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In this episode, host Dr. Michael Barazza interviews Dr. John Smirniotopoulos about genicular nerve ablation, an innovative treatment option for the management of osteoarthritis. --- SHOW NOTES Dr. John Smirniotopoulos is an assistant professor of clinical radiology in the IR department at MedStar Georgetown University and MedStar Washington Hospital Center in DC. He developed the idea of genicular nerve ablation after consulting with his orthopedic colleagues at Georgetown about various pain interventions. He then formulated a treatment algorithm that begins with a conservative approach, using a nerve block for ablation. If the initial response is limited, a second ablation can be performed within six months. However, if the patient experiences only a short-term response, genicular artery embolization may be considered. Genicular nerve ablation proves to be a valuable therapy for patients who are not yet ready for knee replacements or need to postpone the procedure due to factors like high BMI or recent organ transplant. The therapy uses fluoroscopy or ultrasound to target four trunks of nerves, including the superomedial genicular, superolateral, inferomedial, and the suprapatellar nerves. The procedure is done under conscious sedation, and Dr. Smirniotopoulos aims for 50% pain reduction with his patients which is usually reached at six weeks. Dr. Smirniotopoulos and his team recently conducted a study to evaluate the outcomes of genicular nerve ablation. The results indicated a significant reduction in both the WOMAC score, which measures pain and functionality, and the Visual Analogue Scale (VAS) score, which is a subjective measure of pain. Surprisingly, they discovered that age over 50 was the biggest predictor of positive outcomes, contrary to their initial expectation that BMI would play a more significant role. They attribute this finding to a higher prevalence of advanced OA in the older age group. Additionally, patients under 50 may have more sports-related injuries such as meniscal tears, leading them to return to high-intensity activities sooner than older patients. Dr. Smirniotopoulos has also seen success in performing nerve ablation in the hip, shoulder, SI, and intervertebral joints. This wide application of the procedure makes it a valuable and versatile treatment option for patients. --- RESOURCES Genicular Nerve Radiofrequency Ablation: Is There a Predictor of Outcomes?: https://www.jvir.org/article/S1051-0443(22)01597-4/fulltext
This is a LIVE replay of A Trauma Survivor Thriver's Podcast which aired Wednesday, April 26th, 2023 at 1130am ET on Fireside Chat. Today's guest is Jamie Mustard, Co-Author of the book the Invisible Machine: The Startling Truth About Trauma and the Scientific Breakthrough That Can Transform Your Life. For more information about the Dual Sympathetic Reset Procedure, visit The Stella Center. Lorilee Binstock 00:16:58 Welcome. I'm Lorilee Binstock, and this is A Trauma Survivor Thriver's Podcast. Thank you so much for joining me live on Fireside Chat, where you can be a part of the conversation as my virtual audience. I am your host, Lorriely Benstock, Everyone has an opportunity to ask me or our guest questions on this show by requesting a hop on stage or sending a message in the chat box. I will try to get to you, but I do ask that everybody be respectful. Today's guest is Jamie mustard, co author of the book, The Invisible Machine, The startling truth about trauma and the scientific breakthrough that can transform your life. Jamie, thank you so much for joining me today. Jamie Mustard 00:17:55 Thank you for having me. I'm sorry. I've not used this platform before, so I'm just having technical difficulties. Lorilee Binstock 00:18:02 Oh, you are not the first one, and you will be the last So there's no worry there. I'm just glad we were able to get you on because I really am so fascinated by this because I've actually never heard about this. You co authored this book, the invisible machine, the startling truth about trauma, and the scientific breakthrough. Jamie Mustard 00:18:05 Perfect. I Lorilee Binstock 00:18:19 And this you did this with doctor Eugene Lipov. An anesthesiologists who developed this treatment. Could you actually describe it? Because you actually underwent this treatment. Correct? Jamie Mustard 00:18:30 I did. And one of the reasons, you know, a lot of people would ask kind of why would an artist coauthor look with, you know, Yuzhou Lab is more than a anesthesiologist. He's a you could say he's the Einstein of modern anesthesiology and a a scientist. So the question is, you know, why would write her all go author a book with that guy? And and the answer is kind of your your the way you kinda said at the top that you'd never heard of it. And the reason you've never heard of it is because it's been around for twenty years, and the military is using it. Yeah. And the military is used doing fifteen to twenty thousand of these a year. The second largest cohort getting it is sexual assault victims. Lorilee Binstock 00:19:04 Stop, really. Jamie Mustard 00:19:12 When I saw this, I saw something that, you know, whenever you see it on it's been on sixty minutes. It's been on Joe Rogan. It's been on CBS this morning. But when if you ever see it in the media, it's always at the extremes. It's always a navy seal, a fur a nine eleven first responder, when I came across this, I didn't see this as something for people at the extreme. I saw this as something that maybe could be affecting forty to fifty percent of the US and global population. So my work was to go, hey. This is not for the extreme. This is for society and everyone that is experiencing the symptoms that are associated with fight or flight that may never have even associated themselves with trauma. Lorilee Binstock 00:20:03 I mean, to be honest, I never associated myself with trauma. I'm a childhood sexual abuse survivor, and I didn't realize I experienced trauma. I thought that was just something really bad that happened that I will never talk about, but you're right. I feel like that this is very fascinating, and it's a non invasive outpatient procedure? Jamie Mustard 00:20:23 Okay. So, yeah, you asked me what it is. I wouldn't use the word noninvasive. I would use the word safe. Lorilee Binstock 00:20:27 Okay. Jamie Mustard 00:20:29 And minimally invasive. It's basically, he uses a needle to do what we well, we know it's safe because the shot was originally developed retaining hands in nineteen twenty six. It's now evolved. The doctor kind of reconfigured it and evolved it. So you it's now we call it he's evolved into what we're calling what he calls the dual sympathetic reset. And, basically, what you're doing is you're doing a pain injection that's guided that's guided by an ultrasound. You get a local anesthetic first, so you don't even it feels like nothing. And he uses an ultrasound to guide a needle that has a tiny you know, so a small amount of anesthetic in it, the same anesthetic that goes into an epidural, same two dollar amount of anesthetic that goes into an epidural. And your sympathetic nervous system is basically located in the ganglion, which is a nerves a a a a a a a a string of nerves that run from your amygdala all the way down your but your sympathetic your fight or flight system is in your neck on both sides of your neck. And what he does is he in inject this. God, I think it's I'm gonna get the name of it wrong. But yeah. But it's the same it's the same, you know, Lorilee Binstock 00:21:45 Yeah. Jamie Mustard 00:21:47 stuff that goes into an epidural. And what it does is it turns off your sympathetic nervous system, and it comes online about ten minutes later at baseline to the pre trauma state. So you're basically resetting the sympathetic nervous system. And what we're fine with what what they found is, you know, the adult trauma or blunt force trauma is on the right side. You can only do one side per day. K? You do two injections on one side, and then you can get the next injection the next day. Anything before puberty or childhood trauma is on the left side. And then yeah. So they'll always do the right side first, and then people that will have have had trial to hood trauma Lorilee Binstock 00:22:27 Well, Jamie Mustard 00:22:30 may not experience the reset. So they're starting more and more to to to both on almost everybody. Lorilee Binstock 00:22:40 Wow. You know, I I and, you know, I know about fight or flight, and I didn't know it was about a cluster of nerves in your neck. I'm wondering, is this why I have neck pain? Jamie Mustard 00:22:49 It might be I mean, you have to think of it like this. Well, first of all, Laura Lee, let me say thank you so much for having me. It's, you know, just a real honor to be here. Lorilee Binstock 00:22:57 Oh, of course. Jamie Mustard 00:23:00 You know, you there's two things that causes. One is blunt force trauma. Like, you and I are very Well, we're similar in this regard. I experienced an extreme massive amount of trauma as a kid probably that most people would never not be able to survive in any sort of meaningful way and live my entire life up until, I don't know, five years ago, seven years ago. Where I was in total denial that I'd even been traumatized. You know, in my in my upbringing, you know, growing up how I grew up is where I grew up in the neighborhood I grew up in. You know, being a victim was the last thing you could ever be. So I never Lorilee Binstock 00:23:30 Mhmm. Jamie Mustard 00:23:39 the thought of thinking of myself as a victim was just not in my, you know, just in my in my thought profile. So I just didn't think I had trauma. I got therapy for the first time five or six years ago with your counseling. After about six weeks. This very lovely. I talked about this in the book. Therapists diagnosed me with, you know, acute post traumatic stress disorder. And it's not a disorder. It's actually a physical injury to the body, and you can see it on a brain scan. But she diagnosed me with PTSD. I laughed in her face, because I thought it was such a ridiculous thing. She her eyes walled up, and she looked at me And she said, Jamie, have you been listening to the stories you've been telling me? And I said, yes. And she said, how could you not? And in that moment, my whole kind of bullshit life narrative fell apart, and I kinda went home and hugged the cactus. I I started, you know, realizing not only you know, I I not only has I had I've been victimized. I had been you know, just completely savaged and ravaged as a child, you know, abandoned you know, at birth with strangers, you know, very little physical touch in and out of institutional environments. You know, all this stuff It was, you know, just severe, egregious trauma, and I was just like, wow. You know, that's normal. That's what I knew. Lorilee Binstock 00:25:11 Well, Jamie Mustard 00:25:15 Yeah. So so about five or six years ago, when my my first book came out, maybe it's less, maybe it's, you know, or maybe it was before that. I was starting to get to kinda where I wanted in life, and I for the first time ever was looking back. You know, I didn't wanna look back. But when I was getting what I wanted, my discomfort as a person wasn't going away. In my mind, I thought, god. If I'm just successful, I'll feel relaxed. And I was getting successful and feeling very unrelaxed, but actually more dis more uncomfortable than I'd ever felt, and I couldn't understand why. So I started when I got this post traumatic stress diagnosis, I started looking. I was friends I turned a literary juke with a a really well known military psychologist, Shawna Springer, Doc Springer, and she had started She was sending people for this procedure, and I ended up in the middle of COVID to have years ago, getting on a plane in the middle of COVID and going to Chicago in the winter to do this kind of what I thought was a very avant garde procedure. And it was very strange that I did that literally because when you grew up, like, raised by wolves or kinda thrown away like I was, you don't go to the doctor. So you don't go to regular doctors. Let alone go and do kind of new treatments. Lorilee Binstock 00:26:41 Yeah. Jamie Mustard 00:26:45 But I I when my first book came out, I had a very well known forensic psychologist named doctor j Faber, who works at Amen Clinic. He was a fan of my book, and he and I become friends. And so I just said as a friend, can you bet this thing for me? And it was all upside and no downside. And so I almost backed out fifty times, but I did it. Lorilee Binstock 00:27:11 Can you tell me what that was like? Jamie Mustard 00:27:13 Oh my gosh. Yes. It was the most transformative thing that I've ever done in my life, it completely changed my worldview. And that is because it was like, I had a lot of judgment towards people, you know, towards people where I grew up the bad neighborhoods where I grew up towards addicts. Towards people that were, you know, couldn't get their life together. I had judgment. K? When I had when I got both sides of this thing done, the discomfort that I'd been experiencing my entire life that I thought was a part of me I won't you know, was gone. It was just like I was me. I didn't feel I didn't even know I couldn't feel that way. I didn't even know because, like, when you're abandoned at birth, what's your I I never even experience baseline. Okay? Lorilee Binstock 00:28:04 Well, mhmm. Jamie Mustard 00:28:07 So it I'm ever walking this is a good way to describe it. I was walking down the street after getting it in Chicago. I went to the Chicago Art Museum. I was there with friend who is supporting me. And I saw these, like, hustler guys on the street, and they were like and they were looking at me. And I kind of you know, that's something that's triggering for me. I really resent that because it kinda reminds me of my neighborhood, and these guys were looking at me like a mark. And, normally, that would make me mad. When I saw these guys, all of a sudden, I didn't see crazy people. I didn't see hustlers. I saw their biology. These guys are stuck in fight or flight. And I can explain to you what happens, but, you know, you don't need blunt force trauma. Like, what you and I went through to need this. The I think the biggest cause of this and why I think it's such a massive swath of the population, and why I think most people that have post traumatic stress. Don't even associate with trauma. You can get is that what one, two things cause this. One is blunt force trauma like what would happen in war seeing your buddy killed in front of you Lorilee Binstock 00:29:10 Mhmm. Jamie Mustard 00:29:11 or a sexual assault. But the other thing that causes this, and I think it's the much more predominant cause is prolonged allostatic load, chronic stress over time. Okay? And so Lorilee Binstock 00:29:28 Yeah. Jamie Mustard 00:29:29 just so by by feeling that sense of comfort, my own body, and sense of relief. My it changed the way just I interact with people now when I see somebody reacting in fight or flight towards me rather than taking it personally or thinking they're crazy. I understand the biology of it, so it just I just I I have only compassion. Lorilee Binstock 00:29:54 That's amazing. That's amazing. And I and I feel that You're right. I feel like I don't know, like, probably ninety, even more than that percent of the population has dealt with chronic stress, especially in America. And I feel like, you know, everyone can benefit from from, you know, a a treatment like this. I feel like that there's every a lot of people everyone I know deals with a lot of stress and a lot of anxiety. And for something like this to be available and to you say twenty years. I'm like, what? I just heard about this, like, last month. And so I'm intrigued. Does this treatment need to be accompanied by ongoing therapy or or or what? What would you suggest? Jamie Mustard 00:30:43 It it it's a it's a great question, and and I'd like to answer it, and then I'd like to kinda back up and explain very specifically how one could get this and how a lot of your listeners right now are are going, well, do I have trauma and I know it? And how would you know it? And but something he's saying is resonating to me. So look with me. So I wish I could understand this more. So let me kind of explain the kind of how it works with other therapies. And then let me kind of back it up and explain why and how I came to write a book with who I think made the most preminent most important medical discovery since the discovery of Penicillin in nineteen twenty eight. And I would compare it as a human discovery to the moon landing. If we can reset the nervous system, it changes the world. And so I think this guy will go on to win the Nobel Prize because even if you compare it to the polio vaccine, you know, suicide is linked to fight or flight. If you, you know, fifty thousand people a year stopped dying because when they when the polio vaccine was discovered, I think, in the forties, That the amount of suicides this could could prevent in a year dwarfs that number compared to all the other ailments and physical conditions because this conduct if you have an a a novactive sympathetic nervous system, if your nervous system is stuck in fight or flight, you're gonna have a cascade of physiological problems. It discombobulates the immune system. It destroys this scavenger system in the body, Lorilee Binstock 00:32:13 Right. Jamie Mustard 00:32:15 which is the system that is constantly, you know, keeping you from having autoimmune diseases, orthopedic problems, cancer, that system can get discombobulated. Right? So, you know, if the body keeps the score, that I would say this is the scorekeeper. But I think maybe backing it up and and and and kind of coming to how did I come to write an artist and and our come to write a book with a a a scientist. Right? But so, basically, I went and did this thing. My life was changed. And a couple months later, I got invited by two colonels that run all the training for special forces. To speak to come to Fort Bragg and speak to special forces at JFK auditorium regarding my book, The Iconist, okay, which is kind of like a Malcolm Gladwell type book to business communications and art book. And it was kind of crazy. You know, I'm a kid from the strums slums of LA, and all of a sudden, I was going to Fort Bragg and teaching site, you know, psychological operations how to create better counter propaganda against the Russians and the Chinese. You know, I mean, it's crazy. That I would be in that situation. So I got invited to Fort Bragg. When I got this procedure, the doctor came into the wait into the to the host op room. And he said, hey. And I wish I'd get it from the inventor, doctor Eugene La Bauch, my co author. And he said, hey. I was told to treat you like a VIP. Why? And I said, well, I'm an author, and we have a mutual friend. So our mutual friend, you know, I have a bit of a platform, you know, probably wanted to make sure I was taken care of. And then he left again, and then he came back. And he said, listen. This procedure is gonna this I mean, I get what what are you this the try this anesthesia, this thing that you just got in your neck, it's gonna wear off in about seven or eight hours. Can I pick you up at the hotel and take you to dinner? And we we talk about this in the book. And I said, Sure. You know, why not? And so he picks me up from the hotel. We go to this Mexican restaurant, this fancy Mexican restaurant with the windows open. It's raining. In the middle of COVID. The wind is blowing through, and he starts pouring glasses of expensive red wine. And download and gives me a three hour download of the science and history of this thing. And my mind and my my just mouth my jaw fell up. And I remember turning to my friend who was at the dinner with us. He kinda sped off in his Tesla. We Ubered home, And I turned to my friend and I said, we just had dinner with the smartest human being I've ever met. And, you know, I've met a lot I mean, I went to the one in school then economics. I know a lot of smart people. Right? Lorilee Binstock 00:35:04 Wow. Jamie Mustard 00:35:07 So so he and I so then a few I get back to Portland a few days go by, and I get a call from this guy, and he says, hey. I just read your book. And we just started talking, and we became friends. Right after that, I got invited to Fort Bragg. And I and the doctor couldn't believe that I was being invited to Fort Bragg by these colonel. So he said, hey. Can I come sit in the audience for your talk? I know they're doing my procedure at Fort Bragg, but they won't talk to me. I don't know how. So basically, I talked to these colonel. They had never heard of this thing, the DSR at that time. It was called the FGB, the slight gainly a block. But they started researching it. They called me back, and they said, yeah. We're doing ten of these a day, six days a week. They're they were doing three thousand a year Fort Greg alone. Lorilee Binstock 00:35:57 And was this on active military? Jamie Mustard 00:36:01 Yes. Lorilee Binstock 00:36:03 Interesting. So Jamie Mustard 00:36:04 So Lorilee Binstock 00:36:05 go ahead. Jamie Mustard 00:36:05 yeah. No. So the VA was probably doing more. But the lot what really, what happened is there was a post traumatic stress, meaning where I got really upset because I had to sit in you know, the colonel's arranged ten days of meetings. Even though it was six weeks away, it normally takes seven months to a year to get grand rounds at Wilmac. Doctor Lipa, the Dunground rounds at Walter Reed, the colonels arranged for the doctor to come with me and do Grand Rounds for all the doctors at Womack because they were doing the procedure at Fort Bragg based off of the ten year old paper. So it was to bring them into all the modifications because ten years ago, this thing was seventy percent effective in the relief post traumatic stress. Now it's up to eighty and five to ninety percent. So because of latest modifications. So he did ground rounds. And in one of the post traumatic stress meetings, I sat around for two hours and listened to these guys and come back from Iraq and Afghanistan and special forces guys. And their stories, and they were all told that they had a disorder, and it made me really angry because at that point, I knew one hundred percent that they had a physical injury to their body and that post traumatic stress disorder does not exist. It's post traumatic stress injury, is it physical injury to the body? You can see it on a brain scan. So at the end of that meeting, I expressed my rage at the fact that these guys are sacrificing their bodies, their families, their wives, their children. They don't come back the same. And then they're being then their government is telling them they're crazy. It may be mad. And I said that. And so I think the guy that runs the health initiative task force, I think he was kind of you know, he kinda saw me as this Arty Rider guy. He didn't know what to make of me. But when I expressed my truth. I think he kinda started to respect me, and he called me over at the end of the meeting. And he said, Jamie, have you ever heard of operator syndrome? And I said, no. And he showed of these symptoms on his phone. It was about eight symptoms. And the the symptoms that you would experience if you were running from a tiger Okay? And I and and that this is what happens if you're never in a fight or fight at Fort Black bragging. Or to say, you're never in a fire fight in Afghanistan or Iraq, but you just you're deployed at a firebase, and you have the stress of being away from your family, and maybe you could die that day from an IED or from something else. Right? So it's this prolonged allostatic load, but you're never in a fight. They call that operator syndrome. Okay? And when I saw that list of symptoms, Laura Lee, I didn't see the military. I saw the Mexican neighborhoods where I grew up in Los Angeles. And so my mind started spinning. Could it be that the stress of poverty or if you're middle class and the stress of having distant parents, a mother that needles you, a mean father, could it be that the chronic stress of that, a divorce could cause the exact same biological injury as someone coming back from war. Because the sympathetic nervous system is a machine, an invisible machine, hence the name of the book, the invisible machine. Could it be that that it doesn't think it's apathetic. So could it be that average people have the exact same symptoms in their body as someone coming back from war, but they don't know it because they just got it from having, you know, parents that didn't hug them. Or talk to them a certain way. And that and that's where my mind met doctor Lipov's staggering innovation. Lorilee Binstock 00:39:28 Yeah. I mean, that affects the majority of people. Right? These are these they they are considered, I guess, little tee traumas, but the react the reaction and the activation within the you know, the amygdala, it's all the same. Right? Jamie Mustard 00:39:46 Yeah. I mean, let me kinda tell you kind of how let me kind of give a primitive way of how one gets this. Lorilee Binstock 00:39:51 Mhmm. Jamie Mustard 00:39:51 And then go and why don't I go over the seven symptoms? That way, the people listening can go, well, I don't have trauma. Then they can listen to me, list it, and they go, maybe I do. Right? Lorilee Binstock 00:40:01 Please. Please. Jamie Mustard 00:40:01 So yeah. So listen. I people, like, at the extreme, were seeking this out and finding it. But people like me were not and and, again, I wasn't the extreme. I just didn't know it. And I you know, my goal was to bring this to military My goal is to bring this into the light, and I think it should be more popular or known than LASIK. It contains the way we we interact. As a species. But, basically, you have to think of it as if you were running from a tiger. You know, you live in a jungle, you know, a bounce years ago, you're and you're and you're a tiger comes out of nowhere. Well, in the moment, It's Peter Levine's work. That guy, he wrote a book, I think, in the yeah. In the was it in the eighties or nineties cold run? Yeah. Lorilee Binstock 00:40:43 Yeah. Awaken. Awaken the tiger. Jamie Mustard 00:40:48 Yeah. Running from the tiger. Yeah. Yeah. Lorilee Binstock 00:40:48 An unspoken voice. Yeah. It's a yeah. Awaken the Tiger. Yes. I've read I've read the unspoken voice of Peter Levine. I'm fascinated with somatic experiencing. But, yes, continue. Jamie Mustard 00:40:55 Okay. Okay. So, say, a tiger comes out of nowhere. You live in the jungle a thousand years ago. Well, what is gonna happen in that moment? Is you're gonna have seven or eight symptoms. K? You're gonna have seven or eight feelings. Your amygdala is gonna send a signal to these nerves on each side of your neck, and that's gonna jerk you into response. So you are walking on you're hiking up a mountain, and there's a cliff, and you almost slip and fall down it. Your amygdala sends a signal you signal to these are you on the swerve your car and hit somebody, but just you avert the accident just in time because your amygdala sends a signal to these nerves in your neck that jerk you in action to either flee or fight for your life. K? Fireflies. Lorilee Binstock 00:41:40 Mhmm. Jamie Mustard 00:41:40 Well, typically, if that happens and it's something like swerving your car, you're heightened for five maybe three to five hours because you felt like you almost died. And then for for, you know, four or five hours later, you'll come back down to baseline. Right? But if the trauma is too great, like your buddy being killed in front of you, or you or then or a sexual assault, and you have this overwhelming trauma. The your your sympathetic nervous system actually gets locked into fire flight. So you're locked into feeling like you're running from a tiger twenty four hours a day, three hundred and sixty five days a year, seven days a week. K? So what would you experience if a tiger or leap out of you? You would experience anxiety. You'd be anxious that the tiger was gonna kill you. You'd have mild paranoia that the tiger was right there at that that moment. You would have a sense of doom. You'd feel like the other shoe is gonna drop every second because you knew the tiger was right there. You would be hyper vigilant about the tiger. You would be hyper aroused about the tiger. You wouldn't be able to sleep because you can't sleep if a tiger is chasing you. You would be highly reactive and have a hair trigger because you would need to be reactive to survive the tiger. Lorilee Binstock 00:42:49 Right. Jamie Mustard 00:42:55 K? And these guys that come back from Afghanistan and Iraq, a massive majority of them, something like twenty five percent of them all have erectile dysfunction because you can't have sex if you're running from a tiger. In the military, the ultimate form of fight, and the ultimate form of flight in the military, suicide, is the ultimate form of flight where people are changing to protect. It's the ultimate form of flight. In the neighborhoods where I grew up where maybe violence is acceptable, or life is cheaper, homicide is the ultimate form of fight. So I believe when you see these violence rates in the community that I live in, and you see these suicide rates in the military, it is one hundred percent an overactive sympathetic nervous system. So when you experience those symptoms, you can get that say the tiger never eats you. You're just in a jungle where there's lots of tigers. So you're you're carrying the stress of the type of tigers all the time. K? It it would be a it would be a survival mechanism. It would be a survival tool to be locked in firefly. It actually would help you to survive. K? The problem is if you're sitting at home watching Netflix, you know, eating Cheetos, and drinking, you know, a LaCroix, and you're feeling that way, it creates a really, really big problem. And and think about it also like this. We're meant to experience those symptoms, anxiety, paranoia, sense of doom or mild paranoid, hyper vigilant, hyper aroused, a lack of sleep, hair trigger reactivity. We're meant to experience that for about thirty seconds where we either flee from the tiger or we fight the tiger. K? And then we're supposed to calm down and be normal as humans. K? Those are supposed to be short bursts. Lorilee Binstock 00:44:43 Mhmm. Jamie Mustard 00:44:46 Of fight or flight. If you have to experience like a tiger is gonna eat you in every second, twenty all the time. Which is what happens when your sympathetic gets stuck in fight or flight. You're gonna you're not gonna wanna live. You're gonna wanna kill yourself. We're not designed to wanna live like a tiger is gonna eat us every second. You're gonna either wanna kill yourself or you're gonna wanna kill somebody. Right? So there was a guy named Frank Oport who defined Lorilee Binstock 00:45:13 Yeah. Jamie Mustard 00:45:16 Stockholm syndrome, for the in the nineteen seventies for the FBI, and he's a very famous psychiatrist. And and in two thousand twelve, He's been working since two thousand twelve. He's been working very hard with others to try and get the name changed from post traumatic stress disorder. To post traumatic stress, injury, PTSD. So can I keep going? I don't you know, I don't be able to Okay. So okay. Okay. No. So so Lorilee Binstock 00:45:44 Of course. Yes. Keep going. No. This is fascinating. Jamie Mustard 00:45:49 so let's back it up. So let so everyone's different. Like, the You can, to a child, a father that is distant, a mother that needles you, that allastatic load for a child is staggering. And that person would not associate themselves with trauma. So I'm trying to get this away from just the extremes. I want those people to get it, but I'm trying to bring this to it. Kindergarten teachers, yoga instructors, plumbers, CEOs, accountants, attorneys. I'm trying to bring this to the every person. Right? But, you know, I think a really good way to explain this is Back at nineteen seventy, doctor Frank Ochberg, this guy that came up with a term post traumatic stress injury, And, again, you can see this on a brain scan, Laura Lee. So if I if someone has an overactive sympathetic nervous system and I scan their brain with a functional MRI, I will see overactivity in their amygdala, and I will see decreased blood flow to their frontal cortex. Normally to g to fix to kind of mitigate against that, and then we're gonna get after I explain this, we'll get to how it relates to other therapies. Normally, to mitigate against that, I might need six months of hyperbaric, no drugs and alcohol, Cademy, so as you know, I could do a million things, and I would only mitigate against that so much. To and I could get some decrease in that overactivity in the amygdala from all those therapies for years. And maybe I would get some increased blood flow to my frontal cortex. If you do this injection where you just reset the nervous system with no side effects no long term side effects. There's a side effect that day. They get you get it. And then the second day, you get it. And then by the evening of both days, it's gone. If you get the reset, you you're just a person again, and you're not having to use all these things to it's like physical therapy in a broken leg. You wouldn't do physical therapy over a broken leg. You'd set the leg, then you'd do physical therapy. So all these incredible therapies work but we're doing them over a broken leg. Lorilee Binstock 00:48:03 Right. Jamie Mustard 00:48:08 And so what you would see on a brain scan after doing a DSR dual sympathetic reset is that overactivity in the amygdala would be gone in a day. It'd be completely gone, and you have increased blood flow to the your frontal cortex in a way that that years of all those other modalities combined would never achieve. Because you're doing physical therapy over a broken leg. It also when you when you call it a disorder, it's incredibly stigmatizing, and you could even say inhumane if it's a lie, which it is because it's actually a physical injury of the body. So it's like, if you we don't have broken leg syndrome or broken leg disorder. When you call something a mental disorder that's actually a physical injury, it's very harmful. Incredibly stigmatizing. But if you call it a physical injury, you take all the stigma away. No one has a stigma for over you having a broken leg because you can see it. Lorilee Binstock 00:48:59 Yeah. Jamie Mustard 00:49:08 You can't see an overactive sympathetic, but it's just as broken as a broken leg. It's the best metaphor to describe it. And that's why we call the book the Invisible Machine, the StarLink truth about Trauma, and the scientific breakthrough that can transform your life. But what I'd like to do, Lorely, and then I'll kind of back up and answer your question next question. I think I think this is the best way for people to understand and and and unequivocally that what I'm saying is true. Like, I can hear people listening right now going, is that true? Is that true? Come on. How can it be a physical injury? I'm gonna say, well, here's how it's a physical injury. When I explain this, no one no one will question it anymore. K? Because I'll give you an an analogy that everyone can understand. Back in nineteen seventy, doctor Frank Ochberg published a book with a one through Stanford, scientists, the guy that came up with PTSD in two thousand twelve back in nineteen excuse me. He published a book called violence and the struggle for existence. That book was put out by Little Brown, It was the the the forward to that book was written by Caretta Scott King, the wife of doctor Martin Luther King because it was two years after his assassination. Violence in the struggle for existence. In that book, there is a chapter called biology and aggression. And and what what what these scientists explain is we one hundred percent know that trauma is biological. And the reason we know it, we don't know how, but the reason we know it is because if you beat or abuse a dog, a goat, a chicken, a cat, it's behavior changes. Either becomes highly aggressive, fight, or incredibly timid, flight. Well, we didn't just give that goat or that dog a disorder. It's not sentient in the same way a human being is. So doctors, we knew we've known for a long, long time that when we traumatize something, we've changed the biology. We just didn't know how until doctor Lipac first published on this in two thousand, I think, two thousand eight. Barack Obama endorsed this as far back as two thousand ten. So it's it's been out there. It's just always associated with the extreme. You know? So when pop when doctor Lipa published on this in two thousand eight, Frank Ochberg found him. Now they're close friends. So, obviously, we've all can relate to an animal that we know has been traumatized. We didn't give it a disorder. We know we've changed this biology. Doctor Lipov figured out how and then how to reset anybody to the pre trauma state. Lorilee Binstock 00:52:04 Wow. Well, I've this is this is extremely fascinating because, you know, I I am a huge fan. I don't know if you've listened to any of my podcasts prior, but I'm a huge advocate for psychedelic assisted therapy. But I I'm would you say that doing something like the DSR And then, I mean, do you if for it to go haywire again, you would just have to experience traffic and or or you're completely reset. Jamie Mustard 00:52:33 No. If you go traumatize yourself again, you're one hundred percent going to have to do this. You know? So a couple things I would, you know, say is one thing is, you know, what one of the things that got me started on this journey. Is that is a conversation that I had with Daniel Amon? Do you know who he is? Lorilee Binstock 00:52:53 Yes. I do. Yes. Very fascinating stuff. Jamie Mustard 00:52:54 Okay. Yeah. The ring that came to meet Daniel Amon is that forensic psychiatrist, doctor j Faber, who got me really started on this journey. I mean, I would not If I don't meet Kaye Faber, who runs the Encino Amon Clinic, who's probably the most bona fide forensic psychiatrist in the United States, maybe the world in terms of education, degrees, and board certifications. He was a fan of the book, The Economist. He contacted me on the website and said, can you come to LA and speak to inner city kids, and I'll pay you through my my foundation? And I said, well, hey, man. I'll I'll come to LA, and I'll talk to kids. But I don't think I could take money for going to my hometown and talking to kids. But but I'll come out and do it, but I I just wanna take your money. And but public speaking is a way that I make money, but just I wouldn't do it that way. Yeah. I wouldn't do I I told my agent that I couldn't charge for that. You know? And Lorilee Binstock 00:53:47 Yeah. Jamie Mustard 00:53:47 but this guy, he reads he and I become friends. So he's the one that vetted the at the time it was SGB, now it's DCR DSR for me. And, basically, I asked him about this because I was really wanting to feel better because I was successful And now I didn't have a reason for discomfort because I thought, well, if I just achieved my goals, I'll I'll feel good. And then I had all my goals achieved, and I was feeling worse than ever, and that was causing me to be very concerned. And what you know, and the precursor to that is you know, growing up in poverty, people you know, I was semi literate into my late teens. And I went from because through the a relative gave me an opportunity, to not be in poverty and to just focus on my studies for the first time in my life and to have eyeglasses and medical care when I was nineteen. And I went from doing remedial classes at a community college to graduating from the London School of Economics in just over five years. Lorilee Binstock 00:54:46 No. Jamie Mustard 00:54:47 And people say, how did you do that? Why did you do that? And the thing was I was desperate. I had lived in poverty and ignorance. And in my mind, I thought if I have affluence, which an education, that means I won't have pain. So if if if if if poverty and ignorance meant pain, affluence and education would mean no pain. So it drove me to this extraordinary overcoming of my life. And I remember arriving to the one in school of economics at twenty one or twenty years old, you know, twenty one years old Man. And thinking, finally, I would be I was away from pain, and I was around, you know, the some of the most smartest people in the world And when I got there, they had they were just as messed up and maybe had more problems than the people in the neighborhoods where I grew up. And so my whole premise fell apart, Laura Lee, because I thought, well, at least we had a reason to have these problems. We're dealing with, you know, reality every day in terms of aspects of survival. These guys are just have out everything that you can imagine, but they have the same anomalies and problems. And and so I was kind of disheartened and deflated because it didn't solve my problems. I didn't understand why everyone experiences this these aspects of existence until I went through this procedure twenty years later, twenty five years later. Okay? But So, you know, one thing that kind of got me on on this project also was three and a half years ago, doctor Lipbob teamed up with a private equity firm Sterling Partners and and Chicago. They are a multimillion dollar private equity firm to open up clinics all over the United States, which is called the Stella Center. And one thing I would say is the only place that has doctor Lipob's, what I would call, the Stella protocols. Doctor Lipob is the chief medical officer there. Is the Stella center. There's thirty five of them in the United States. If you don't go to a Stella center, you're not getting this. Okay? But without them, I would have never chosen to do a book because why promote a book to the world if it's not available to everyone? Right? But back to this conversation. Lorilee Binstock 00:57:03 That's what I was gonna ask. Jamie Mustard 00:57:05 Yeah. But let me tell you about this conversation with Daniel Amon, and then I'll shut up and open and let your your questions. So so doctor one day, doctor Faber said to me, we and I become friends. He'd written a book called Escape, rehabilitate your brain and stay on the legal system that kind of really where he where they were able to rehabilitate people's brains that had been through addicts, and I was really impressed by the data science in that book. And so one day, he starts insisting that Daniel, Eamon and I have to have a phone call. Right? So So he he forces Daniel Amon and I onto a Zoom call. I was excited about it because I get to meet, you know, the great Daniel Amon. I think Daniel Lima did not wanna be there. Lorilee Binstock 00:57:47 Yeah. Jamie Mustard 00:57:48 He was like, what am I doing on a call with this guy? And so what I did for the first four it was about an hour and a half call. What I did the first forty five minutes of that call was just asked Daniel questions. Why this? Why that? You know, just was curious. And I think after about forty five minutes later, And, you know, he said, how can I help you? Jamie, what do you want for me? And I said, listen. You're the one that's been leading the charge for the last thirty years saying, that mental issues or brain health issues, that they're biological. He knew nothing about the this aspect of the sympathetic nervous system, the SDB. I wouldn't say nothing, but it was not something he'd been investigating. He was mostly dealing with brain toxicity and TBI. Lorilee Binstock 00:58:30 Mhmm. Jamie Mustard 00:58:31 And I said, listen. You're the one that's been leading this charge. So if I'm right and this is an a major part of the mechanism, a, then you just you need to be a part of it. You know, you're the one that you're the first person through the gate taking all the hits. Saying this stuff is biological. This is a major part of the equation. You I think that it makes total sense that you're a part of this. And so he this is forty five minutes in. I can kinda see him relax, and he says, hold on. And he starts googling right in front of me thoroughly. And I I we're I'm staring at him through the Zoom, and his kinda mouth comes, falls open, and he goes, and I said, what? And he said, hey. There is a very credible study here that says that this is seventy percent effective in the permanent relief of most ex post traumatic stress symptoms. And I said, whoa. Whoa. Whoa, Daniel? And then and he said, And I said, well, Daniel, that's an old study with the it's gotta be a ten year old paper with the recent modifications of the dual injection in the right and left side. It's at eighty five to ninety percent. Lorilee Binstock 00:59:34 Mhmm. Jamie Mustard 00:59:42 And Daniel Lehman looks at me through the Zoom and says, Jamie, you don't understand. At seventy percent, this is no surprise winning work. I'll help you. Lorilee Binstock 00:59:56 Wow. Jamie Mustard 00:59:57 Yeah. And then he's been a massive partner for me. You know, I sent my first awarded people that I sent to Chicago because they were doing it wrong at Womac, was I a private jet company donated a plane to send thirteen of my special forces operators, to Fort Bragg, or no, to to Chicago. I scan their brains and name in clinic in Chicago, do this procedure on them over two days, scan their brains again less than forty eight hours later, and Amy. So Amy's been a massive supporter partner for me. I could not have done this book without him. Lorilee Binstock 01:00:29 Wow. Amazing. Amazing. So Is this procedure covered by insurance by any chance? Jamie Mustard 01:00:37 It isn't, but it's actually a not a very expensive procedure compared to the cost of talk therapy, the cost of all the other things that you could be doing out there. Compared to hyperbaric. You can there's a it's typically I think it's probably in the two to three thousand dollar range. But you don't have but it but then but the amount of gain or I don't know if I wanna use that word, but the amount of Lorilee Binstock 01:01:00 Benefit. Mhmm. Jamie Mustard 01:01:01 benefit, change, relief, comfort is kind of hard to It's it's it's too unbelievable. You know, it's it's it's it's I mean, it's it's it's like it's you just I was nervous to do it, Lolly, because I'm an artist, and I thought if my angst goes away, will I be able to create? Lorilee Binstock 01:01:23 Oh, yes. That's a very yeah. That's a very legitimate concern as an artist. Jamie Mustard 01:01:27 Yeah. But the yeah. But the thing is, like you know, think about it like but here's what actually happened. That was my concern. But here's what happened. If you're stuck in fight or flight and you think there's a tiger every second of the day, you're not gonna be able to experience emotion. You're not gonna cry during a movie, or have lovely moments with people. If you feel like a tiger is about to eat you all the time, you're concerned with a tiger. These mere nerves in your neck are lying to your brain. So when that when that went away and I was no longer in fire flight, I was ex my joy My ability to experience emotion was just freed, and it made me a far better artist. Lorilee Binstock 01:02:05 Wow. Well, I you know, I'm just I am bothered by the fact that there's so many effective treatments I feel like that are out there. And this being a Jamie Mustard 01:02:06 Yep. Lorilee Binstock 01:02:15 a huge one that insurance doesn't cover, but they'll they cover talk therapy for twenty, thirty years. Makes you wonder. But, yes, this is is this something that anyone's, like, lobbying for for for insurance to say, hey. This is mental health is a huge problem, you know, in our country and worldwide. You know, this is something that that should be covered for for the majority of people who probably need it the most are probably the ones that who wouldn't be able to spend you know, two thousand, three thousand dollars on it. You know, this this is this is this is my concern with psychedelic work or I mean, I'm ketamine is not my my one of the things that I advocate for, but, I mean, you know, the other stuff is illegal. But once it does become legal, you know, the insurance is is probably not going to cover it, especially immediately, and they're not even covering ketamine, which is legal. So is this something that, you know, somebody is is mhmm. Jamie Mustard 01:03:14 Oh, okay. It's a great question. It's a great question. And I will say that I'm a massive fan of ketamine. Okay? And the reason I'm a fan of ketamine is because of how it works. What you know, I'm not a fan of the disassociate associative state. I don't think that's how it works. A lot of people would disagree with me. Ketamine, the way that doctor Lip Bob, if you were here, would describe it, is like fertilizer for nerve growth in the brain. Lorilee Binstock 01:03:41 Mhmm. Jamie Mustard 01:03:41 So a lot of people that have that are having mental issues You know, when I was on that call with Daniel, I kept using the term mental illness or something. He looked at me really sour one time, and he said, please. Don't use that term. Please stop. And I said, why? What's wrong with it? He goes, well, it's not true. It's not no one has that. I said, well, it's stigmatizing, and it's inhumane, and it's not true. And I said, well, we what what do you use? And he said brain health issues. Let's just call it brain health issues. Lorilee Binstock 01:04:15 That's legit. Yeah. Jamie Mustard 01:04:16 Yeah. So so, you know, Nathaniel's been scanning brains since nineteen eighty nine. His whole thing was when he started and he was a considered, you know, an out outsider for a long time and had a opposed, you know, even a quack. As the brain science has come in the last ten years, he's been hailed as a genius and hero. Okay? And but, basically, his view was, you know, if your arm hurts and I'm gonna get to the insurance, thing. I just wanna give this kind of entry to it. If your arm hurts or your leg hurts, you x-ray it. Somebody acts crazy, and you know one's looking at people's brains when they act crazy, he thought that made no sense. And that's why in nineteen eighty nine, over thirty years ago, he started scanning brains. In the last thirty years, it's made him the most famous psychiatrist in America that probably drugs people the least. His thing on drugs on on on psychotropics is when you use a psychotropic, which can be effective to give somebody relief, you're creating a problem to solve a problem. The psychotropic changes your brain so that you need it. So now you have two problems. That he thinks you know, so But so he's got a massive dataset of what of what of two almost two hundred thousand brain scans. So one of the things that we know is we know that alcohol ravages the brain in terms of blood flow and other toxicities. With Lorilee Binstock 01:05:38 Right. Jamie Mustard 01:05:40 THC is even worse. So we freed up marijuana. It's legal in the state of Oregon where I live, but it actually ravages the brain and creates all sorts of mental problems in terms of this the anxiety, and and then you need it just to feel normal, and you're destroying your brain. Okay? So all I'm interested in is the data science. But back to this insurance question, right now, this NYU study is being done. The army's been studying for years. So there's lots of incredible studies. There's one sixty minutes. There was a sixty minutes episode five, ten years ago that talked about the army study. But the right now, the the the there's a a study being done in FMRI or an FMRI study being done in NYU that makes this unequivocally undeniable. So I don't think we're far away from the insurance companies approving this. Also, the the doctor is connected to a nonprofit charity. Called Race PTSD now, and they're paying for treatment for a phenomenal amount of people. So you can apply to to that. But what I would say is, you know, get the invisible machine book, understand that a huge part of the book is explaining how this relates to all the other incredible therapeutics out there. I believe psilocybin works. We don't have a lot of data on the long term effects of it. But with with the DSR, there's no down there I don't wanna say there's no real downside. You get all of the gain. You get it instantly. And you don't have to worry about you know, I've had people tell me they do psilocybin and they have a really bad experience on what psychological or same thing with ketamine, which I'm a fan of. So this is all the upside with none of the downside, and you yeah, I had a doctor one time, a military doctor that was telling me that, you know, that there you know, this wasn't the only treatment, and I was overselling it and blah blah blah blah blah blah. And at Fort Bragg, and I and I said to her, okay. Let me ask you a question. Say somebody was in real trouble, and they weren't feeling well. And they can and then you have every modality at what your disposal to give them. What should they do first? And she said, well, they should do the DSR first because then we that they would get so far in so little time with no downside, that it would it makes everything else more effective. So what we're finding is that people that reset the It's the difference between physical therapy and a broken leg, Laura Lee. You physical therapy is gonna be far more effective if you reset the leg. You wouldn't do physical therapy over a broken mic. So you're gonna find that if you do psilocybin, where you do hyperbaric, where you do talk therapy, These things go exponentially faster and better and have more far more efficacy if you do a d s DSR first. The my most there's a again, all of this is parsed apart in the book, the Invisalign. The Temple of that book is a guy named Trevor Beenan, who is a guy that I was afraid of for about a year, who's now one of my best friends, and I was afraid of him. I was afraid of him because I interviewed him at Fort Bragg. He is a guy that was molested by a stepfather for eight years from eight to sixteen. The guy went to jail. He shot up medical heroin in Afghanistan. He killed people. He's seen people killed. And for thirty years, he was homicidal towards a stepfather in suicidal. The only thing keeping him alive was his wife and his children. This guy just hit just wanted to die. And so when I met him, I interviewed him for three hours of Fort Bragg, was the hardest interview I ever did. He started calling me wanting to talk, and I did not want that. I didn't want he wanted to send me stuff. I didn't want him having my address. I was terrified of this guy when I got back to Portland after that trip before Greg. The you the military does not want special forces doesn't want crazy special operators out there. So there's they get more resources than regular army. They they had spent hundreds of thousands of dollars, you know, trying to giving Trevor, everything you could possibly reimagine, e m d r, every therapy, the the greenberry foundation, the military would pay for him to get better. Nothing worked. He was suicidal and homicidal towards his stepfather. After that interview, it took me six months to get her to Chicago, That was eighteen months ago, Trevor's just gone back to being a person. And Lorilee Binstock 01:10:15 No. Wow. Jamie Mustard 01:10:17 and the and, you know, and and what's and and, you know, you you would never know there's anything wrong with him. He looks like a guy that would be playing he he looks like an actor that would play a special forces hero in a movie. He's just a good looking white guy. You know? But he was beating him the Latin kings at eleven Lorilee Binstock 01:10:33 Yeah. Jamie Mustard 01:10:35 and grew up in poverty outside of Chicago, but you would never know it from looking at him. And so that so three months ago, he's doing ten in Portland, He came to addition for Ted in Portland a few months ago, and this guy that I didn't wanna even know before he did the DSR stayed in my house. Lorilee Binstock 01:10:55 Well, wow. Jamie Mustard 01:10:55 Yeah. Yeah. So yeah. So so the so that's how I I the the way I explained in terms of other therapies is set the leg, and then all these other amazing modalities out there will be so much more effective. Lorilee Binstock 01:11:10 You really have me. I'm like, after this conversation, I'm going to be googling where this is this treatment is available because I am extremely intrigued because Yes. I've done, you know, the psilocybin, the MDMA, and it has worked wonders for me. I was able to get off of all my SSM our eyes. And but there, you know, there are moments when I I I feel like my nervous system just gets goes haywire, you know, after like, four or five months after I've done it. So I'm wondering, like, am I I should I try this DSR treatment? And then continue along my IFS therapy and, you know, whatever else that that, you know, I'm doing now. And, yeah, I'm I'm extremely intrigued. Where can we find more information about where this is available? Jamie Mustard 01:12:02 Okay. Well well, can can I comment on what you just said about yourself? And then I'll tell you. Lorilee Binstock 01:12:05 Yes. Please. Jamie Mustard 01:12:08 Listen. You're any other thing that you're doing, you're mitigating against it. These things work. Like, yoga works. We're also not meant to live in artificial cities and virtual environments. So this system is a very useful system if they were in a tiger infested jungle, being stuck in fight or fight is actually very good. We actually it makes sense. That trauma is not a disorder. It makes sense that it's a physical injury because we would all have to have an identical response to fire flight or to trauma with fire flight if we're gonna survive as a species. It doesn't make any sense that it would be a disorder. Okay? We you were of a survival species. We have to have a homogeneous uniform response Lorilee Binstock 01:12:41 Mhmm. Jamie Mustard 01:12:48 to survival or we don't survive. K? But, you know, what you're doing when you do yoga, psilocybin I've seen wonders with psilocybin. And hyperbaric wonders, but a lot of that is your minute it's mitigation. Like, you have to do yoga. You have to run every day. Nature is incredible. You know, we're we're you know, I find, you know, nature helps mitigate against this, but we don't live in most of us don't live in natural environments anymore, so we don't have that mitigator. Lorilee Binstock 01:13:14 Right. Jamie Mustard 01:13:15 Right? So you can kind of reduce it and bring it down through holistic health. But the only way to reset it is to reset it. Okay? Again, the the Stella center. Go to I I think it's is it stellar center dot com? Lorilee Binstock 01:13:33 I might be able to find it. Jamie Mustard 01:13:34 Yeah. Let me Lorilee Binstock 01:13:35 Sela center dot com. Yep. You're right. Jamie Mustard 01:13:37 yeah. Yeah. Or go to talk yeah. I would also highly recommend Lorilee Binstock 01:13:38 Excellent. Jamie Mustard 01:13:42 if you're not getting this from Stella Center, I don't work for them. They don't pay me. K. I'm not a I just note the only place that has the modern protocols, which I'll call the stellar protocols, is the stellar center. I if you're not getting this, if you're not going to sell a center, you're not getting this. That's why I had to send my first cohort of people two years ago from Fort Bragg from Woamath, the most advanced medical hospital a military hospital in the world, I had to send my guys to Chicago. So first of all, Larlie, where do you live? Lorilee Binstock 01:14:16 I live in Washington, DC. Jamie Mustard 01:14:18 Okay. Well, they're Lorilee Binstock 01:14:20 There's one in New York, I see. Jamie Mustard 01:14:20 I would highly recommend Yeah. I do go to New York. No. Like like, you you're like, first of all, let's talk offline, but I I would I want you to go to Chicago and get it from doctor Lipoff. Lorilee Binstock 01:14:27 Yes. Jamie Mustard 01:14:32 Unequivocally. Okay? And if you do that, I'll get you a discount. Okay? Lorilee Binstock 01:14:36 Well, yes. Well, let's let let's chat after this conversation. She said, yes. That's a very Jamie Mustard 01:14:39 Okay. Okay. If you decide, there's pressure. Lorilee Binstock 01:14:42 no. I I'm very intrigued. I I'm trust me. I I mean, from where I was five years ago is just exponentially better. I don't recognize who I was, but I do have these moments where You know? I'm I just tore my ACL. I've just I'm recovering from ACL surgery, and I was single parenting for, like, a week, and my children just the sound of my children's voices up stairs screaming would, like, send me into, like, this, like, what is happening? I'm just freaking out over no reason. It's really because and I'm and I imagine myself and I think about Peter Levine's book where I was, like, maybe I'm I feel like a wounded animal with the just this this slight sound of, like, danger or any issues sends my nervous system, like, off the charts. And this was over the last week. Jamie Mustard 01:15:29 Yeah. One hundred percent one of the things I hear over and over, and this is true for me, is, you know, that moment where you just react, that's a physiological response. That is an overactive sympathetic nervous system. That's what went away when I got this. So you get that extra five seconds. You get that extra ten seconds where you're not having a physiological
Welcome to this episode -our 50th episode!- of Physician's Weekly podcast. I am your host, Dr. Rachel Giles, from Medicom Medical Publishers, in collaboration with Physician's Weekly. Today's episode takes an inDEPTH look at osteoarthritis, a condition that affects more than 32 million adults in the United States. “Wear and Tear arthritis” has been in the news lately, because despite being the most frequent reason for activity limitation in adults, a new study has found that walking can ward off knee pain for people with osteoarthritis. Education, exercise, and weight loss are cornerstones of management, complemented by NSAIDs (for patients who are candidates), corticosteroid injections, and several adjunctive medications. For persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.Later in this episode, Physician's Weekly's Martta Kelly interviews Dr. Ewa Roos (University of Southern Denmark, Odense, Denmark). She recently published a paper looking at exercise therapy and how it was effective in improving muscle strength at 3- and 12-month follow-up compared to partial meniscectomy. She said these results made her, “re-think the way I think as a clinician”. But first, I interview Dr. Philip Conaghan (Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK) to define meaningful within-patient change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). His team analyzed data from 3 phase 3 clinical trials (ClinicalTrials.gov: NCT02697773, NCT02709486, NCT02528188) of tanezumab, a novel treatment intended for the relief of signs and symptoms of moderate-to-severe osteoarthritis, administered subcutaneously every 8 weeks. Patients with moderate-to-severe OA of the hip or knee completed the WOMAC and patient global assessment of OA (PGA-OA) at regular time points. Enjoy listening! Further reading: Berg B, Roos EM, Kise NJ, Engebretsen L, Holm I, Risberg MA. Muscle Strength and Osteoarthritis Progression After Surgery or Exercise for Degenerative Meniscal Tears: Secondary Analyses of a Randomized Trial. Arthritis Care Res (Hoboken). 2022 Jan;74(1):70-78. doi: 10.1002/acr.24736. PMID: 34151533.Conaghan PG, Dworkin RH, Schnitzer TJ, Berenbaum F, Bushmakin AG, Cappelleri JC, Viktrup L, Abraham L. WOMAC Meaningful Within-patient Change: Results From 3 Studies of Tanezumab in Patients With Moderate-to-severe Osteoarthritis of the Hip or Knee. J Rheumatol. 2022 Jun;49(6):615-621. doi: 10.3899/jrheum.210543. Epub 2022 Mar 1. PMID: 35232805.
Ever heard of WOMAC & LEQUESNE indexes? On this episode, Prof. Fadoua Allali will explain how to use these and other OA indexes to measure the patient's pain and support doctors in the diagnosis and follow up process. Dr. Allali will give tips and recommendations for the use of these tools and explain how they work to better monitor the patient's disease progression and how to interpret the data as a guidance to adapt the treatment to new circumstances, if necessary. Dr. Allali has confirmed her participation in a future episode so we hope you'll continue to join us in Let's Talk OA. The comments of the speakers are their own. The podcast is for HCPs (Healthcare Professionals) only. The podcast have a HCPs educational purpose. Laboratories Expanscience as sponsors are not responsible for the healthcare professional's positions.
¿Alguna vez has oído hablar de los índices WOMAC y LEQUESNE? En este episodio, la profesora Fadoua Allali explicará cómo usar estos y otros índices de OA para medir el dolor del paciente, así como para apoyar a los médicos en el proceso de diagnóstico y seguimiento. La Dra. Allali dará consejos y recomendaciones para el uso de estas herramientas, y revelará su funcionamiento tanto para un mejor monitoreo de la progresión de la enfermedad en el paciente como para, si fuera necesario, saber interpretar los datos a forma de guía para adaptar el tratamiento a las nuevas circunstancias. La Dra. Allali ha confirmado su participación en un episodio futuro, por lo que esperamos que sigais uniéndoos a nosotros en Let´s Talk OA. Los comentarios y opiniones expresados por los ponentes son propios. Esta serie de podcasts está dirigido a profesionales de la salud exclusivamente. Los podcasts tienen un fin educativo para los profesionales de la salud. Laboratorios Expanscience como patrocinadores no se hacen responsables de las opiniones de los profesionales sanitarios expresados en esta serie de podcast.
Avez-vous déjà entendu parler des indices WOMAC et LEQUESNE? Dans cet épisode, le professeur Fadoua Allali expliquera comment utiliser ces indices ainsi que d'autres existants pour mesurer la douleur du patient et pour pouvoir aider les médecins dans leur processus de diagnostic et suivi. Le docteur Allali donnera des conseils et recommandations pour l'usage de ces outils et montrera leur fonctionnement pour un suivi de la progression de la maladie et pour pouvoir si nécessaire interpréter ces données et être capable d'adapter le traitement à de nouvelles circonstances. Le docteur Allali a confirmé sa participation dans un futur épisode et nous esperons que vous vous joindrez à nous sur Let's Talk OA. Les commentaires et opinions des intervenants sont les leurs. Le podcast est réservé aux professionnels de santé. Le podcast a un but éducatif pour les professionnels de santé. Les Laboratoires Expanscience en tant que sponsors ne sont pas responsables des opinions du professionnel de santé.
FDA 批准靶向IL-23的单克隆抗体治疗银屑病Arthritis & Rheumatol 替格瑞洛治疗后骨关节炎风险的降低JAMA 生物力学鞋对膝骨关节炎患者膝关节疼痛的影响LANCET 非布司他与别嘌醇在痛风患者中的长期心血管安全性Nature子刊 抑制MEK使CD8+ T淋巴细胞重新编码为具有潜在抗肿瘤特性的记忆干细胞替达珠单抗（tildrakizumab）替达珠单抗（tildrakizumab）是人源化IgG1x单克隆抗体，靶向IL-23的p19亚基并阻断其与IL-23受体结合，抑制细胞因子与趋化因子释放。2018年3月FDA批准替达珠单抗用于治疗成人中重度斑块型银屑病。《reSURFACE1和reSURFACE2研究52周的综合分析：替达珠单抗治疗中重度银屑病52周的疗效的3期临床研究》Journal of European Academy of Dermatology & Venereology，2019年12月 (1) reSURFACE1和reSURFACE2研究的目的是观察替达珠单抗治疗中重度银屑病的疗效，前28周的结果已经证实了替达珠单抗的疗效，这篇文章报告了随访52周的结果，旨在评价治疗对患者皮肤科生活质量评分（DLQI）和银屑病面积和严重程度指数（PASI）评分的影响。两项研究中使用替达珠单抗100 mg或200 mg治疗的1156位患者，在第28周合并，然后根据第28周时的PASI评分改善程度分为5组：0-49分、50-74分、75-89分、90-99分和100分。第28周，替达珠单抗100 mg组和200 mg组根据PASI评分改善程度分组后的患者比例分别为8.3%、14.3%、23.8%、30.4%、23.1%，和4.0%、18.1%、19.6%、29.1%、29.3%。第28周疗效较差的、PASI改善50的患者中，持续使用相同剂量的替达珠单抗至第52周，PASI评分持续改善。两种剂量都观察到了类似的结果。28周时PASI改善较好的患者中，DLQI 0/1的比例较高，且维持或改善至52周。然而，并不是所有PASI改善100患者的DLQI都为0/1。结论：替达珠单抗疗效较差的患者可在第8周确定，疗效好、PASI评分改善≥90的患者通常可在第4周确定。第28周PASI改善水平与生活质量改善相关。骨关节炎骨关节炎（osteoarthritis，OA）是最常见的关节炎。发病机制中有很多重要的因素，包括生物力学因素、促炎因子和蛋白酶等。症状主要是特征性关节组织病理改变所引起的疼痛和关节功能改变，所有的OA患者都存在关节软骨、骨骼、滑膜和软组织的病理表现。《回顾性分析：与氯吡格雷相比，替格瑞洛治疗后骨关节炎风险的降低》Arthritis & Rheumatol，2020年11月 (2)细胞外腺苷具有抗炎作用，在动物模型中可预防和治疗骨关节炎。替格瑞洛和氯吡格雷都用于冠心病患者，但只有替格瑞洛增加了细胞外腺苷水平。这项研究是为了确定治疗替格瑞洛是否与降低骨关节炎风险有关。研究纳入替格瑞洛或氯吡格雷治疗≥90天的、没有关节炎病史的、21000例患者。平均治疗天数分别为287天和284天。两组患者的平均年龄均为64岁，73%为男性。多变量Cox回归分析估计，与氯吡格雷相比，替格瑞洛治疗后发生OA的危险比为0.71(95%可信区间0.64-0.79)(P < 0.001)。结论：在5年的随访中，与氯吡格雷治疗相比，替格瑞洛治疗降低了骨关节炎发病风险达29%，这可能与我们假设接受替格瑞洛的患者中OA的减少可能部分是由于细胞外腺苷水平的增加。《软骨缺失会导致骨关节炎疼痛吗？如果会，疼痛程度是多少?》Annals of Rheumatic Disease，2020年9月 (3)虽然骨关节炎的治疗重点是软骨保护，但目前尚不清楚预防软骨损失能在多大程度上减轻关节疼痛。研究量化了骨髓病变和滑膜炎后软骨损失、和膝关节疼痛恶化之间的关系，并检查了这些因素在多大程度上介导了这种关联。研究人员在基线、12个月和24个月时，对600例膝关节MRI定量、半定量测量骨关节炎的结构特征。定量的计算了内侧软骨厚度的变化、软骨损失情况、使用西安大略和麦克马斯特大学骨关节炎指数疼痛评分（WOMAC疼痛评分）评价疼痛程度。随访24个月，软骨厚度的减少与疼痛的轻微恶化显著相关。例如，两年内软骨厚度减少0.1mm，WOMAC疼痛增加0.32。软骨厚度的减少与疼痛的关系是通过滑膜炎的改变，而不是骨髓病变的改变。亚分析结果相似。结论：软骨厚度的减少只与少量的膝关节疼痛恶化有关，这种关联部分是由滑膜炎恶化引起的。通过软骨保护减少膝盖疼痛可能是难以实现的。骨关节炎的治疗膝关节骨性关节炎的治疗方法包括非药物治疗、药物治疗和手术，旨在缓解疼痛、改善关节功能以及改变骨关节炎进展的危险因素。尽管研究很多，但改变疾病病程的疗法效果欠佳。轻度骨性关节炎着重体重管理、镇痛、局部物理治疗；中重度骨性关节炎着重情绪疏导、镇痛、关节内注射类固醇、运动（建议水中锻炼，耐受性比地面锻炼好）和手术。《VITAL研究：补充维生素D和ω-3脂肪酸对老年慢性膝盖疼痛的影响》Arthritis & Rheumatol，2020年11月 (4)膝痛是成人骨关节炎的常见病因。该研究的目的是评价维生素D、ω-3脂肪酸治疗膝关节疼痛的效果。这项双盲、安慰剂对照的研究纳入25,871名参与者，按照2x2设计随机接受维生素D或ω-3脂肪酸，随机化之前，确定了一个膝盖疼痛的亚组，这组人群共1398人，平均年龄67岁，66%为女性，根据WOMAC评分评价关节疼痛程度。基线时，WOMAC疼痛评分平均值为37，平均随访时间为5.3年后，WOMAC疼痛评分在维生素D组、ω-3脂肪酸组和安慰剂组之间没有差异。随着时间的推移，补充维生素D和ω-3脂肪酸对WOMAC功能或僵硬评分也没有显著影响。结论：在慢性膝关节疼痛的大样本中，补充维生素D和ω-3脂肪酸持续5.3年并不能减轻膝关节疼痛、或改善关节功能或僵硬。《随机、双盲、安慰剂对照试验：白细胞介素-1β抑制对髋关节和膝关节置换术发生率的影响》Annals of Internal Medicine，2020年10月 (5) 研究的目的是确定IL-1抑制卡那单抗是否减少全髋关节或膝关节置换术的发生率。研究纳入1061例CANTOS研究的参与者，随机给予安慰剂、或卡那单抗50mg、150mg或300mg ip 三个月一次。平均随访3.7年，与安慰剂相比，卡那单抗组的关节置换的风险比分别为：50mg组为0.60，150mg组为0.53，300 mg组为0.60，均有统计学意义。将治疗组数据合并，关节置换发生率为0.31/100人年，安慰剂组为0.54例/100人年（风险比 0.58，P=0.001）。结论：该随机对照试验的探索性分析结果支持进一步研究IL-1抑制治疗大型关节骨性关节炎。《随机对照研究：膝关节骨性关节炎的物理治疗与糖皮质激素注射比较》New England Journal of Medicine，2020年4月 (6)物理治疗和关节内注射糖皮质激素已被证明对膝骨关节炎有临床疗效。该研究的目的是评价这两种疗法在缓解疼痛、改善身体功能方面的短期和长期效果。这项随机试验纳入单膝或双膝骨关节炎患者共156人，平均年龄56岁，随机接受糖皮质激素注射或接受物理治疗。基线WOMAC功能或僵硬度评分平均值，糖皮质激素注射组为108.8分，物理治疗组为107.1分；1年时的平均值分别为55.8分和37.0分。组间平均差异为18.8分，物理治疗更好。结论：与接受关节内糖皮质激素注射的膝关节骨性关节炎患者相比，接受物理治疗的膝关节骨性关节炎患者在1年的疼痛和功能残疾更少。《BIOTOK研究：生物力学鞋对膝骨关节炎患者膝关节疼痛的影响》JAMA，2020年5月 (7)研究的目的是评价个体化校准的生物力学鞋疗法是否可能改善有症状性的、膝骨关节炎患者的疼痛和功能。这项随机临床试验纳入症状性膝关节骨关节炎患者220名，平均年龄65.2岁，给予生物力学鞋治疗或安慰剂治疗，随访24周。随访24周时，生物力学鞋组的标准化WOMAC疼痛评分平均值从4.3提高到1.3，对照组鞋组从4.0提高到2.6（P 50岁的、膝关节骨关节炎和软骨下骨髓病变的223名成年患者，平均年龄62岁，女性52%。随机分组，分别在试验开始时和12个月的时候静脉滴注一次5mg唑来膦酸组或100ml生理盐水作为安慰剂。随访24个月，唑来膦酸组和安慰剂组的胫股软骨体积变化无显著差异（P = 0.50）。次要结果的组间差异均无统计学意义，包括膝关节疼痛评分、WOMAC骨关节炎指数、骨髓病灶大小变化。唑来膦酸的不良事件比安慰剂更常见。结论：症状性膝骨关节炎和骨髓病变患者中，每年注射唑来膦酸并没有显著减少软骨体积损失。这些发现不支持使用唑来膦酸治疗膝骨关节炎。《随机对照研究：姜黄提取物治疗膝关节骨关节炎症状及渗出性滑膜炎的疗效观察》Annals of Internal Medicine，2020年12月 (9)研究的目的是探讨姜黄提取物对症状性、膝关节骨性关节炎和膝关节渗出性滑膜炎的疗效。这项单中心研究招募了70名参与者，连续12周，每天2粒姜黄提取物或安慰剂。12周后，与安慰剂相比，姜黄提取物改善视觉模拟疼痛（VAS）评分的幅度为-9.1mm（P = 0.039），但没有改变渗出性滑膜炎体积（3.2mL）。姜黄提取物还可改善WOMAC膝关节疼痛评分（P = 0.006），但没有改善MRI腓骨外侧软骨T2松弛时间（−0.4 ms）。两组不良事件发生率相似（P = 0.16）结论：对于膝关节疼痛，姜黄提取物比安慰剂更有效，但不影响膝关节渗出性滑膜炎或软骨成分。需要更大样本量的多中心试验来评估这些发现的临床意义。痛风痛风是尿酸单钠结晶沉积病，其生化特点是细胞外液尿酸盐浓度达到饱和，血液中表现为高尿酸血症，即血尿酸盐浓度超过400μmol/L，该水平接近于尿酸盐的溶解度极限。痛风的临床表现包括：炎症性关节炎的反复发作、慢性关节病、尿酸盐结晶累积形成痛风石沉积、尿酸性肾结石等。急性期止痛，可以使用全身或关节内糖皮质激素、NSAID、秋水仙碱，难治性痛风发作可尝试使用抑制IL-1β的生物制剂（欧盟已批准卡那单抗治疗难治性痛风发作）。缓解期降尿酸，可以使用别嘌醇、非布司他、丙磺舒、苯溴马龙或聚乙二醇重组尿酸酶。《FAST研究：非布司他与别嘌醇在痛风患者中的长期心血管安全性》LANCET，2020年11月 (10)这项前瞻性、随机、开放、非劣效研究，纳入≥60岁、已经接受别嘌醇治疗的、合并心血管危险因素的患者，共6128人。患者平均年龄71岁，85%为男性，33.4%有心血管疾病病史。被随机分配别嘌醇或非布司他治疗，中位随访时间为1467天。在非致死性心梗或急性冠脉综合征住院的发生率方面，非布司他为1·72次/100人年，低于别嘌醇2·05次/100人年（风险比 0·85，p
FDA 批准靶向IL-23的单克隆抗体治疗银屑病Arthritis & Rheumatol 替格瑞洛治疗后骨关节炎风险的降低JAMA 生物力学鞋对膝骨关节炎患者膝关节疼痛的影响LANCET 非布司他与别嘌醇在痛风患者中的长期心血管安全性Nature子刊 抑制MEK使CD8+ T淋巴细胞重新编码为具有潜在抗肿瘤特性的记忆干细胞替达珠单抗（tildrakizumab）替达珠单抗（tildrakizumab）是人源化IgG1x单克隆抗体，靶向IL-23的p19亚基并阻断其与IL-23受体结合，抑制细胞因子与趋化因子释放。2018年3月FDA批准替达珠单抗用于治疗成人中重度斑块型银屑病。《reSURFACE1和reSURFACE2研究52周的综合分析：替达珠单抗治疗中重度银屑病52周的疗效的3期临床研究》Journal of European Academy of Dermatology & Venereology，2019年12月 (1) reSURFACE1和reSURFACE2研究的目的是观察替达珠单抗治疗中重度银屑病的疗效，前28周的结果已经证实了替达珠单抗的疗效，这篇文章报告了随访52周的结果，旨在评价治疗对患者皮肤科生活质量评分（DLQI）和银屑病面积和严重程度指数（PASI）评分的影响。两项研究中使用替达珠单抗100 mg或200 mg治疗的1156位患者，在第28周合并，然后根据第28周时的PASI评分改善程度分为5组：0-49分、50-74分、75-89分、90-99分和100分。第28周，替达珠单抗100 mg组和200 mg组根据PASI评分改善程度分组后的患者比例分别为8.3%、14.3%、23.8%、30.4%、23.1%，和4.0%、18.1%、19.6%、29.1%、29.3%。第28周疗效较差的、PASI改善50的患者中，持续使用相同剂量的替达珠单抗至第52周，PASI评分持续改善。两种剂量都观察到了类似的结果。28周时PASI改善较好的患者中，DLQI 0/1的比例较高，且维持或改善至52周。然而，并不是所有PASI改善100患者的DLQI都为0/1。结论：替达珠单抗疗效较差的患者可在第8周确定，疗效好、PASI评分改善≥90的患者通常可在第4周确定。第28周PASI改善水平与生活质量改善相关。骨关节炎骨关节炎（osteoarthritis，OA）是最常见的关节炎。发病机制中有很多重要的因素，包括生物力学因素、促炎因子和蛋白酶等。症状主要是特征性关节组织病理改变所引起的疼痛和关节功能改变，所有的OA患者都存在关节软骨、骨骼、滑膜和软组织的病理表现。《回顾性分析：与氯吡格雷相比，替格瑞洛治疗后骨关节炎风险的降低》Arthritis & Rheumatol，2020年11月 (2)细胞外腺苷具有抗炎作用，在动物模型中可预防和治疗骨关节炎。替格瑞洛和氯吡格雷都用于冠心病患者，但只有替格瑞洛增加了细胞外腺苷水平。这项研究是为了确定治疗替格瑞洛是否与降低骨关节炎风险有关。研究纳入替格瑞洛或氯吡格雷治疗≥90天的、没有关节炎病史的、21000例患者。平均治疗天数分别为287天和284天。两组患者的平均年龄均为64岁，73%为男性。多变量Cox回归分析估计，与氯吡格雷相比，替格瑞洛治疗后发生OA的危险比为0.71(95%可信区间0.64-0.79)(P < 0.001)。结论：在5年的随访中，与氯吡格雷治疗相比，替格瑞洛治疗降低了骨关节炎发病风险达29%，这可能与我们假设接受替格瑞洛的患者中OA的减少可能部分是由于细胞外腺苷水平的增加。《软骨缺失会导致骨关节炎疼痛吗？如果会，疼痛程度是多少?》Annals of Rheumatic Disease，2020年9月 (3)虽然骨关节炎的治疗重点是软骨保护，但目前尚不清楚预防软骨损失能在多大程度上减轻关节疼痛。研究量化了骨髓病变和滑膜炎后软骨损失、和膝关节疼痛恶化之间的关系，并检查了这些因素在多大程度上介导了这种关联。研究人员在基线、12个月和24个月时，对600例膝关节MRI定量、半定量测量骨关节炎的结构特征。定量的计算了内侧软骨厚度的变化、软骨损失情况、使用西安大略和麦克马斯特大学骨关节炎指数疼痛评分（WOMAC疼痛评分）评价疼痛程度。随访24个月，软骨厚度的减少与疼痛的轻微恶化显著相关。例如，两年内软骨厚度减少0.1mm，WOMAC疼痛增加0.32。软骨厚度的减少与疼痛的关系是通过滑膜炎的改变，而不是骨髓病变的改变。亚分析结果相似。结论：软骨厚度的减少只与少量的膝关节疼痛恶化有关，这种关联部分是由滑膜炎恶化引起的。通过软骨保护减少膝盖疼痛可能是难以实现的。骨关节炎的治疗膝关节骨性关节炎的治疗方法包括非药物治疗、药物治疗和手术，旨在缓解疼痛、改善关节功能以及改变骨关节炎进展的危险因素。尽管研究很多，但改变疾病病程的疗法效果欠佳。轻度骨性关节炎着重体重管理、镇痛、局部物理治疗；中重度骨性关节炎着重情绪疏导、镇痛、关节内注射类固醇、运动（建议水中锻炼，耐受性比地面锻炼好）和手术。《VITAL研究：补充维生素D和ω-3脂肪酸对老年慢性膝盖疼痛的影响》Arthritis & Rheumatol，2020年11月 (4)膝痛是成人骨关节炎的常见病因。该研究的目的是评价维生素D、ω-3脂肪酸治疗膝关节疼痛的效果。这项双盲、安慰剂对照的研究纳入25,871名参与者，按照2x2设计随机接受维生素D或ω-3脂肪酸，随机化之前，确定了一个膝盖疼痛的亚组，这组人群共1398人，平均年龄67岁，66%为女性，根据WOMAC评分评价关节疼痛程度。基线时，WOMAC疼痛评分平均值为37，平均随访时间为5.3年后，WOMAC疼痛评分在维生素D组、ω-3脂肪酸组和安慰剂组之间没有差异。随着时间的推移，补充维生素D和ω-3脂肪酸对WOMAC功能或僵硬评分也没有显著影响。结论：在慢性膝关节疼痛的大样本中，补充维生素D和ω-3脂肪酸持续5.3年并不能减轻膝关节疼痛、或改善关节功能或僵硬。《随机、双盲、安慰剂对照试验：白细胞介素-1β抑制对髋关节和膝关节置换术发生率的影响》Annals of Internal Medicine，2020年10月 (5) 研究的目的是确定IL-1抑制卡那单抗是否减少全髋关节或膝关节置换术的发生率。研究纳入1061例CANTOS研究的参与者，随机给予安慰剂、或卡那单抗50mg、150mg或300mg ip 三个月一次。平均随访3.7年，与安慰剂相比，卡那单抗组的关节置换的风险比分别为：50mg组为0.60，150mg组为0.53，300 mg组为0.60，均有统计学意义。将治疗组数据合并，关节置换发生率为0.31/100人年，安慰剂组为0.54例/100人年（风险比 0.58，P=0.001）。结论：该随机对照试验的探索性分析结果支持进一步研究IL-1抑制治疗大型关节骨性关节炎。《随机对照研究：膝关节骨性关节炎的物理治疗与糖皮质激素注射比较》New England Journal of Medicine，2020年4月 (6)物理治疗和关节内注射糖皮质激素已被证明对膝骨关节炎有临床疗效。该研究的目的是评价这两种疗法在缓解疼痛、改善身体功能方面的短期和长期效果。这项随机试验纳入单膝或双膝骨关节炎患者共156人，平均年龄56岁，随机接受糖皮质激素注射或接受物理治疗。基线WOMAC功能或僵硬度评分平均值，糖皮质激素注射组为108.8分，物理治疗组为107.1分；1年时的平均值分别为55.8分和37.0分。组间平均差异为18.8分，物理治疗更好。结论：与接受关节内糖皮质激素注射的膝关节骨性关节炎患者相比，接受物理治疗的膝关节骨性关节炎患者在1年的疼痛和功能残疾更少。《BIOTOK研究：生物力学鞋对膝骨关节炎患者膝关节疼痛的影响》JAMA，2020年5月 (7)研究的目的是评价个体化校准的生物力学鞋疗法是否可能改善有症状性的、膝骨关节炎患者的疼痛和功能。这项随机临床试验纳入症状性膝关节骨关节炎患者220名，平均年龄65.2岁，给予生物力学鞋治疗或安慰剂治疗，随访24周。随访24周时，生物力学鞋组的标准化WOMAC疼痛评分平均值从4.3提高到1.3，对照组鞋组从4.0提高到2.6（P 50岁的、膝关节骨关节炎和软骨下骨髓病变的223名成年患者，平均年龄62岁，女性52%。随机分组，分别在试验开始时和12个月的时候静脉滴注一次5mg唑来膦酸组或100ml生理盐水作为安慰剂。随访24个月，唑来膦酸组和安慰剂组的胫股软骨体积变化无显著差异（P = 0.50）。次要结果的组间差异均无统计学意义，包括膝关节疼痛评分、WOMAC骨关节炎指数、骨髓病灶大小变化。唑来膦酸的不良事件比安慰剂更常见。结论：症状性膝骨关节炎和骨髓病变患者中，每年注射唑来膦酸并没有显著减少软骨体积损失。这些发现不支持使用唑来膦酸治疗膝骨关节炎。《随机对照研究：姜黄提取物治疗膝关节骨关节炎症状及渗出性滑膜炎的疗效观察》Annals of Internal Medicine，2020年12月 (9)研究的目的是探讨姜黄提取物对症状性、膝关节骨性关节炎和膝关节渗出性滑膜炎的疗效。这项单中心研究招募了70名参与者，连续12周，每天2粒姜黄提取物或安慰剂。12周后，与安慰剂相比，姜黄提取物改善视觉模拟疼痛（VAS）评分的幅度为-9.1mm（P = 0.039），但没有改变渗出性滑膜炎体积（3.2mL）。姜黄提取物还可改善WOMAC膝关节疼痛评分（P = 0.006），但没有改善MRI腓骨外侧软骨T2松弛时间（−0.4 ms）。两组不良事件发生率相似（P = 0.16）结论：对于膝关节疼痛，姜黄提取物比安慰剂更有效，但不影响膝关节渗出性滑膜炎或软骨成分。需要更大样本量的多中心试验来评估这些发现的临床意义。痛风痛风是尿酸单钠结晶沉积病，其生化特点是细胞外液尿酸盐浓度达到饱和，血液中表现为高尿酸血症，即血尿酸盐浓度超过400μmol/L，该水平接近于尿酸盐的溶解度极限。痛风的临床表现包括：炎症性关节炎的反复发作、慢性关节病、尿酸盐结晶累积形成痛风石沉积、尿酸性肾结石等。急性期止痛，可以使用全身或关节内糖皮质激素、NSAID、秋水仙碱，难治性痛风发作可尝试使用抑制IL-1β的生物制剂（欧盟已批准卡那单抗治疗难治性痛风发作）。缓解期降尿酸，可以使用别嘌醇、非布司他、丙磺舒、苯溴马龙或聚乙二醇重组尿酸酶。《FAST研究：非布司他与别嘌醇在痛风患者中的长期心血管安全性》LANCET，2020年11月 (10)这项前瞻性、随机、开放、非劣效研究，纳入≥60岁、已经接受别嘌醇治疗的、合并心血管危险因素的患者，共6128人。患者平均年龄71岁，85%为男性，33.4%有心血管疾病病史。被随机分配别嘌醇或非布司他治疗，中位随访时间为1467天。在非致死性心梗或急性冠脉综合征住院的发生率方面，非布司他为1·72次/100人年，低于别嘌醇2·05次/100人年（风险比 0·85，p
An Author Interview with Dr. Daniel Riddle and Dr. Robert Perera.
Fox MT et al. Comparative effectiveness of antibiotic treatment duration in children with pyelonephritis. JAMA Netw vOpen 2020 May 1; 3:e203951. (https://doi.org/10.1001/jamanetworkopen.2020.3951) Rates of treatment failure did not differ significantly between the short and prolonged courses (11.2% and 9.4%). https://jamanetwork.com/journals/jama/fullarticle/2765729?guestAccessKey=2169ba8b-43fc-4360-bed7-acf7a31b1c9d&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=etoc&utm_term=051220 Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis: The BIOTOK Randomized Clinical Trial In jama may 12 – look to see if special biomechanical footwear could help osteoarthirits knee pain- At 24 weeks of follow-up, the mean standardized WOMAC pain subscore improved from 4.3 to 1.3 in the biomechanical footwear group and from 4.0 to 2.6 in the control footwear group (between-group difference in scores at 24 weeks of follow-up, −1.3 [95% CI, −1.8 to −0.9]; P
Sergeant Mark Green served in the U.S. Army National Guard for 12 years. On his last deployment and upon his return home he was transitioned to the Army Warrior Transition Battalion where he underwent two surgeries and began his recovery. Encouraged to get up and out of his room by his cadre, Green began going to adaptive sports activities and was introduced to not only adaptive cycling, but now, Run For The Warriors Race Director, Robyn Womac, who at the time was the adaptive sports coordinator for the Battalion. Handcycling quickly became his outlet where he didn’t feel limited by his disability and gave him the opportunity to socialize. When he was faced with the news of having another surgery, Green was worried that he would have to give up his newfound passion. This was a fear Womac wouldn’t allow him to have. Not even a month after surgery, Womac moved Green from a recumbent bike to a handcycle that allowed him to still remain active despite his cast. Hope For The Warriors Details ___ Hope For The Warriors, a national nonprofit dedicated to restoring a sense of self, family and hope for veterans, service members and military families. For more than 12 years, Hope For The Warriors has continued to provide a full cycle of care through many programs to restore self, family, and hope to post-9/11 service members, their families, and families of the fallen across the country. Since its inception, Hope For The Warriors has served more than 23,200 service members, veterans and military families through a comprehensive approach to well-being focusing on, clinical health and wellness sports and recreation transition In 2018, Hope For The Warriors processed more than 4,200 applicants for assistance. 58 percent of the veterans separated from the service within the last 6 or more years. 70 percent of those applicants were servicemembers or veterans, 30 percent were military spouses, caregivers or family members. If Hope For The Warriors does not have a program that meets a specific need, we connect with one of our partners. Clinical Health and Wellness:Provides a holistic, person-centered approach in addressing the physical, psychological, social, moral, and environmental needs of the service member, their family, and families of the fallen. Programs: Critical Care Coordination Comprehensive Case Management Military and Veteran Caregiver Support Services Family Resiliency Services Sports and Recreation:Reintroduces a loved sport or hobby with an emphasis on organic healing or gives the opportunity to gain new skills with the use of adaptive equipment to assist in physical and psychological recovery. Programs: Outdoor Adventures Run For The Warriors® Team Hope For The Warriors® Transition Services:Supports the career, educational, and personal goals of service members, veterans, and their family members as they experience the many military transitions. Programs: A Warrior’s Wish® Warrior’s Compass Military Spouse and Caregiver Scholarships Accolades: Hope For The Warriors is a part of the Combined Federal Campaign, designated as a “Best in America” by the Independent Charities of America, and accredited by the Better Business Bureau’s Wise Giving Alliance. Hope For The Warriors has earned a four-star rating from Charity Navigator for superior overall performance as an organization eight years in a row, has a 2019 Guidestar Gold Seal of Transparency and has been designated a top-rated charity by Great Nonprofits. For more information on Hope For The Warriors visit hopeforthewarriors.org
Among the many things you could find remarkable about Arwen Podesta and there are plenty perhaps the singularly most impressive is the fact there is a part of your body named after her. There is a part of everybody s body name after her. It s in your DNA. Arwen was a part of the Human Genome Project the folks who mapped the human genome and as a result there is a human gene named after her, called AR 1. It is an interluken atagonist interceptor, which at one point might have turned out to be the key to curing cancer. On top of that minor detail, Arwen is also a psychiatrist who started out life as the daughter of a father who was and is a massage therapist. Arwen went into the family business, mutated from massage to medicine to clinical superstar, to leading authority on addiction and author of the book, Hooked. Genevieve Douglass s grandfather was an Admiral in the Navy. Yes, an Admiral. Somehow he ended up in New Orleans, Genevieve s dad went to Tulane law and has a standalone practice in Kenner where he s, 30 years later, still looking for a slogan to compete with Putting the Womac on em and One Call That s All. Genevieve who, by the way is a Sagittarius is equally entrepreneurial. She is the marketing mastermind at entrepreneurial consultant firm Trepwise, and the creative force behind a great business idea, called Kindred, which was a mother child wellness and fun spot. Now it s a place to get your hair blown out, and that s another entrepreneurial story. Dustan Louque s life story has the greatest opening line of any singer songwriter, ever. "I grew up in a town where there was no music." In a small town in St James Parish called Grand Point Pop 500 Dustan was the first person ever to play music. Ever. In the mid 90 s, the sounds of Alternative rock, played by the likes of Depeche Mode, filtered into Dustan s bedroom courtesy of New Orleans radio station The Zephyr, and inspired Dustan to play music. Ultimately he moved to New York, got signed by Atlantic records, then turned his back on fame and the music industry and lived anonymously in the Bywater for 7 years, before re finding himself and choosing to play music in small venues across the country. On this show Dustan plays a song inspired by the day Lou Reed died, 10 27 13 the one magical day we were all hipsters listening The Velvet Underground. Photos at Wayfare by Jill Lafleur.
The association between preoperative tibial subchondral bone marrow lesion (BML) patterns and outcomes after isolated meniscus allograft transplantation (MAT) are unknown. The purpose of this study was to determine (1) if a superior classification means exists (ie, high interrater reliability [IRR]) for grading tibial subchondral BML before isolated MAT and (2) whether quality and/or severity of preoperative tibial subchondral BML patterns was associated with clinical outcomes and/or failure rates after isolated MAT. Nearly two-thirds of patients who undergo isolated MAT have subchondral BML on preoperative MRI. Our findings suggest that increasing BML size (Welsch et al) is correlated with worse postoperative pain measures (KOOS pain, WOMAC pain) and worse activity ratings (Marx Activity Rating Scale). Additionally, increasing disruption or depression of the normal contour of the cortical surface, with or without lesion contiguity with the subjacent articular surface (Costa-Paz et al), is correlated with greater postoperative satisfaction. Click here to read the article.
Anwer, S., Alghadir, A., & Brismee, J. (2016). Effect of Home Exercise Program in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. Journal of Geriatric Physical Therapy, 39(1), January-March 2016, 38-48. "The Osteoarthritis Research Society International recommended that non-pharmacological methods include patient education programs, weight reduction, coping strategies, and exercise programs for the management of knee osteoarthritis (OA). However, neither a systematic review nor a meta-analysis has been published regarding the effectiveness of home exercise programs for the management of knee OA." "The purpose of this systematic review was to examine the evidence regarding the effect of home exercise programs with and without supervised clinic-based exercises in the management of knee OA." Questions or comments? Find me here: Twitter: @jdaniels_SPT Facebook: Joe Daniels Email: jd2012@nova.edu Enjoy! -------------------- If you like what you hear, consider Joining the Senior Rehab Project to get access to: Monthly Mastermind Meetup Newsletter Private FB Group Go to http://SeniorRehabProject.com/JOIN *This podcast is sponsored by GREAT Seminars And Books. As a fan of SRP, YOU can get $25 off by using promo code: SRP25 at SeniorRehabProject.com/GREAT
The Executive Director of the Specialty Family Foundation, Joe Womac, joins Dr. Tim Uhl on the "Catholic School Matters" podcast to discuss their involvement with Catholic schools in Los Angeles. #catholicschoolmatters
Debemos considerar la flexibilidad como una herramienta para mejorar patrones de movimiento. Destacamos varios tipos de estiramientos: ESTIRAMIENTO ESTÁTICO En los estiramientos estáticos debes mantener la posición final de estiramiento durante al menos 15-20 segundos, aunque en algunos casos necesitas al menos un minuto para que el tejido sufra modificaciones relevantes. El estiramiento debe ser incómodo, pero no doloroso. Si notas dolor, reduce la presión que aplicas. Al estirar debes estar relajado, respirando normalmente y sin hacer gestos de dolor. El sistema límbico, que controla las emociones, está íntimamente ligado con el sistema neuronal que controla la longitud y tensión muscular. Resultado práctico: si tienes ansiedad o estás intranquilo, tu flexibilidad se ve impactada. ESTIRAMIENTO DINÁMICO Los estiramientos dinámicos, como su nombre indica, pretenden mejorar la flexibilidad del músculo en movimiento. incluyen cosas como giros de cuello y brazos, desplantes, correr en el sitio. FACILITACIÓN NEUROMUSCULAR PROPIOCEPTIVA (FNP) El FNP parte de la misma base que el estiramiento estático, pero incorpora el conocimiento sobre el funcionamiento de tu cerebro. consiste en contraer un músculo que estás estirando. Cuando tu sistema nervioso detecta tu contracción voluntaria inhibe el reflejo de estiramiento. Interpreta que lo tienes todo bajo control y se relaja. En este momento, cuando tu cerebro deja de vigilar el músculo, liberas la contracción y lo estiras un poco más. Beneficios de una buena flexibilidad • Mejora tu postura • Aumenta el rango de movimiento de tus articulacioens • Previene lesiones • Facilita el riego sanguíneo de los músculos. • Relaja el cuerpo y la mente. • Te libera del estrés. • Mejora tu rendimiento deportivo. ¿Cuándo debemos estirar? Lo ideal es que antes de hacer deporte, realices estiramientos dinámicos para calentar mejor tu musculatura. Sobre todo hacer estiramientos dinámicos de las zonas que vas a utilizar. Adicionalmente, tras el entrenamiento es ideal hacer estiramientos FNP y en estático para ayudar a relajar la musculatura. Relación entre alimentos y la flexibilidad La salud de músculos y articulaciones tiene una influencia directa en la flexibilidad y, según nutricionistas de la University of Hawaii, la ingesta de vitaminas puede incidir en el tema. Seguir una dieta equilibrada y saludable puede aportarte todas las vitaminas que tus músculos y articulaciones necesitan para mantenerse saludables y flexibles. La flexibilidad es una cualidad que en muchos casos está determinada por la genética y la predisposición que nuestro organismo tiene para adquirirla mediante la práctica. Pero existen otras variables que la determinarán, por ejemplo la alimentación ocupa un papel importante. Como ya sabemos los alimentos son un aliado de nuestro organismo para conseguir mejorarlo y reforzar algunas partes del mismo. En el caso de las articulaciones y los músculos es importante que éstos reciban la dosis de nutrientes que necesitan para funcionar. Muchos alimentos nos las aportan, y además contribuyen a que las fibras sean más flexibles y capaces de estirarse, aumentando de esta manera la flexibilidad general del cuerpo. Vitaminas importantes para nuestros músculos La vitamina D y el calcio trabajan juntos para proteger las articulaciones y aumentar la fuerza ósea, y en ambos casos se mejora la flexibilidad. La vitamina D a menudo se agrega a productos lácteos, como la leche y el yogur, y está presente en el pescado y los aceites de pescado. Tu cuerpo también produce vitamina D cuando la piel se expone a la luz solar. La vitamina B3, o niacina, se encuentra en el atún (tuna), los hongos, los mariscos, el tofu y las semillas de girasol. La vitamina B5, o ácido pantoténico, se puede obtener en alimentos tales como huevos, porotos de soja, germen de trigo, cereales integrales, lentejas y cacahuetes. La vitamina B6 está presente en las carnes, el pescado, los frutos secos, las legumbres y los plátanos. Según la University of Hawaii, la vitamina C es "esencial para la producción de proteínas específicas que forman parte del cartílago de las articulaciones" y puede ser "un nutriente especialmente importante para la salud articular". Entre los alimentos ricos en vitamina C se incluyen el brócoli, la col, el melón, la coliflor, los cítricos, los vegetales de hojas verdes, los mangos, el pimiento rojo, la espinaca y las fresas. La University of Hawaii informa que, al igual que la vitamina C, la vitamina E contiene antioxidantes que, según algunos investigadores, mejoran la salud articular. La vitamina E puede aliviar los calambres en las piernas y el dolor asociado con la artrosis al reducir la inflamación. Los alimentos naturalmente ricos en vitamina E son frutos secos tales como las almendras, las avellanas, las nueces, las semillas de girasol y las semillas de cártamo; cereales integrales como el germen de trigo y la harina de trigo integral, los vegetales de hojas verde oscuro como la acelga, la mostaza castaña y los grelos; y los aguacates. Principalmente debemos ingerir alimentos que permitan un correcto drenaje de las articulaciones, evitando la retención de líquidos y la inflamación de estas zonas, ya que si esto se produce nuestra movilidad se verá reducida enormemente. Algunos alimentos que nos ayudan a mejorar el drenaje corporal son frutas y verduras como la piña, la sandía, el melón... que tienen efectos diuréticos que a la larga se acaban notando en la disminución de la retención de líquidos del organismo. La inflamación articular es otro problema que afecta directamente a la flexibilidad. Para evitar la inflamación en las articulaciones debemos ingerir alimentos antiinflamatorios. Un ejemplo son los ácidos grasos omega-3 que encontramos en pescados azules como el salmón o el atún, y que ayudan a mejorar el estado de las articulaciones. Lo mismo sucede con algunas especias que debemos utilizar en la elaboración de nuestras comidas. Algunas como el curry son destacables, debido a su alto contenido en cúrcuma, un componente que podría intervenir en la conservación del cartílago. Otras plantas como el jengibre o la cebolla contienen efectos antiinflamatorios que nos ayudan a mejorar el estado de las articulaciones y aumentar así su predisposición a ser más flexibles. En el caso de la cebolla contiene altas dosis de zinc y selenio que mejoran los tejidos corporales y la conectividad de los mismos, aumentando así su movilidad. Alimentos y plantas que tienen efectos antiinflamatorios: https://www.ivoox.com/91-alimentos-plantas-tienen-efectos-antiinflamatorios-audios-mp3_rf_16174742_1.html Referencias: Fitness revolucionario Myfitness.com • University of Hawaii at Manoa, ATC: Easy Stretch to Maintain Flexibility (University of Hawaii en Manoa, ATC: estiramientos simples para mantener la flexibilidad) • Arthritis Treatment and Relief: Foods or Vitamins that Help with Joint Pain (Arthritis Treatment and Relief: alimentos y vitaminas que alivian el dolor articular) • Alive: Healing Muscles and Joints (Alive: cómo sanar músculos y articulaciones) • Dynamic Chiropractic: A Quick Review of Vitamin Toxicity (Dynamic Chiropractic: A Quick Review of Vitamin Toxicity: revisión rápida de la toxicidad de las vitaminas) • Colorado State University Extension: Fat Soluble Vitamins (Colorado State University Extension: vitaminas solubles en grasa) Eficacia y tolerancia de un condroprotector oral a base de ácido hialurónico y colágeno hidrolizado sobre la funcionalidad articular en individuos activos con artrosis de rodilla Introducción Se estudió la eficacia y la tolerancia de la administración diaria de un condroprotector oral conteniendo ácido hialurónico (AH) y colágeno hidrolizado (HC) sobre la funcionalidad articular, y el dolor asociado, en individuos activos afectos de osteoartrosis de rodilla. Material y métodos Se realizó un estudio piloto exploratorio en fase IV, multicéntrico, abierto y no comparativo. Se incluyeron 108 sujetos afectos de osteoartrosis de rodilla que realizaban actividad física diaria. Se les administró, durante 90 días consecutivos, un vial oral con 7 g de HC y 25 mg de AH. La evaluación clínica de la funcionalidad articular y del dolor se realizó utilizando el índice WOMAC para incapacidad funcional y rigidez, una escala analógica visual (EAV) para dolor, y la opinión del médico y el paciente. Resultados La evolución de la escala WOMAC, en sus componentes de incapacidad funcional y rigidez, mostró un progresivo descenso a partir de la visita inicial (p < 0,01). Paralelamente, se produjo una disminución del dolor articular desde el inicio del tratamiento (p < 0,01). Se observó un aumento de la eficacia en las sucesivas visitas. La tolerancia al tratamiento fue valorada positivamente durante todo el estudio. Conclusiones La administración oral de un suplemento diario de AH y HC durante 90 días consecutivos es eficaz, mejorando la capacidad funcional de la articulación y disminuyendo el dolor en individuos activos con gonartrosis. El valor medio de todos los parámetros de eficacia a lo largo de las diferentes visitas indicó una clara mejoría durante todo el estudio. El tratamiento fue bien tolerado. REVISIÓN DE LOS EFECTOS BENEFICIOSOS DE LA INGESTA DE COLÁGENO HIDROLIZADO SOBRE LA SALUD OSTEOARTICULAR Y EL ENVEJECIMIENTO DÉRMICO Se obtiene de la gelatinización y posterior hidrólisis enzimática de colágeno nativo procedente de tejidos animales ricos en esta proteína. Existe abundante evidencia científica sobre el efecto positivo que la toma de CH ejerce sobre las patologías osteoarticulares degenerativas y el envejecimiento dérmico. Objetivo: revisar los estudios científicos existentes actualmente sobre el CH y evaluar su acción terapéutica sobre algunos tejidos colaginosos como cartílagos, huesos y piel. Resultados: hasta la fecha se han realizado más de 60 estudios científicos (in vitro, in vivo, clínicos y de biodisponibilidad) sobre la efectividad del CH a la hora de reducir las consecuencias del deterioro y pérdida de colágeno tisular como son el dolor y el desgaste articular (artrosis), la pérdida de masa ósea (osteoporosis) y el envejecimiento dérmico. Conclusiones: los estudios preclínicos indican que el CH estimula la regeneración de los tejidos colaginosos, potenciando la síntesis de colágeno tisular y también de los restantes componentes minoritarios de dichos tejidos (proteoglicanos y ácido hialurónico). Los estudios clínicos demuestran que la ingesta continuada de CH ayuda a reducir el dolor articular de desgaste, a ralentizar la pérdida de masa ósea y a atenuar los signos de envejecimiento dérmico. Estos resultados, junto con su alto nivel de seguridad y tolerancia, hacen del CH un suplemento adecuado para tomar a largo plazo, indicado para prevenir y tratar enfermedades crónicas degenerativas (artrosis y osteoporosis), así como para prevenir y atenuar el envejecimiento dérmico. Conclusiones Adecuadamente obtenido y presentado, el CH es una excelente fuente de AA de muy buena tolerancia, digestibilidad y biodisponibilidad. Tomar 10 gramos diarios de CH estimula y facilita la síntesis de colá- geno tisular y, por lo tanto, ayuda a potenciar la regeneración de los tejidos colaginosos, previniendo y tratando las enfermedades degenerativas que afectan a los mismos (artrosis y osteoporosis) y también el deterioro dérmico. Todo ello viene respaldado por los resultados de los estudios expuestos anteriormente y por recopilaciones de los mismos24,30,44,49. Debido a su funcionalidad de salud, los grupos de población para los que el CH está especialmente indicado son los que tienen mayor riesgo de deterioro (o ya lo padecen) de los tejidos colaginosos, bien sea debido a la edad (en general, a partir de los 40 años), al sobreuso (deporte y actividad física intensa) o a otras circunstancias (sobrepeso, menopausia, traumatismos, quemaduras, intervenciones quirúrgicas, implantes dérmicos o dentales, tratamientos oncológicos agresivos…). Sería conveniente realizar más estudios para determinar el efecto de la ingesta de CH en otros tejidos en donde el colágeno también es un componente esencial (vasos sanguíneos, fascias, mucosas, córnea ocular, dientes y encías), así como para determinar la repercusión de dicha ingesta en funciones propias de la proteína de colágeno distintas a las locomotoras (inmunológicas y hemodinámicas). Colágeno asimilable. Fuente de prevención de enfermedades osteoarticuladas El colágeno es la proteína más abundante de nuestro cuerpo humano y uno de sus componentes esencial de articulaciones, cartílago, ligamento, tendones, huesos, piel. Su especial estructura lo hacen único, presenta una estructura fibrosa, que aporta gran resistencia y flexibilidad a los tejidos de los que forma parte. Cuando este colágeno se degrada, origina diversas e importantes alteraciones en el organismo: artrosis, osteoporosis y la aparición de flacidez y arrugas dérmicas. La degradación del colágeno tisular normalmente está asociada a la edad, pero también puede darse en personas jóvenes por sobreuso (práctica intensiva de deporte, sobrepeso o cargar pesos), por traumatismos o por inactividad. Los estudios científicos indican que tomar 10 gramos diarios de colágeno hidrolizado ayuda a reducir el dolor articular de desgaste, la pérdida de masa ósea y el envejecimiento dérmico. Método: Todos los datos que se utilizan en este estudio, se obtuvieron vía Internet de la literatura científica recogida en las bases de datos MEDLINE, LILACS (incluyendo SciELO) y la Cochrane Library. Objetivos: Aumentar el aporte de colágeno asimilable de una forma progresiva y eficaz.Disminuir los problemas debido a la pérdida de colágeno. Conclusiones: La introducción en nuestra dieta de colágeno asimilable debería de hacerse de una manera progresiva y habitual. Dicha introducción de colágeno favorecerá de una forma eficaz la reducción de los dolores articulares propios de la edad adulta, la perdida de masa ósea y el envejecimiento dérmico, con la consiguiente mejora de nuestra calidad de vida. Introducción: El colágeno es la proteína más abundante de nuestro cuerpo humano y uno de sus componentes esencial de articulaciones, cartílago, ligamento, tendones, huesos, piel. Su especial estructura lo hacen único, presenta una estructura fibrosa, que aporta gran resistencia y flexibilidad a los tejidos de los que forma parte. Cuando este colágeno se degrada, origina diversas e importantes alteraciones en el organismo: artrosis, osteoporosis y la aparición de flacidez y arrugas dérmicas. La degradación del colágeno tisular normalmente está asociada a la edad, pero también puede darse en personas jóvenes por sobreuso (práctica intensiva de deporte, sobrepeso o cargar pesos), por traumatismos o por inactividad. El colágeno hidrolizado es una mezcla de péptidos con un PM entre 2.000 y 5.000 Da. Procede de la gelatinización y posterior hidrólisis enzimática del colágeno nativo animal. Via oral el Colageno hidrolizado contribuye eficazmente a la nutrición y generación de los tejidos colaginosos, ayudando a reducir, prevenir y ralentizar su deterioro. Los estudios científicos indican que tomar 10 gramos diarios de colágeno hidrolizado ayuda a reducir el dolor articular de desgaste, la pérdida de masa ósea y el envejecimiento dérmico. Método: Todos los datos que se utilizan en este estudio, se obtuvieron vía Internet de la literatura científica recogida en las bases de datos MEDLINE, LILACS (incluyendo SciELO) y la Cochrane Library. Objetivos: Aumentar el aporte de colágeno asimilable de una forma progresiva y eficaz.Disminuir los problemas debido a la pérdida de colágeno. Conclusiones: La introducción en nuestra dieta de colágeno asimilable debería de hacerse de una manera progresiva y habitual. Dicha introducción de colágeno favorecerá de una forma eficaz la reducción de los dolores articulares propios de la edad adulta, la perdida de masa ósea y el envejecimiento dérmico, con la consiguiente mejora de nuestra calidad de vida. Eficacia y seguridad de un tratamiento oral a base de mucopolisacáridos, colágeno tipo I y vitamina C en pacientes con tendinopatías Introducción y objetivos La tendinopatía es una lesión frecuente durante la práctica deportiva que cursa con una alteración estructural del tendón. El objetivo de este estudio fue evaluar la eficacia y la seguridad de un complemento alimentario a base de mucopolisacáridos, colágeno tipo I y vitamina C (Tendoactive®) sobre la evolución clínica y estructural de las tendinopatías del tendón de Aquiles, rotuliano y del epicóndilo lateral del codo. Material y métodos Se realizó un estudio multicéntrico prospectivo, de tipo exploratorio en fase IV, abierto y no comparativo. Se incluyeron un total de 98 pacientes con tendinopatías (32 de Aquiles, 32 de rotuliano y 34 del epicóndilo lateral) que recibieron una dosis diaria de 435 mg de mucopolisacáridos, 75 mg de colágeno tipo I y 60 mg de vitamina C (equivalente a 3 cápsulas al día de Tendoactive®) durante 90 días consecutivos. Mensualmente se evaluó el dolor en reposo y en actividad mediante una escala visual analógica (EVA), la función articular mediante los cuestionarios VISA-A, VISA-P y PRTEE, y se caracterizó ecográficamente el tendón afectado. Los mucopolisacáridos son cadenas largas de moléculas de azúcar que se encuentran a lo largo de todo el cuerpo, a menudo en las mucosidades y en el líquido alrededor de las articulaciones Resultados En los 3 tipos de tendinopatía se registró una reducción significativa del dolor tanto en reposo como en actividad desde la primera visita de control (día 30) hasta el final del estudio (día 90). Asimismo el día 90 se detectó una mejora del 38% en VISA-A, del 46% en VISA-P y del 77% en PRTEE (p < 0,001). Simultáneamente se registró una reducción del 12% en el grosor del tendón de Aquiles, del 10% en el rotuliano y del 20% en el tendón del epicóndilo lateral (p < 0,05). Conclusiones Los resultados del estudio indican que la administración de Tendoactive® es segura y eficaz para mejorar los síntomas clínicos y la evolución estructural de las tendinopatías del tendón de Aquiles, tendón rotuliano y tendón del epicóndilo lateral. Gracias de nuevo, hasta el siguiente episodio. Podcast de salud, nutrición y bienestar en Ivoox. Podcast de Tulcop Trade e Internacionalfarma. Patrocinador de colágenos: http://tulcoptrade.com/ Web: https://www.internacionalfarma.com/ Canal de Soundcloud: https://soundcloud.com/user-837726583 Canal de Youtube: https://www.youtube.com/channel/UCl16xs1I8oHKthSeZUEOEnw Página de Google Plus: https://plus.google.com/communities/105557399913056882293 Grupo de Facebook: https://www.facebook.com/groups/parafarmaciasalud/
Eficacia y tolerancia de un condroprotector oral a base de ácido hialurónico y colágeno hidrolizado sobre la funcionalidad articular en individuos activos con artrosis de rodilla Introducción Se estudió la eficacia y la tolerancia de la administración diaria de un condroprotector oral conteniendo ácido hialurónico (AH) y colágeno hidrolizado (HC) sobre la funcionalidad articular, y el dolor asociado, en individuos activos afectos de osteoartrosis de rodilla. Material y métodos Se realizó un estudio piloto exploratorio en fase IV, multicéntrico, abierto y no comparativo. Se incluyeron 108 sujetos afectos de osteoartrosis de rodilla que realizaban actividad física diaria. Se les administró, durante 90 días consecutivos, un vial oral con 7 g de HC y 25 mg de AH. La evaluación clínica de la funcionalidad articular y del dolor se realizó utilizando el índice WOMAC para incapacidad funcional y rigidez, una escala analógica visual (EAV) para dolor, y la opinión del médico y el paciente. Resultados La evolución de la escala WOMAC, en sus componentes de incapacidad funcional y rigidez, mostró un progresivo descenso a partir de la visita inicial (p < 0,01). Paralelamente, se produjo una disminución del dolor articular desde el inicio del tratamiento (p < 0,01). Se observó un aumento de la eficacia en las sucesivas visitas. La tolerancia al tratamiento fue valorada positivamente durante todo el estudio. Conclusiones La administración oral de un suplemento diario de AH y HC durante 90 días consecutivos es eficaz, mejorando la capacidad funcional de la articulación y disminuyendo el dolor en individuos activos con gonartrosis. El valor medio de todos los parámetros de eficacia a lo largo de las diferentes visitas indicó una clara mejoría durante todo el estudio. El tratamiento fue bien tolerado. REVISIÓN DE LOS EFECTOS BENEFICIOSOS DE LA INGESTA DE COLÁGENO HIDROLIZADO SOBRE LA SALUD OSTEOARTICULAR Y EL ENVEJECIMIENTO DÉRMICO Se obtiene de la gelatinización y posterior hidrólisis enzimática de colágeno nativo procedente de tejidos animales ricos en esta proteína. Existe abundante evidencia científica sobre el efecto positivo que la toma de CH ejerce sobre las patologías osteoarticulares degenerativas y el envejecimiento dérmico. Objetivo: revisar los estudios científicos existentes actualmente sobre el CH y evaluar su acción terapéutica sobre algunos tejidos colaginosos como cartílagos, huesos y piel. Resultados: hasta la fecha se han realizado más de 60 estudios científicos (in vitro, in vivo, clínicos y de biodisponibilidad) sobre la efectividad del CH a la hora de reducir las consecuencias del deterioro y pérdida de colágeno tisular como son el dolor y el desgaste articular (artrosis), la pérdida de masa ósea (osteoporosis) y el envejecimiento dérmico. Conclusiones: los estudios preclínicos indican que el CH estimula la regeneración de los tejidos colaginosos, potenciando la síntesis de colágeno tisular y también de los restantes componentes minoritarios de dichos tejidos (proteoglicanos y ácido hialurónico). Los estudios clínicos demuestran que la ingesta continuada de CH ayuda a reducir el dolor articular de desgaste, a ralentizar la pérdida de masa ósea y a atenuar los signos de envejecimiento dérmico. Estos resultados, junto con su alto nivel de seguridad y tolerancia, hacen del CH un suplemento adecuado para tomar a largo plazo, indicado para prevenir y tratar enfermedades crónicas degenerativas (artrosis y osteoporosis), así como para prevenir y atenuar el envejecimiento dérmico. Conclusiones Adecuadamente obtenido y presentado, el CH es una excelente fuente de AA de muy buena tolerancia, digestibilidad y biodisponibilidad. Tomar 10 gramos diarios de CH estimula y facilita la síntesis de colá- geno tisular y, por lo tanto, ayuda a potenciar la regeneración de los tejidos colaginosos, previniendo y tratando las enfermedades degenerativas que afectan a los mismos (artrosis y osteoporosis) y también el deterioro dérmico. Todo ello viene respaldado por los resultados de los estudios expuestos anteriormente y por recopilaciones de los mismos24,30,44,49. Debido a su funcionalidad de salud, los grupos de población para los que el CH está especialmente indicado son los que tienen mayor riesgo de deterioro (o ya lo padecen) de los tejidos colaginosos, bien sea debido a la edad (en general, a partir de los 40 años), al sobreuso (deporte y actividad física intensa) o a otras circunstancias (sobrepeso, menopausia, traumatismos, quemaduras, intervenciones quirúrgicas, implantes dérmicos o dentales, tratamientos oncológicos agresivos…). Sería conveniente realizar más estudios para determinar el efecto de la ingesta de CH en otros tejidos en donde el colágeno también es un componente esencial (vasos sanguíneos, fascias, mucosas, córnea ocular, dientes y encías), así como para determinar la repercusión de dicha ingesta en funciones propias de la proteína de colágeno distintas a las locomotoras (inmunológicas y hemodinámicas). Colágeno asimilable. Fuente de prevención de enfermedades osteoarticuladas El colágeno es la proteína más abundante de nuestro cuerpo humano y uno de sus componentes esencial de articulaciones, cartílago, ligamento, tendones, huesos, piel. Su especial estructura lo hacen único, presenta una estructura fibrosa, que aporta gran resistencia y flexibilidad a los tejidos de los que forma parte. Cuando este colágeno se degrada, origina diversas e importantes alteraciones en el organismo: artrosis, osteoporosis y la aparición de flacidez y arrugas dérmicas. La degradación del colágeno tisular normalmente está asociada a la edad, pero también puede darse en personas jóvenes por sobreuso (práctica intensiva de deporte, sobrepeso o cargar pesos), por traumatismos o por inactividad. Los estudios científicos indican que tomar 10 gramos diarios de colágeno hidrolizado ayuda a reducir el dolor articular de desgaste, la pérdida de masa ósea y el envejecimiento dérmico. Método: Todos los datos que se utilizan en este estudio, se obtuvieron vía Internet de la literatura científica recogida en las bases de datos MEDLINE, LILACS (incluyendo SciELO) y la Cochrane Library. Objetivos: Aumentar el aporte de colágeno asimilable de una forma progresiva y eficaz.Disminuir los problemas debido a la pérdida de colágeno. Conclusiones: La introducción en nuestra dieta de colágeno asimilable debería de hacerse de una manera progresiva y habitual. Dicha introducción de colágeno favorecerá de una forma eficaz la reducción de los dolores articulares propios de la edad adulta, la perdida de masa ósea y el envejecimiento dérmico, con la consiguiente mejora de nuestra calidad de vida. Introducción: El colágeno es la proteína más abundante de nuestro cuerpo humano y uno de sus componentes esencial de articulaciones, cartílago, ligamento, tendones, huesos, piel. Su especial estructura lo hacen único, presenta una estructura fibrosa, que aporta gran resistencia y flexibilidad a los tejidos de los que forma parte. Cuando este colágeno se degrada, origina diversas e importantes alteraciones en el organismo: artrosis, osteoporosis y la aparición de flacidez y arrugas dérmicas. La degradación del colágeno tisular normalmente está asociada a la edad, pero también puede darse en personas jóvenes por sobreuso (práctica intensiva de deporte, sobrepeso o cargar pesos), por traumatismos o por inactividad. El colágeno hidrolizado es una mezcla de péptidos con un PM entre 2.000 y 5.000 Da. Procede de la gelatinización y posterior hidrólisis enzimática del colágeno nativo animal. Via oral el Colageno hidrolizado contribuye eficazmente a la nutrición y generación de los tejidos colaginosos, ayudando a reducir, prevenir y ralentizar su deterioro. Los estudios científicos indican que tomar 10 gramos diarios de colágeno hidrolizado ayuda a reducir el dolor articular de desgaste, la pérdida de masa ósea y el envejecimiento dérmico. Método: Todos los datos que se utilizan en este estudio, se obtuvieron vía Internet de la literatura científica recogida en las bases de datos MEDLINE, LILACS (incluyendo SciELO) y la Cochrane Library. Objetivos: Aumentar el aporte de colágeno asimilable de una forma progresiva y eficaz.Disminuir los problemas debido a la pérdida de colágeno. Conclusiones: La introducción en nuestra dieta de colágeno asimilable debería de hacerse de una manera progresiva y habitual. Dicha introducción de colágeno favorecerá de una forma eficaz la reducción de los dolores articulares propios de la edad adulta, la perdida de masa ósea y el envejecimiento dérmico, con la consiguiente mejora de nuestra calidad de vida. Eficacia y seguridad de un tratamiento oral a base de mucopolisacáridos, colágeno tipo I y vitamina C en pacientes con tendinopatías Introducción y objetivos La tendinopatía es una lesión frecuente durante la práctica deportiva que cursa con una alteración estructural del tendón. El objetivo de este estudio fue evaluar la eficacia y la seguridad de un complemento alimentario a base de mucopolisacáridos, colágeno tipo I y vitamina C (Tendoactive®) sobre la evolución clínica y estructural de las tendinopatías del tendón de Aquiles, rotuliano y del epicóndilo lateral del codo. Material y métodos Se realizó un estudio multicéntrico prospectivo, de tipo exploratorio en fase IV, abierto y no comparativo. Se incluyeron un total de 98 pacientes con tendinopatías (32 de Aquiles, 32 de rotuliano y 34 del epicóndilo lateral) que recibieron una dosis diaria de 435 mg de mucopolisacáridos, 75 mg de colágeno tipo I y 60 mg de vitamina C (equivalente a 3 cápsulas al día de Tendoactive®) durante 90 días consecutivos. Mensualmente se evaluó el dolor en reposo y en actividad mediante una escala visual analógica (EVA), la función articular mediante los cuestionarios VISA-A, VISA-P y PRTEE, y se caracterizó ecográficamente el tendón afectado. Los mucopolisacáridos son cadenas largas de moléculas de azúcar que se encuentran a lo largo de todo el cuerpo, a menudo en las mucosidades y en el líquido alrededor de las articulaciones Resultados En los 3 tipos de tendinopatía se registró una reducción significativa del dolor tanto en reposo como en actividad desde la primera visita de control (día 30) hasta el final del estudio (día 90). Asimismo el día 90 se detectó una mejora del 38% en VISA-A, del 46% en VISA-P y del 77% en PRTEE (p < 0,001). Simultáneamente se registró una reducción del 12% en el grosor del tendón de Aquiles, del 10% en el rotuliano y del 20% en el tendón del epicóndilo lateral (p < 0,05). Conclusiones Los resultados del estudio indican que la administración de Tendoactive® es segura y eficaz para mejorar los síntomas clínicos y la evolución estructural de las tendinopatías del tendón de Aquiles, tendón rotuliano y tendón del epicóndilo lateral. Gracias de nuevo, hasta el siguiente episodio. Podcast de salud, nutrición y bienestar en Ivoox. Podcast de Tulcop Trade e Internacionalfarma. Patrocinador de colágenos: http://tulcoptrade.com/ Web: https://www.internacionalfarma.com/ Canal de Soundcloud: https://soundcloud.com/user-837726583 Canal de Youtube: https://www.youtube.com/channel/UCl16xs1I8oHKthSeZUEOEnw Página de Google Plus: https://plus.google.com/communities/105557399913056882293
The use of platelet-rich plasma (PRP) for the treatment of osteoarthritis (OA) has demonstrated mixed clinical outcomes in randomized controlled trials when compared with hyaluronic acid(HA), an accepted nonsurgical treatment for symptomatic OA. Biological analysis of PRP has demonstrated an anti-inflammatory effect on the intra-articular environment. We found no difference between HA and PRP at any time point in the primary outcome measure: the patient-reported WOMAC pain score. Significant improvements were seen in other patient-reported outcome measures, with results favoring PRP over HA. Preceding a significant difference in subjective outcomes favoring PRP, there was a trend toward a decrease in 2 proinflammatory cytokines, which suggest that the anti-inflammatory properties of PRP may contribute to an improvement of symptoms. Click here to read the article.
ProMetic Life Science hits two significant clinical milestones, Antibe Therapeutics reports promising Phase 2 results, In BC researchers, take a closer look at the DNA of the world’s greatest wines, and using genomics to treat and track tuberculosis We have this and more on this week’s Biotechnology Focus Podcast! Welcome to Biotechnology Focus Podcast. I’m your host Shawn Lawrence. Story 1 We start this week’s show in beautiful British Columbia, highlighting two local projects with an international flavor. The first story sees UBC researchers Dan Durall and Mansak (Ben) Tantikachornkiat getting ever closer to identifying the biological personalities of the world’s greatest wines. In a recent study, published in the International Journal of Food Microbiology , the duo developed a technique that combines a process to identify the full spectrum of DNA in yeast and bacteria samples with a technique that distinguishes between live and dead micro-organisms. As Durall, an associate professor of biology at UBC’s Okanagan campus, explains, since only live micro-organisms are relevant in the various stages of fermentation as they relate to the senses, this study provides some of the important tools that will be necessary to determine why different types of wine taste and smell as they do. Their findings could also lead to the identification and elimination of micro-organisms that are responsible for spoilage. In undertaking the study, the pair used a number of different kinds of yeast and bacteria specimens, including those typically found in wine fermentations. Key in the development of the new scientific technique was the use of a light-sensitive dye, propidium monoazide, which binds to dead DNA and prevents it from being detected. This allows scientists to identify and focus on the more relevant aspects of a test sample. According to Tantikachornkiat, this technique has allowed them to quickly and accurately monitor in one experiment what previously could have taken multiple experiments and months of trial and error. The next stages of their research will focus this technique on different types of wine making methods to see how they change micro-organisms that affect the final wine product. Story 2 Our second BC story focuses on a new collaborative project involving the BC Centre for Disease Control (BCCDC), Oxford University and Public Health England (PHE). Together they are working to build data-sharing capacity between eachother to accelerate the use of genomics as a tool for the diagnosis, treatment and tracking of tuberculosis (TB). Led by Dr. Jennifer Gardy at BCCDC and Dr. Derrick Crook, University of Oxford and PHE, the research project is exploring how to communicate the complex data from a genomics-based test in a simple and effective laboratory report allowing clinicians, many of whom have not worked with genomic data before, to quickly and easily find the information and get the interpretation they need to ensure a direct benefit for patients. Funded in part by Genome BC, the project also supports PHE and BCCDC’s efforts to validate the use of a genomic platform in a clinical setting through developing user-friendly reports to assist doctors in faster and more effective diagnosis and treatment. The use of genomics in the clinic means patients will have access to the most effective treatment several weeks earlier. Through a previous collaboration, the researchers have already demonstrated that using genomics to diagnose and characterize TB infections can reduce the time to diagnose and fully characterize an infection from an average of 31 days to just five days. Genomics also provides important information on the drug resistance profile of the tuberculosis strain, which helps doctors to identify the best treatment and avoid using antibiotics that will not be effective. Valued at $168,000, the initiative called SMAC: Sharing Mycobacterial Analytic Capacity will use techniques from the field of information visualization to design the better laboratory reporting form. Through a series of online surveys and iterative designs, the researchers hope to develop a simple, two-page report that describes a patient’s diagnosis, the antibiotics that are predicted to work to treat the infection, and whether or not the patient is part of an outbreak. As part of SMAC, the UK and Canadian teams are also sharing resources and expertise in TB genomics and bioinformatics in order to accelerate the clinical validation and implementation of genomics-based TB diagnostics, first in the UK, and ultimately in BC. The partnership is a product of a MOU signed by Genome British Columbia and Genomics England last year to improve diagnostic capability and outcomes for patients with cancer, rare diseases and infectious diseases. Story 3 In Atlanta, Georgia, Toronto based med tech company Synaptive Medical has launched a revolutionary brain surgery technology at Emory University Hospital. The technology, called BrightMatter™ is an innovative neurosurgery solution that offers advanced imaging, surgical planning and navigation through robotic visualization. Synaptive’s technology shares a common imaging hub, which analyzes and assesses the quality of imaging scans in real-time prior to surgical planning and creates the foundation for a clinically-integrated imaging informatics research platform. Using an imaging method called diffusion tensor imaging, or DTI, BrightMatter enhances MRI images of the entire brain’s pathways, allowing physicians to consider approaches for navigating around critical structures in neurological surgery. Synaptive’s integrated imaging and navigation systems allow physicians to see details that can’t be seen with the naked eye or a standard MRI, and may allow access to brain locations previously deemed inoperable. The automatic positioning system with an attached camera follows the physician’s tools, showing an image of the patient’s anatomy with unprecedented detail. This robotic arm includes a hands-free optical visualization system that allows for better surgical ergonomics, facilitates collaboration with operating room staff, and consumes less surgical time without the need to manipulate cumbersome optics. Dr. Gustavo Pradilla, an Emory assistant professor of Neurosurgery, and chief of neurosurgery for Grady, co-director of the Grady Skull Base Center, and director of the Cerebrovascular Research Laboratory said that acquiring Synaptive’s platform will bring innovative neurosurgical treatments that are the next technological frontier in intraoperative navigation, robotic-assisted visualization, corridor-based neurosurgery and clinical informatics. He adds that the technology will expand the hospitals ability to treat previously inoperable lesions in delicate areas of the brain, leading to safer and more efficient procedures, smaller incisions, shorter hospital stays. Story 4 In clinical trial news, Toronto’s Antibe Therapeutics Inc. has posted positive results from its Phase 2 clinical trial of ATB-346 in osteoarthritis (OA). ATB-346, is an NSAID (non-steroidal anti-inflammatory drug), and a hydrogen sulfide-releasing derivative of naproxen, the most-prescribed NSAID in North America. As part of the trial, 12 patients with OA of the knee were treated once daily for 10 days with the drug at a dose of 250 mg. The dose contains one-sixth of the typical daily dose of naproxen for treating OA. According to the company, the lower dose was found to be very effective at reducing pain, and equal to or better than naproxen or celecoxib in comparable studies. The drug was also found to be safe and well-tolerated. As part of the trial, patients recorded their level of pain one day prior to starting treatment and again on days four and 10 of treatment. The “WOMAC pain scale”, the gold standard in arthritis clinical trials, was used as the measure of beneficial effect. The enhanced effectiveness of ATB-346 as compared to the market-leading drugs for osteoarthritis was a pleasant surprise, particularly considering the low dose of ATB-346 that was used said both the company’s chief science officer John Wallace and the company’s CEO Dan Legault. Legault added that the company plans to expeditiously perform additional clinical trials to confirm the results seen in this phase 2 study, and explore the effectiveness of even lower doses of ATB-346. The Phase 2 clinical trial was carried out in Toronto, Canada by Topstone Research Ltd. Story 5 A research team at the Krembil Research Institute has discovered a pair of tissue biomarkers that directly contribute to the harmful joint degeneration associated with spine osteoarthritis. In a study study, published in the Journal of Clinical Investigation Insight, the researchers were able to show that elevated levels of both of these biomarkers cause inflammation, cartilage destruction and collagen depletion. Osteoarthritis affects about three million Canadians and is characterized by a breakdown of the protective cartilage found in the body’s spine, hand, knee and hip joints. There is no known cure. The study involved tissue biopsies from 55 patients undergoing decompression or discectomy at the Krembil Neuroscience Centre at Toronto Western Hospital. As part of the study, the research team – led by Dr. Mohit Kapoor at the Krembil Research Institute and comprising Dr. Akihiro Nakamura, a post-doctoral fellow, and Dr. Y. Raja Rampersaud, a clinical expert and spine surgeon – explored the role, function and signaling mechanisms of two tissue biomarkers: microRNA-181a-5p and microRNA-4454. The study screened 2,100 microRNAs and found that measuring the levels of these two specific biomarkers can help clinicians determine the stage to which the disease has progressed, and provide a tool for determining the degree of cartilage destruction. Dr. Kapoor discusses his team’s discovery of the pair of tissue biomarkers in the following audio provided by (Video: UHN From 0:26-1:09,1:30-2:02). The discovery represents the end of the first stage of research. The team is now investigating whether these biomarkers can be detected in the blood – which would help clinicians more simply determine the stage of spine osteoarthritis – and whether further studying the biomarkers will allow researchers to halt and reverse spine degeneration. Story 6 It’s been a week filled with successful milestones for Laval, QC’s ProMetic Life Sciences. A developer of products used in the purification of biologics, drug development, proteomics and the removal of pathogens, the company announced on August 9th it had completed enrollment of the adult patient cohort for its pivotal intravenous immunoglobulin (IVIG) Phase3 clinical trial for the treatment of primary immunodeficiency diseases (PIDD). The company also announced on August 11 that it had completed patients enrolment of the congenital plasminogen deficient patients in its pivotal phase 2/3 clinical trial required for the accelerated regulatory approval pathway with the U.S. Food and Drug Administration In terms of the Phase 3 trial, completion of enrollment for the adult patient population is five months ahead of schedule and puts the company on the fast track to becoming the first Canadian-based company to locally produce IVIG. It’s also a further indication of the near-term commercial prospect of what will be the company’s second plasma protein. According to company CEO and president Pierre Laurin, Canadian patients are amongst the largest consumers of IVIG on a per capita basis worldwide and the demand continues to grow at a rapid pace. He believes that the manufacturing advantages provided by the company’s proprietary PPPS™ technology can help alleviate Canada’s current dependence on foreign plasma derived therapeutics. IVIG is a preparation of antibodies purified from plasma donations from normal individuals. It is indicated for the maintenance treatment of patients with primary immunodeficiencies including common variable immunodeficiency, X-linked agammaglobulinemia, severe combined immunodeficiency and as a treatment of immune thrombocytopenic purpura (ITP). It is also used for the treatment of many other autoimmune diseases, including Guillain-Barré syndrome, Kawasaki disease. The Phase 3 trial is an open label, single arm, two-cohort multicenter study investigating the safety, tolerability, efficacy and pharmacokinetics of ProMetic’s plasma derived IVIG in a total of 75 patients suffering from PIDD, and the adult cohort includes the 50 enrolled adults (cohort 1) and will also include 25 children (cohort 2). ProMetic anticipates the completion of enrollment for cohort 2 to go quickly with completion of the IVIG Phase 3 clinical trial expected in the second half of 2017. As for the second trial, the FDA has agreed to an accelerated regulatory approval pathway, given the rarity of the condition and the related unmet medical need. To secure an accelerated pathway approval, a drug must treat a serious condition, provide a meaningful advantage over available therapies and demonstrate an effect on a surrogate endpoint that is reasonably likely to predict clinical benefit. Dr John Moran, Chief Medical Officer of ProMetic commented that the ongoing clinical trial has enabled ProMetic to meet the primary end-point of achieving the targeted increase in plasma concentration of plasminogen and to define the optimal treatment regimen. Plasminogen is a naturally occurring protein that is synthesized by the liver and circulates in the blood. Activated plasminogen, plasmin, is a fundamental component of the fibrinolytic system and is the main enzyme involved in the lysis of blood clots and clearance of extravasated fibrin. Plasminogen is therefore vital in wound healing, cell migration, tissue remodeling, angiogenesis and embryogenesis. ProMetic's Plasminogen has received an Orphan Drug Designation by the FDA and the European Commission for the US and the European markets respectively. ProMetic also received a Fast Track Designation by the FDA, a process designed to facilitate the development and expedite review of drugs and biologics intended to treat serious or life-threatening conditions and that demonstrate the potential to address unmet medical needs. With that we’ve come to the end of this week’s program. We hope you enjoyed it. Thanks to Laskey Hart our production manager. You can find us online at www.biotechnologyfocus.ca and we’re always looking for your feedback, story ideas and suggestions so we’d love to hear from you. Simply reach out to us on twitter: @BiotechFocus . For all of us here at Biotechnology Focus, thank you for listening.
Background: To facilitate the discussion on the increasing number of total hip replacements (THR) and their effectiveness, we apply a joint evaluation of hospital case costs and health outcomes at the patient level to enable comparative effectiveness research (CER) based on the preoperative health state. Methods: In 2012, 292 patients from a German orthopedic hospital participated in health state evaluation before and 6 months after THR, where health-related quality of life (HRQoL) and disease specific pain and dysfunction were analyzed using EQ-5D and WOMAC scores. Costs were measured with a patient-based DRG costing scheme in a prospective observation of a cohort. Costs per quality-adjusted life year (QALY) were calculated based on the preoperative WOMAC score, as preoperative health states were found to be the best predictors of QALY gains in multivariate linear regressions. Results: Mean inpatient costs of THR were 6,310 Euros for primary replacement and 7,730 Euros for inpatient lifetime costs including revisions. QALYs gained using the U.K. population preference-weighted index were 5.95. Lifetime costs per QALY were 1,300 Euros. Conclusions: The WOMAC score and the EQ-5D score before operation were the most important predictors of QALY gains. The poorer the WOMAC score or the EQ-5D score before operation, the higher the patient benefit. Costs per QALY were far below common thresholds in all preoperative utility score groups and with all underlying calculation methodologies.
Background: The aim of the study was to analyze the effect of preoperative patient characteristics on health outcomes 6 months after total hip replacement (THR), to support patient's decision making in daily practice with predicted health states and satisfaction thresholds. By giving incremental effects for different patient subgroups, we support comparative effectiveness research (CER) on osteoarthritis interventions. Methods: In 2012, 321 patients participated in health state evaluation before and 6 months after THR. Health-related quality of life (HRQoL) was measured with the EQ-5D questionnaire. Hip-specific pain, function, and mobility were measured with the WOMAC in a prospective observation of a cohort. The predictive capability of preoperative patient characteristics - classified according to socio-demographic factors, medical factors, and health state variables - for changes in health outcomes is tested by correlation analysis and multivariate linear regressions. Related satisfaction thresholds were calculated with the patient acceptable symptom state (PASS) concept. Results: The mean WOMAC and EQ-5D scores before operation were 52 and 60 respectively (0 worst, 100 best). At the 6-month follow-up, scores improved by 35 and 19 units. On average, patients reported satisfaction with the operation if postoperative (change) WOMAC scores were higher than 85 (32) and postoperative (change) EQ-5D scores were higher than 79 (14). Conclusions: Changes in WOMAC and EQ-5D scores can mainly be explained by preoperative scores. The lower the preoperative WOMAC or EQ-5D scores, the higher the change in the scores. Very good or very poor preoperative scores lower the probability of patient satisfaction with THR. Shared decision making using a personalized risk assessment approach provides predicted health states and satisfaction thresholds.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 01/19
Long-term outcome in patients with osteoarthritis of the hip or knee after comprehensive rehabilitation: A prospective 2 year follow-up study Objective: To examine the course of pain and physical function after a comprehensive inpatient rehabilitation intervention in patients with osteoarthritis (OA) of the hip or knee. Design: Prospective 24-months cohort study with assessments at baseline (entry into clinic), 1 (discharge), 3, 6, 9, 12 and 24 months after baseline. Setting: Inpatient rehabilitation clinic. Patients: Consecutively referred patients to inpatient rehabilitation fulfilling the inclusion criteria. Intervention: Three to four week comprehensive rehabilitation intervention including strengthening exercise, flexibility training, endurance training, relaxationstrategies and consultations for preventive measures. Individual home rehabilitation programs were instructed. Main Outcome Measures and Analysis: Generic health status was followed using the SF-36, condition specific health was followed with the WOMAC questionnaire. Effects were analyzed with sensitivity statistics (effect size, ES) and nonparametric tests. Results: The data of 128 patients with complete follow-up data could be analyzed. Both pain and physical function improved moderately (WOMAC pain: ES = 0.56, WOMAC function ES = 0.44) until discharge of the clinic. While the effect in pain reduction remained significant until month 24 (WOMAC: ES = 0.26), physical function deteriorated close to baseline values after 12 months. Conclusions: Comprehensive in-patient rehabilitation of patients with OA of the hip or knee may improve pain and physical function for 6 months and pain in the long-ter
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