee to nearly that of a healthy adult your age.
That's the finding of a University of Delaware study published in the February issue of Arthritis Care & Research.
The authors include Lynn Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at the University of Delaware, Stephanie Petterson, clinical faculty at Columbia University, Ryan Mizner, an assistant professor at Eastern Washington University, Jennifer Stevens, an assistant professor at the University of Colorado at Denver, and Drs. Leo Raisis, Alex Bodenstab, and William Newcomb of First State Orthopaedics in Newark, Delaware.
"It sounds logical that exercises to strengthen your knee should be a component of your post-operative physical therapy after a total knee replacement, but it's not the convention at all," says Snyder-Mackler.
"There are all of these old wives' tales that strength training is a detriment to the patient and that the new knee should be treated delicately," Snyder-Mackler notes. "Our study demonstrates that intensive strength exercise as outpatient therapy is critical to begin three to four weeks after surgery."
Nearly 500,000 knee replacements, also known as total knee arthroplasties, are performed every year in the United States to treat severe knee osteoarthritis, the loss of the cushiony cartilage padding the knee. The joint disease leaves its sufferers with persistent pain and limited function, resulting in an overall diminished quality of life.
While knee replacement alleviates the pain of osteoarthritis and improves function, patients exhibit impaired quadriceps strength and function for such activities as walking and climbing stairs, and the levels remain below those of healthy people of the same age.
In a randomized controlled trial at the University of Delaware's Physical Therapy Clinic conducted between 2000 and 2005, 200 patients who had undergone knee replacements were given six weeks of progressive strength training two or three times a week starting four weeks after surgery. Half of the group also received neuromuscular electrical stimulation (NMES).
Their function was compared to that of 41 patients who received conventional rehabilitation and home physical therapy. Quadriceps strength, knee range of motion, and gait were measured in such tests as timed up and go, stair climbing and a six-minute walk.
The group in the progressive strength-training program showed significant improvement in quadriceps strength and functional performance. They also demonstrated substantially greater quadriceps strength and functional performance after 12 months than the group that underwent conventional rehabilitation.
"This study clearly demonstrates the importance of surgeons encouraging their patients to be compliant with progressive quadriceps strengthening during their rehabilitation to enhance their clinical improvement and function post-total knee replacement," notes Dr. Leo Raisis, a total joint surgeon and adjunct associate professor at the University of Delaware.
"Why undergo a $25,000 elective surgery and then not do as much as you can to get the most out of it and improve your quality of life?" Snyder-Mackler says. "Older people are incredibly motivated - they hurt after the surgery and they want to be better. They need to do this."
Source: Andrea Boyle
University of Delaware
среда, 18 мая 2011 г.
New Understanding Of COX-1 And COX-2 Enzymes Could Revise Classification Of Pain Meds
COX-1 and COX-2 enzymes may be blocked by pain medications such as Advil and Vioxx in a more complex manner than was previously understood, a Queen's University study has found.
"The results of the study have potential implications for how we classify the commonly used anti-inflammatory and pain drugs for aches, pains, and fever," says Colin Funk, a professor of Biochemistry and Physiology at Queen's and Canada Research Chair in Molecular, Cellular and Physiologiocal Medicine.
Published on-line in Nature Medicine, the study was conducted in collaboration with University of Pennsylvania researchers.
The study was initiated to explore the biochemistry associated with COX-2 inhibitors such as Vioxx, Bextra and Celebrex, which are now associated with an increased incidence of heart attack and stroke. Researchers looked at mice that were genetically modified so that their COX-2 was inhibited - to create a physiology in mice that roughly mimics that of users of COX-2 inhibitors. They found that the COX-1 enzymes in the mice "hooked up" in an unanticipated way with their remaining COX-2 enzymes creating what is called a new heterodimer.
Dr. Funk's co-researcher, Queen's biochemist Robert Campbell, has developed a computer model to show how the COX-1/COX-2 molecules can associate.
"It's possible the COX-2 inhibitor medications may affect the resulting new enzyme which is a mix of COX-1 and COX-2," says Dr. Funk.
This effect is being further explored by scientists and may lead to a broadened understanding of the biochemistry of common pain medications. It is now pointing toward possible alternatives to drugs like Vioxx and Celebrex, says Dr. Funk.
A study published April 13 by The Journal of Clinical Investigation (JCI) by the same research team found that new types of anti-inflammatory drugs may reduce COX-2 cardiovascular problems. That study was conducted after this one and incorporated the genetically modified mice created in this study.
The JCI study found a drug target that might substitute for COX-2: an enzyme called microsomal prostaglandin E synthase (mPGES)-1. The researchers showed that this drug did not predispose the animals to thrombosis or elevate blood pressure.
Sarah Withrow
withrowspost.queensu.ca
Queen's University
queensu.ca/
View drug information on Bextra; Vioxx.
"The results of the study have potential implications for how we classify the commonly used anti-inflammatory and pain drugs for aches, pains, and fever," says Colin Funk, a professor of Biochemistry and Physiology at Queen's and Canada Research Chair in Molecular, Cellular and Physiologiocal Medicine.
Published on-line in Nature Medicine, the study was conducted in collaboration with University of Pennsylvania researchers.
The study was initiated to explore the biochemistry associated with COX-2 inhibitors such as Vioxx, Bextra and Celebrex, which are now associated with an increased incidence of heart attack and stroke. Researchers looked at mice that were genetically modified so that their COX-2 was inhibited - to create a physiology in mice that roughly mimics that of users of COX-2 inhibitors. They found that the COX-1 enzymes in the mice "hooked up" in an unanticipated way with their remaining COX-2 enzymes creating what is called a new heterodimer.
Dr. Funk's co-researcher, Queen's biochemist Robert Campbell, has developed a computer model to show how the COX-1/COX-2 molecules can associate.
"It's possible the COX-2 inhibitor medications may affect the resulting new enzyme which is a mix of COX-1 and COX-2," says Dr. Funk.
This effect is being further explored by scientists and may lead to a broadened understanding of the biochemistry of common pain medications. It is now pointing toward possible alternatives to drugs like Vioxx and Celebrex, says Dr. Funk.
A study published April 13 by The Journal of Clinical Investigation (JCI) by the same research team found that new types of anti-inflammatory drugs may reduce COX-2 cardiovascular problems. That study was conducted after this one and incorporated the genetically modified mice created in this study.
The JCI study found a drug target that might substitute for COX-2: an enzyme called microsomal prostaglandin E synthase (mPGES)-1. The researchers showed that this drug did not predispose the animals to thrombosis or elevate blood pressure.
Sarah Withrow
withrowspost.queensu.ca
Queen's University
queensu.ca/
View drug information on Bextra; Vioxx.
POZEN Announces Positive Top Line Results For Its PN 400 Phase 3 Trials
POZEN Inc. (NASDAQ: POZN), today announced positive Phase 3 trial results for its PN 400 product candidate (enteric coated naproxen 500 mg and immediate release esomeprazole 20 mg) conducted by POZEN under an agreed Special Protocol Assessment with the FDA.
Both the PN 400-301/302 studies achieved the primary endpoints. Subjects taking PN 400 experienced statistically significantly fewer endoscopically confirmed gastric ulcers on PN 400 compared to subjects receiving enteric coated naproxen during the six-month period. In each of the trials, approximately 400 subjects received either PN 400 or enteric coated naproxen 500 mg, twice daily, over a six-month treatment period. Subjects underwent upper endoscopies at baseline and at one, three, and six months with the primary endpoint as the cumulative incidence of gastric ulcers. The FDA has recently informed POZEN that the appropriateness of this endpoint is the subject of an internal review and an FDA internal meeting is planned in Q1 2009 to discuss this matter.
POZEN and AstraZeneca entered into a co-development agreement for PN 400 in August 2006. PN 400 is an investigational product under clinical development in patients who require chronic non-steroidal anti-inflammation drug (NSAID) treatment for arthritis pain, such as osteoarthritis and who are at risk for developing NSAID-associated gastric ulcers. The NDA submission is planned for mid-2009. Full results of the PN 400 Phase 3 studies will be published in a timely manner.
Osteoarthritis is one of the most frequent causes of physical disability among adults. An estimated 46 million adults in the U.S. have physician diagnosed arthritis, accounting for 21 percent of the U.S. adult population, and two thirds of the people that have doctor-diagnosed arthritis are under the age of 65. Fifty percent of people on chronic NSAID's are at risk for developing NSAID-associated gastric ulcers.
About POZEN
POZEN is a pharmaceutical company committed to developing therapeutic advancements for diseases with unmet medical needs where it can improve efficacy, safety, and/or patient convenience. POZEN's efforts are focused primarily on the development of pharmaceutical products for the treatment of acute and chronic pain and other pain-related conditions. POZEN has development and commercialization alliances with GlaxoSmithKline for Treximet®, which was approved by the United States Food and Drug Administration for the acute treatment of migraine attacks; and with AstraZeneca for proprietary fixed dose combinations of naproxen with the proton pump inhibitor esomeprazole magnesium in a single tablet for conditions such as osteoarthritis and rheumatoid arthritis in patients who are at risk for developing NSAID-associated gastric ulcers. The company's common stock is traded on The Nasdaq Stock Market under the symbol "POZN". For detailed company information, including copies of this and other press releases, see POZEN's website: pozen.
Statements included in this press release that are not historical in nature are "forward-looking statements" within the meaning of the "safe harbor" provisions of the Private Securities Litigation Reform Act of 1995. You should be aware that our actual results could differ materially from those contained in the forward-looking statements, which are based on management's current expectations and are subject to a number of risks and uncertainties, including, but not limited to, our failure to successfully commercialize our product candidates; costs and delays in the development and/or FDA approval of our product candidates, including as a result of the need to conduct additional studies, or the failure to obtain such approval of our product candidates, including as a result of changes in regulatory standards or the regulatory environment during the development period of any of our product candidates, such as the current uncertainty regarding primary clinical endpoints for our PN and PA programs; uncertainties in clinical trial results or the timing of such trials, resulting in, among other things, an extension in the period over which we recognize deferred revenue or our failure to achieve milestones that would have provided us with revenue; our inability to maintain or enter into, and the risks resulting from our dependence upon, collaboration or contractual arrangements necessary for the development, manufacture, commercialization, marketing, sales and distribution of any products, including our dependence on GlaxoSmithKline for the sales and marketing of Treximet; competitive factors, including the potential introduction of competing generic products; our inability to protect our patents or proprietary rights and obtain necessary rights to third party patents and intellectual property to operate our business; our inability to operate our business without infringing the patents and proprietary rights of others; general economic conditions; the failure of any products to gain market acceptance; our inability to obtain any additional required financing; technological changes; government regulation; changes in industry practice; and one-time events, including those discussed herein and in our Quarterly Report on Form 10-Q for the period ended September 30, 2008. We do not intend to update any of these factors or to publicly announce the results of any revisions to these forward-looking statements.
POZEN Inc.
Both the PN 400-301/302 studies achieved the primary endpoints. Subjects taking PN 400 experienced statistically significantly fewer endoscopically confirmed gastric ulcers on PN 400 compared to subjects receiving enteric coated naproxen during the six-month period. In each of the trials, approximately 400 subjects received either PN 400 or enteric coated naproxen 500 mg, twice daily, over a six-month treatment period. Subjects underwent upper endoscopies at baseline and at one, three, and six months with the primary endpoint as the cumulative incidence of gastric ulcers. The FDA has recently informed POZEN that the appropriateness of this endpoint is the subject of an internal review and an FDA internal meeting is planned in Q1 2009 to discuss this matter.
POZEN and AstraZeneca entered into a co-development agreement for PN 400 in August 2006. PN 400 is an investigational product under clinical development in patients who require chronic non-steroidal anti-inflammation drug (NSAID) treatment for arthritis pain, such as osteoarthritis and who are at risk for developing NSAID-associated gastric ulcers. The NDA submission is planned for mid-2009. Full results of the PN 400 Phase 3 studies will be published in a timely manner.
Osteoarthritis is one of the most frequent causes of physical disability among adults. An estimated 46 million adults in the U.S. have physician diagnosed arthritis, accounting for 21 percent of the U.S. adult population, and two thirds of the people that have doctor-diagnosed arthritis are under the age of 65. Fifty percent of people on chronic NSAID's are at risk for developing NSAID-associated gastric ulcers.
About POZEN
POZEN is a pharmaceutical company committed to developing therapeutic advancements for diseases with unmet medical needs where it can improve efficacy, safety, and/or patient convenience. POZEN's efforts are focused primarily on the development of pharmaceutical products for the treatment of acute and chronic pain and other pain-related conditions. POZEN has development and commercialization alliances with GlaxoSmithKline for Treximet®, which was approved by the United States Food and Drug Administration for the acute treatment of migraine attacks; and with AstraZeneca for proprietary fixed dose combinations of naproxen with the proton pump inhibitor esomeprazole magnesium in a single tablet for conditions such as osteoarthritis and rheumatoid arthritis in patients who are at risk for developing NSAID-associated gastric ulcers. The company's common stock is traded on The Nasdaq Stock Market under the symbol "POZN". For detailed company information, including copies of this and other press releases, see POZEN's website: pozen.
Statements included in this press release that are not historical in nature are "forward-looking statements" within the meaning of the "safe harbor" provisions of the Private Securities Litigation Reform Act of 1995. You should be aware that our actual results could differ materially from those contained in the forward-looking statements, which are based on management's current expectations and are subject to a number of risks and uncertainties, including, but not limited to, our failure to successfully commercialize our product candidates; costs and delays in the development and/or FDA approval of our product candidates, including as a result of the need to conduct additional studies, or the failure to obtain such approval of our product candidates, including as a result of changes in regulatory standards or the regulatory environment during the development period of any of our product candidates, such as the current uncertainty regarding primary clinical endpoints for our PN and PA programs; uncertainties in clinical trial results or the timing of such trials, resulting in, among other things, an extension in the period over which we recognize deferred revenue or our failure to achieve milestones that would have provided us with revenue; our inability to maintain or enter into, and the risks resulting from our dependence upon, collaboration or contractual arrangements necessary for the development, manufacture, commercialization, marketing, sales and distribution of any products, including our dependence on GlaxoSmithKline for the sales and marketing of Treximet; competitive factors, including the potential introduction of competing generic products; our inability to protect our patents or proprietary rights and obtain necessary rights to third party patents and intellectual property to operate our business; our inability to operate our business without infringing the patents and proprietary rights of others; general economic conditions; the failure of any products to gain market acceptance; our inability to obtain any additional required financing; technological changes; government regulation; changes in industry practice; and one-time events, including those discussed herein and in our Quarterly Report on Form 10-Q for the period ended September 30, 2008. We do not intend to update any of these factors or to publicly announce the results of any revisions to these forward-looking statements.
POZEN Inc.
Massive meta analysis clarifies cardiovascular safety of celecoxib (Celebrex)
The COX-2 specific inhibitor celecoxib (Celebrex) is not associated with an increased risk of serious cardiovascular thrombotic events compared to placebo or NSAIDs, according to a meta-analysis of 41 clinical studies in 44,308 patients, reported at the American College of Rheumatology (ACR) 2005 Annual Scientific Meeting, San Diego, California (November 12-17th).
The meta analysis, reported by Dr Lee Simon, Associate Clinical Professor of Medicine at Harvard Medical School, evaluated the cardiovascular safety of celecoxib versus both placebo and nonselective (ns) NSAIDs.
Clinical trials included in the analysis lasted at least two weeks and included end points evaluating the incidence of heart attack, stroke and death and a composite sum of these three end points, explained Dr Simon, a former Division Director of the Arthritis, Analgesic & Ophthalmologic Drug Product Division at the Center for Drug Evaluation and Research, United States Food and Drug Administration.
The meta-analysis showed that patients taking celecoxib had no more risk for heart attack, stroke, or CV death combined than those given placebo or ns-NSAIDs.
There were no significant differences in the number of strokes among patients given celecoxib or placebo. However, there were significantly more strokes among patients taking ns-NSAIDs than those treated with celecoxib.
The number of heart attacks was numerically higher with celecoxib than with ns-NSAIDs. However, the difference was not statistically significant. When evaluated against people taking placebo, people taking celecoxib had no significant difference in the number of heart attacks.
"There were no cardiovascular signals that were any different to the active comparators. Celecoxib was no different to non selective drugs in terms of cardiovascular risk," he said. Comparators included placebo, naproxen, diclofenac, ibuprofen, loxoprofen, acetaminophen and ketoprofen.
Significantly fewer patients receiving celecoxib experienced hypertension or oedema compared with those receiving nonselective NSAIDs. Furthermore, the incidence of cardiac failure was numerically lower in the celecoxib group than in the nonselective NSAID group, he explained.
"In this large meta-analysis comprising studies of two weeks to three years duration involving patients with chronic conditions, celecoxib at doses of 200mg or more total daily dose was not associated with an increased risk of serious CV thromboembolic events compared with placebo or nonselective NSAIDs," Dr Simon concluded.
Dr Gail Cawkwell, Senior Medical Director, Arthritis, Pain and Musculoskeletal at Pfizer (the company that funded the meta analysis) said that the study was being prepared for publication in a peer reviewed journal, and the data had been shared with US and EU regulatory authorities.
"This analysis confirms once again that medicines like naproxen, ibuprofen and diclofenac have very similar rates of cardiovascular endpoints (combination of heart attack, stroke and cardiovascular deaths) compared to Celebrex. It is unfortunate that European labelling separates Celebrex from those medications. The US labelling reflects what has been shown by this meta analysis: that all these drugs have a similar cardiovascular safety profile, they all carry similar risks."
"All NSAIDs, selective and nonselective, carry similar levels of risk. We certainly feel there is a level playing field. Whatever risks people have been facing for decades with medicines such as ibuprofen, albeit unknowingly, are now a bit clearer, and that those risks are similar for a medicine like Celebrex."
There was further heartening news for celecoxib from an unrelated study reported at the ACR. The GAIT study (Abstract 622) compared the dietary supplements glucosamine and chondroitin sulphate (alone and in combination) against celecoxib in 1583 patients. Lead author Dr Daniel Clegg, University of Utah, said that there was no difference between placebo and the dietary supplements: only celecoxib reached the primary efficacy endpoint. Given concern over the cardiovascular safety of coxibs, Dr Clegg said that the FDA had asked for an interim safety analysis to see if there was any signal of cardiac problems in celecoxib- versus dietary-supplement treated patients. "There was no such signal, the treatment arms of the study had indistinguishable safety profiles," he said.
Reference
Simon LS, White WB, MacDonald TM, Pan S, Rosenstein RB, Gaffney M. Cardiovascular safety of celecoxib: A meta-analysis of 41 clinical studies in 44,300 patients. Abstract 1049, American College of Rheumatology annual meeting November 2005. Published in Arthritis and Rheumatism, Volume 52, No 9, 2005 page S406.
Written by: Ian Mason
ianmasonntlworld
View drug information on Ketoprofen.
The meta analysis, reported by Dr Lee Simon, Associate Clinical Professor of Medicine at Harvard Medical School, evaluated the cardiovascular safety of celecoxib versus both placebo and nonselective (ns) NSAIDs.
Clinical trials included in the analysis lasted at least two weeks and included end points evaluating the incidence of heart attack, stroke and death and a composite sum of these three end points, explained Dr Simon, a former Division Director of the Arthritis, Analgesic & Ophthalmologic Drug Product Division at the Center for Drug Evaluation and Research, United States Food and Drug Administration.
The meta-analysis showed that patients taking celecoxib had no more risk for heart attack, stroke, or CV death combined than those given placebo or ns-NSAIDs.
There were no significant differences in the number of strokes among patients given celecoxib or placebo. However, there were significantly more strokes among patients taking ns-NSAIDs than those treated with celecoxib.
The number of heart attacks was numerically higher with celecoxib than with ns-NSAIDs. However, the difference was not statistically significant. When evaluated against people taking placebo, people taking celecoxib had no significant difference in the number of heart attacks.
"There were no cardiovascular signals that were any different to the active comparators. Celecoxib was no different to non selective drugs in terms of cardiovascular risk," he said. Comparators included placebo, naproxen, diclofenac, ibuprofen, loxoprofen, acetaminophen and ketoprofen.
Significantly fewer patients receiving celecoxib experienced hypertension or oedema compared with those receiving nonselective NSAIDs. Furthermore, the incidence of cardiac failure was numerically lower in the celecoxib group than in the nonselective NSAID group, he explained.
"In this large meta-analysis comprising studies of two weeks to three years duration involving patients with chronic conditions, celecoxib at doses of 200mg or more total daily dose was not associated with an increased risk of serious CV thromboembolic events compared with placebo or nonselective NSAIDs," Dr Simon concluded.
Dr Gail Cawkwell, Senior Medical Director, Arthritis, Pain and Musculoskeletal at Pfizer (the company that funded the meta analysis) said that the study was being prepared for publication in a peer reviewed journal, and the data had been shared with US and EU regulatory authorities.
"This analysis confirms once again that medicines like naproxen, ibuprofen and diclofenac have very similar rates of cardiovascular endpoints (combination of heart attack, stroke and cardiovascular deaths) compared to Celebrex. It is unfortunate that European labelling separates Celebrex from those medications. The US labelling reflects what has been shown by this meta analysis: that all these drugs have a similar cardiovascular safety profile, they all carry similar risks."
"All NSAIDs, selective and nonselective, carry similar levels of risk. We certainly feel there is a level playing field. Whatever risks people have been facing for decades with medicines such as ibuprofen, albeit unknowingly, are now a bit clearer, and that those risks are similar for a medicine like Celebrex."
There was further heartening news for celecoxib from an unrelated study reported at the ACR. The GAIT study (Abstract 622) compared the dietary supplements glucosamine and chondroitin sulphate (alone and in combination) against celecoxib in 1583 patients. Lead author Dr Daniel Clegg, University of Utah, said that there was no difference between placebo and the dietary supplements: only celecoxib reached the primary efficacy endpoint. Given concern over the cardiovascular safety of coxibs, Dr Clegg said that the FDA had asked for an interim safety analysis to see if there was any signal of cardiac problems in celecoxib- versus dietary-supplement treated patients. "There was no such signal, the treatment arms of the study had indistinguishable safety profiles," he said.
Reference
Simon LS, White WB, MacDonald TM, Pan S, Rosenstein RB, Gaffney M. Cardiovascular safety of celecoxib: A meta-analysis of 41 clinical studies in 44,300 patients. Abstract 1049, American College of Rheumatology annual meeting November 2005. Published in Arthritis and Rheumatism, Volume 52, No 9, 2005 page S406.
Written by: Ian Mason
ianmasonntlworld
View drug information on Ketoprofen.
Meniscus Transplant Can Ease Suffering Of Painful Knee
A meniscus transplant, a rarely performed arthroscopic procedure, might help delay the onset of arthritis and relieve knee pain for young, active people.
"This can be a great procedure for someone under the age of 50 who has pain after a significant meniscal injury or multiple previous meniscus surgeries and is too young and active for a knee replacement," said Dr. Patrick McCulloch, an orthopedic surgeon with the Methodist Center for Sports Medicine in Houston.
"In some cases, the meniscus has been damaged so severely that it has to be removed. This surgery works for people who have no functioning meniscus and have limited damage to the cartilage surfaces of the joint."
The meniscus is a piece of rubbery cartilage that sits between the bones in the knee and acts as a shock absorber and helps to stabilize the knee. People who have had the meniscus removed are more likely to see degenerative changes in the knee joint. This can cause the remaining cartilage that covers the bone to wear away, exposing the bone, which is extremely painful.
"When someone is left with little or no meniscus, we find an organ donor with the same size knee," McCulloch said. "We transplant the meniscus into the patient's knee and once it heals, the hope is that it will act like a normal meniscus and relieve pain."
This technique is used to slow down the progression of arthritis in the knee. While some patients will eventually need a knee replacement, this procedure can give them a number of years of pain-free activity before this has to be considered.
"A meniscus transplant is an arthroscopic procedure, but patients can expect to be on crutches for four to six weeks and spend a few months in rehabilitation," McCulloch said. "My focus is on joint restoration and procedures that regenerate cartilage in the knee. The meniscus transplant is another positive procedure that can relieve pain and keep people active."
Source: Methodist Hospital, Houston
"This can be a great procedure for someone under the age of 50 who has pain after a significant meniscal injury or multiple previous meniscus surgeries and is too young and active for a knee replacement," said Dr. Patrick McCulloch, an orthopedic surgeon with the Methodist Center for Sports Medicine in Houston.
"In some cases, the meniscus has been damaged so severely that it has to be removed. This surgery works for people who have no functioning meniscus and have limited damage to the cartilage surfaces of the joint."
The meniscus is a piece of rubbery cartilage that sits between the bones in the knee and acts as a shock absorber and helps to stabilize the knee. People who have had the meniscus removed are more likely to see degenerative changes in the knee joint. This can cause the remaining cartilage that covers the bone to wear away, exposing the bone, which is extremely painful.
"When someone is left with little or no meniscus, we find an organ donor with the same size knee," McCulloch said. "We transplant the meniscus into the patient's knee and once it heals, the hope is that it will act like a normal meniscus and relieve pain."
This technique is used to slow down the progression of arthritis in the knee. While some patients will eventually need a knee replacement, this procedure can give them a number of years of pain-free activity before this has to be considered.
"A meniscus transplant is an arthroscopic procedure, but patients can expect to be on crutches for four to six weeks and spend a few months in rehabilitation," McCulloch said. "My focus is on joint restoration and procedures that regenerate cartilage in the knee. The meniscus transplant is another positive procedure that can relieve pain and keep people active."
Source: Methodist Hospital, Houston
New 'Biofactories' Produce Rare Healing Substances In The Endangered Devil's Claw Plant
Deep in Africa's Kalahari Desert lies the "Devil's claw," a plant that may hold the key to effective treatments for arthritis, tendonitis and other illnesses that affect millions each year. Unfortunately, years of drought have pushed the Devil's claw toward extinction, so scientists are scrambling to devise new ways to produce the valuable medicinal chemicals of the Devil's claw and other rare plants.
One group of scientists reported a major advance toward that goal here today at the 238th National Meeting of the American Chemical Society (ACS). They described the first successful method of producing the active ingredients in Devil's claw - ingredients that have made the Devil's claw a sensation in alternative medicine in Europe. Their technique may eventually lead to the development of "biofactories" that could produce huge quantities of rare plant extracts quickly and at little cost.
Milen I. Georgiev, Ph.D., who delivered the report, pointed out that for thousands of years, native populations in Southern Africa have used the Devil's claw as a remedy for a huge number of ailments, including fever, diarrhea and blood diseases. Today, there are dozens of medicinal and herbal products around the world that are based on chemicals derived from the Devil's claw.
In particular, studies suggest that two chemicals - the so-called iridoid glycosides harpagoside and harpagide - may have beneficial effects in the treatment of degenerative rheumatoid arthritis, osteoarthritis, tendonitis, and other conditions, Georgiev said.
"In Germany, 57 pharmaceutical products based on Devil's claw, marketed by 46 different companies, have cumulative sales volumes alone worth more than $40 million." Georgiev noted. In the United States, Devil's claw extracts are in phase II clinical trials for the treatment of hip and knee arthritis. Other promising uses are not far behind. But while the demand for these beneficial compounds is increasing, the supply of natural Devil's claw is dwindling.
"The Devil's Claw faces significant problems with its natural renewal, especially low rainfall," Georgiev notes. "These problems are driving efforts to find alternative ways to produce high value compounds from the plant, independent of geographical and climatic factors," he says.
Currently, more than 25 percent of all prescribed medicines used in industrialized countries are derived either directly or indirectly from plants, many of which are rare and sometimes endangered. "Hairy root," an infectious plant disease caused by the soil bacteria Agrobacterium rhizogenes, is at the core of a promising new technique that could one day lead to "biofactories" that produce medicines derived from rare plants in huge quantities at a low cost. Georgiev notes that hairy roots are a big improvement over traditional, greenhouse-based plant culturing.
"The transformed root cultures possess fast growth rates, genetic and biochemical stability and the capacity for synthesis of plant metabolites. It should be also mentioned that the amount of active metabolites in naturally grown plants in greenhouses significantly vary seasonally," notes Georgiev. Hairy root biofactories, on the other hand, could produce consistently high levels of plant metabolites year round.
Georgiev and his team are the first to induce hairy root cultures of Devil's claw. They took the roots of the Devil's claw and infected them with the A. rhizogenes soil bacteria - a natural genetic engineer - to create a system of hairy roots to produce the plant's key medicinal chemicals. Their studies demonstrated stable growth and high production of both iridoid glycosides harpagoside and harpagide. Previous studies were only capable of producing one of these two compounds.
Georgiev notes that there is a long way to go before hairy root biofactories become commercialized, but he hopes to make the technology ready for use within a few years.
"Our target aim is to develop such technology, so we are paying attention not only to fundamental scientific tasks, but also to those related to some of the technological problems associated with hairy root biofactories," Georgiev said. "It is the desire of each scientist is to see the fruits of his work. In the current case, we hope to be able to develop cost-effective laboratory technology for production of these pharmaceutically-important metabolites within the next five years."
Source:
Michael Bernstein
American Chemical Society
One group of scientists reported a major advance toward that goal here today at the 238th National Meeting of the American Chemical Society (ACS). They described the first successful method of producing the active ingredients in Devil's claw - ingredients that have made the Devil's claw a sensation in alternative medicine in Europe. Their technique may eventually lead to the development of "biofactories" that could produce huge quantities of rare plant extracts quickly and at little cost.
Milen I. Georgiev, Ph.D., who delivered the report, pointed out that for thousands of years, native populations in Southern Africa have used the Devil's claw as a remedy for a huge number of ailments, including fever, diarrhea and blood diseases. Today, there are dozens of medicinal and herbal products around the world that are based on chemicals derived from the Devil's claw.
In particular, studies suggest that two chemicals - the so-called iridoid glycosides harpagoside and harpagide - may have beneficial effects in the treatment of degenerative rheumatoid arthritis, osteoarthritis, tendonitis, and other conditions, Georgiev said.
"In Germany, 57 pharmaceutical products based on Devil's claw, marketed by 46 different companies, have cumulative sales volumes alone worth more than $40 million." Georgiev noted. In the United States, Devil's claw extracts are in phase II clinical trials for the treatment of hip and knee arthritis. Other promising uses are not far behind. But while the demand for these beneficial compounds is increasing, the supply of natural Devil's claw is dwindling.
"The Devil's Claw faces significant problems with its natural renewal, especially low rainfall," Georgiev notes. "These problems are driving efforts to find alternative ways to produce high value compounds from the plant, independent of geographical and climatic factors," he says.
Currently, more than 25 percent of all prescribed medicines used in industrialized countries are derived either directly or indirectly from plants, many of which are rare and sometimes endangered. "Hairy root," an infectious plant disease caused by the soil bacteria Agrobacterium rhizogenes, is at the core of a promising new technique that could one day lead to "biofactories" that produce medicines derived from rare plants in huge quantities at a low cost. Georgiev notes that hairy roots are a big improvement over traditional, greenhouse-based plant culturing.
"The transformed root cultures possess fast growth rates, genetic and biochemical stability and the capacity for synthesis of plant metabolites. It should be also mentioned that the amount of active metabolites in naturally grown plants in greenhouses significantly vary seasonally," notes Georgiev. Hairy root biofactories, on the other hand, could produce consistently high levels of plant metabolites year round.
Georgiev and his team are the first to induce hairy root cultures of Devil's claw. They took the roots of the Devil's claw and infected them with the A. rhizogenes soil bacteria - a natural genetic engineer - to create a system of hairy roots to produce the plant's key medicinal chemicals. Their studies demonstrated stable growth and high production of both iridoid glycosides harpagoside and harpagide. Previous studies were only capable of producing one of these two compounds.
Georgiev notes that there is a long way to go before hairy root biofactories become commercialized, but he hopes to make the technology ready for use within a few years.
"Our target aim is to develop such technology, so we are paying attention not only to fundamental scientific tasks, but also to those related to some of the technological problems associated with hairy root biofactories," Georgiev said. "It is the desire of each scientist is to see the fruits of his work. In the current case, we hope to be able to develop cost-effective laboratory technology for production of these pharmaceutically-important metabolites within the next five years."
Source:
Michael Bernstein
American Chemical Society
Ten Elsevier Books Win First Prize At BMA Medical Book Competition
Elsevier is pleased to announce that ten of its professional and scholarly books were honored at the annual BMA Medical Book Competition ceremony in London on September 8th 2009. An additional 19 Elsevier books were highly commended. In total, 684 books were entered to the BMA's competition with 126 prizes awarded with 26 first prizes, 91 highly commended prizes and 9 commended prizes.
Gray's Anatomy for Students by Richard Drake, Wayne Vogl, and Adam Mitchell won first prize in the BMA Basic and Clinical Science category. This is the second edition of an anatomy textbook for medical students that has quickly become a favorite textbook around the world, translated into a dozen languages. It has captured a strong following because it explains complex anatomy with clear, understandable language, strong clinical correlations, and a stunning full-color artwork program. It is now part of an extensive family of Gray's products including Gray's Atlas of Anatomy, Gray's Anatomy for Students Flashcards, Gray's Anatomy Review, Dorland/Gray's Pocket Atlas of Anatomy and, of course, Gray's Anatomy, 40th Edition.
Elsevier's Rheumatoid Arthritis by Marc C. Hochberg, Alan J. Silman, Josef S. Smolen, Michael E. Weinblatt, and Michael H. Weisman was awarded first prize in the BMA Orthopaedics and Rheumatology category. A first edition in brilliant color, it provides the most current insights into the pathogenesis of rheumatoid arthritis, while also including comprehensive coverage of clinical features of the disease, as well as evidence-based options for treatment.
"We congratulate all of the winners and especially thank all of the authors, editors and Elsevier publishing staff who have worked on these prize-winning titles," said Randy Charles, Managing Director Global Clinical Reference Group at Elsevier. "This is an amazing achievement and reflects our dedication to developing and delivering quality content."
First prizes were awarded to Elsevier books in the following categories:
Anesthesia: Andrew Bersten and Neil Soni - Oh's Intensive Care Manual, 6th edition
Basic and Clinical Science: Richard Drake, A. Wayne Vogl, and Adam WM Mitchell - Gray's Anatomy for Students, 2nd edition
Cardiology: John Hampton - The ECG in Practice, 5th edition
Haematology: Stuart H. Orkin and others - Nathan and Oski's Hematology of Infancy and Childhood, 7th edition
Health Care for the Elderly: Hylton B. Menz - Foot Problems in Older People
Medicine: Mark Strachan, Surendra Sharma and John Hunter - Davidson's Clinical Cases
Orthopaedics and Rheumatology: Marc C. Hochberg and others - Rheumatoid Arthritis
Primary Health Care: Andrew Polmear - Evidence-Based Diagnosis in Primary Care
Radiology: Gerald de Lacey, Simon Morley and Laurence Berman - The Chest X-Ray: A Survival Guide
BMA Student Textbook Award: Elspeth Brown and others - Heart Sounds Made Easy with CD-ROM, 2nd edition
Source:
Anna Hogrebe
Elsevier
Gray's Anatomy for Students by Richard Drake, Wayne Vogl, and Adam Mitchell won first prize in the BMA Basic and Clinical Science category. This is the second edition of an anatomy textbook for medical students that has quickly become a favorite textbook around the world, translated into a dozen languages. It has captured a strong following because it explains complex anatomy with clear, understandable language, strong clinical correlations, and a stunning full-color artwork program. It is now part of an extensive family of Gray's products including Gray's Atlas of Anatomy, Gray's Anatomy for Students Flashcards, Gray's Anatomy Review, Dorland/Gray's Pocket Atlas of Anatomy and, of course, Gray's Anatomy, 40th Edition.
Elsevier's Rheumatoid Arthritis by Marc C. Hochberg, Alan J. Silman, Josef S. Smolen, Michael E. Weinblatt, and Michael H. Weisman was awarded first prize in the BMA Orthopaedics and Rheumatology category. A first edition in brilliant color, it provides the most current insights into the pathogenesis of rheumatoid arthritis, while also including comprehensive coverage of clinical features of the disease, as well as evidence-based options for treatment.
"We congratulate all of the winners and especially thank all of the authors, editors and Elsevier publishing staff who have worked on these prize-winning titles," said Randy Charles, Managing Director Global Clinical Reference Group at Elsevier. "This is an amazing achievement and reflects our dedication to developing and delivering quality content."
First prizes were awarded to Elsevier books in the following categories:
Anesthesia: Andrew Bersten and Neil Soni - Oh's Intensive Care Manual, 6th edition
Basic and Clinical Science: Richard Drake, A. Wayne Vogl, and Adam WM Mitchell - Gray's Anatomy for Students, 2nd edition
Cardiology: John Hampton - The ECG in Practice, 5th edition
Haematology: Stuart H. Orkin and others - Nathan and Oski's Hematology of Infancy and Childhood, 7th edition
Health Care for the Elderly: Hylton B. Menz - Foot Problems in Older People
Medicine: Mark Strachan, Surendra Sharma and John Hunter - Davidson's Clinical Cases
Orthopaedics and Rheumatology: Marc C. Hochberg and others - Rheumatoid Arthritis
Primary Health Care: Andrew Polmear - Evidence-Based Diagnosis in Primary Care
Radiology: Gerald de Lacey, Simon Morley and Laurence Berman - The Chest X-Ray: A Survival Guide
BMA Student Textbook Award: Elspeth Brown and others - Heart Sounds Made Easy with CD-ROM, 2nd edition
Source:
Anna Hogrebe
Elsevier
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