MD Biologix’s Post

Dosing in #PRP is a hot topic. We should strive to stay current, but remember foundational principles so we do not go too far with current trends. Heavy emphasis on hot topics has a history of swinging the pendulum too far in the field of #orthobiologics Here is a brief list of #orthobiologics trends that were at one time associated with strong (nearly dogmatic) beliefs, but now those views have softened as we have learned. 1) Activation- some believed PRP needed activation with calcium chloride or thrombin. Interestingly, without any gold-standard study to reference, this topic seems to have all but disappeared from present discussions. 2) Leukocytes- there was a belief that leukocytes must be avoided in the joint. But when BMAC or APS were brought forward, leukocytes were again absent from the conversation. Now, we've come back to admitting maybe some WBCs are helpful. There are at least 2 comparative studies demonstrating that there is no difference between LP- vs LR-PRP for knee OA (both by Filardo et al). 3) Mesenchymal stem cells- early adopters of BMAC touted the MSC content. Then came the realization that BMAC has almost no MSCs in it and that any therapeutic benefit came from sources like IRAP (which comes from the leukocytes!) Present day, there is a strong emphasis on "PRP dosing". Those advocating "high dose" only are not addressing a very large body of literature including the only positive FDA study for knee OA that used a series of lower concentration PRP injections (https://lnkd.in/egkKTqVw) Not only are there multiple RCTs showing that a series of low concentration PRP injections improves outcomes for knee OA (see previous posts for references), but there's more to PRP than the platelet count. I'll cover these other important variables in future posts. Have a great week and keep learning! *PRP for OA is off-label. These posts are intended for education only and do not constitute medical advice*

"Care ... & ... Aware" One of the rare complication of hyperthyroidism is “Thyroid-associated ophthalmopathy” (TAO) or “Graves' ophthalmopathy”, which is a complex disease attributed to the presence of TSH receptors and insulin-like growth factor 1 receptor (IGF-1R) in orbital fibrocytes. Although severe TAO is rare, it is difficult to treat. A 15-20% risk of aggravating severe eye disease may occur following radioactive iodine RAI, especially in those who smoke. Management requires effective treatment of the thyroid disease, usually by total surgical excision or iodine-131 (131-I) ablation of the gland pus anti-inflammatory therapies. Treatment and management: - Elevation of the head to diminish periorbital edema - Artificial tears to relieve corneal drying due to exophthlmos - Smoking cessation to prevent progression of the ophthalmopathy - For severe and acute inflammatory reaction: prednisone 60-100 mg orally daily for about a week, then 60-100 mg every other day, tapering the dose over 6-12 weeks - Teprotumumab (Tepezza), a monoclonal antibody given once every 3 weeks for total of 8 IV infusions, significantly reduces eye bulges, pain and swelling, and double vision - If the aforementioned therapy fails or is contraindicated, irradiation of the posterior orbit, using well-collimated high-energy X-ray therapy, will frequently result in marked improvement of the acute process - Threatened loss of vision is an indication for surgical decompression of the orbit. Eye-lid or eye muscle surgery may be necessary to correct residual problems after the acute process has subsided References: - Katzung's basic & clinical pharmacology, 16th edition #thyroid_associated_ophthalmopathy #insulin_like_growth_factor_1 #teprotumumab #hyperthyroidism #drug_information_76 #clinical_pharmacology #pharmacy_review #counseling_points #patient_education

🚨 In continuous renal replacement therapy, the use of micafungin or caspofungin requires some attention due to unexpected alterations of their efficacy. Here under some recent scientific advances justifying an adapted treatment for patients. There is an increasing body of knowledge supporting the concern regarding the simultaneous use of caspofungin or micafungin and filters used in continuous renal replacement therapy (CRRT). These substances are differentially sequestrated in filters used in CRRT depending on the chemical composition of the filters. In vitro studies provided meaningful information: 1️⃣ In 2019, Purohit et al reported that 22% of caspofungin was adsorbed by the circuit used in CRRT (important ratio if you compare to the 3.5% unbound fraction of #caspofungin in plasma (1). 2️⃣ In 2020, preliminary results on the unbound concentrations of caspofungin and micafungin in the central compartment (CC) by means of NeckEpur methodology using a crystalloid solution and a polyacrylonitrile filter showed  the rapid and complete disappearance of caspofungin and micafungin from the CC without quantifiable amounts in cumulative effluents, features suggestive of an unknown route of elimination (2). 3️⃣ In 2023, confirmation of an extensive sequestration of caspofungin in a polyacrylonitrile derived filter using NeckEpur methodology (3). The Drug Sequestration Rate (DSR) was minimally mitigated by an about 3-fold increase in unbound caspofungin concentrations. 4️⃣ Regarding micafungin, a study in 2017 assessed micafungin sequestration in an in vitro model combining ECMO and CRRT using a polysulfone-derived filter (4). Extensive micafungin sequestration was observed only in the polysulfone-derived filter and not in the ECMO circuit. 5️⃣ In 2024, NeckEpur methodology showed a rapid and complete sequestration of micafungin in a polysulfone-derived filter. In contrast, in a polyacrylonitrile-derived filter, micafungin sequestration eliminated 50% of the initial dose (results presented at the annual congress of the French Society of Anesthesia and Intensive care 2024 (SFAR - Société française d'anesthésie et de réanimation) and at the Consensus, News & Perspectives on organ replacements (Journées CAPSO) at Bordeaux)   These findings suggest difficulties in using echinocandins during sessions of CRRT: ⚠️ Facing a polyacrylonitrile filter, micafungin should be considered instead of caspofungin. The best dosage regimen of micafungin remains to be determined, however. ⚠️ Facing a polysulfone-derived filter, micafungin should not be recommended. Sequestration of #caspofungin in a #polysulfone-derived filter is an unaddressed question. 📑 References below in the first comment. #echinocandins #caspofungin #micafungin #CRRT #sequestration

Ocular Therapeutix Inc hosted an Investor Day where it highlighted clinical development progress with Axpaxli for wet age-related macular degeneration (wet AMD) and non-proliferative diabetic retinopathy (NPDR) and updated its corporate strategy. During its Investor Day, the company noted the SOL-1 study has 60 study sites active and 151 subjects enrolled in various stages of loading and randomization as of June 7, 2024. The study is being conducted under a Special Protocol Assessment (SPA) with the US FDA. The Company intends to randomize 300 treatment naïve patients in the SOL-1 study, comparing a single implant (450µg) to a single aflibercept injection (2mg) after all patients have received two loading doses of aflibercept. Read More: https://ow.ly/I1QN50SiUCN

Exciting Developments in Anticoagulation Therapy with Factor XIa taking the stage here. The results from Anthos Therapeutics AZALEA-TIMI 71 trial, led by Christian Ruff highlight the potential of abelacimab in limiting bleeding events for patients. This groundbreaking research represents a significant step forward in achieving safer anticoagulation therapy. HCPLive HCPLive Cardiology

Jan 2025 (NEJM)—The AZALEA-TIMI 71 trial explored abelacimab, a novel Factor XI inhibitor, versus rivaroxaban in patients with atrial fibrillation. Findings showed that abelacimab significantly lowered major and clinically relevant non-major bleeding events. At the 150 mg dose, bleeding events were reduced by 67%, with an impressive 89% reduction in gastrointestinal bleeding. Despite these promising results, a key drawback is abelacimab’s long half-life (25–30 days) and the absence of a reversal agent. This could present challenges in situations requiring urgent anticoagulation reversal. For more details, check out the study in the New England Journal of Medicine: #AFib #BleedingRisk #StrokePrevention #Cardiology #Electrophysiology

Bone Marrow Adipocytes May Offer Early Detection of MGUS Progression to Multiple Myeloma: Increased bone marrow adiposity is associated with progression of monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma. #finance #pharmacy #lifesciences

📃Scientific paper: Effect of total parathyroidectomy in patients with secondary hyperparathyroidism: a retrospective study Abstract: Purpose To investigate the therapeutic efficacy, feasibility, and safety of total parathyroidectomy (tPTX) in the treatment of secondary hyperparathyroidism (SHPT). Methods The clinical data of 34 SHPT patients admitted to the Department of Nephrology, Yuxi People’s Hospital, from January 2018 to January 2021 who had received tPTX, were retrospectively analyzed. The indications for tPTX were severe SHPT that did not respond to medical treatment and was ineligible for kidney transplantation. tPTX without autotransplantation was adopted to compare the level of symptom relief and changes in serum intact parathyroid hormone (iPTH), blood calcium, and blood phosphorus pre- and postoperatively. Results In 34 patients, 142 parathyroid glands were removed, including 21 ectopic parathyroid glands (14.78%). Six patients (17.64%, 6/34) had supernumerary parathyroid glands. At 6 h postoperatively, arthralgia and bone pain were significantly reduced to almost zero in 94.12% (32/34) of patients. At 24 h postoperatively, relief of bone pain and improvement of limb movement were observed in 100% (34/34) of patients, and pruritus almost disappeared in 86.36% (19/22) of patients. There were significant differences in iPTH ( χ 2 = 134.93, P  < 0.05), calcium ( χ 2 = 23.02, P  < 0.05), and phosphorus ( χ 2 = 102.11, P  < 0.05) levels preoperatively and 40 min, 24 h, 1 week, half a year, and last available (> 1 year) postoperatively. The patients were followed up for 15–47 months (medi... Continued on ES/IODE ➡️ https://etcse.fr/N2X1V ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.

There have been increasing concerns about the risk of aspiration during endoscopy procedures due to retained gastric residue with GLP-1 RA use. In a recent study with Elisabetta Patorno Deborah J. Wexler and colleagues in BMJ, we found no increased risk of pulmonary aspiration during upper gastrointestinal endoscopy among adults with type 2 diabetes using GLP-1 RA. However, GLP-1 RA use was associated with a higher risk of discontinuation of endoscopy. These findings provide important insights for clinical decision-making and patient safety during routine diagnostic procedures. 📝 You can read the full article here:  Glucagon-like peptide-1 receptor agonists before upper gastrointestinal endoscopy and risk of pulmonary aspiration or discontinuation of procedure: cohort study

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