Combination of ultrasound-guided percutaneous A1 pulley release and intra-tendon sheath injection improves the therapeutic outcomes in adult trigger finger patients

AIM

This study aimed to use high-frequency ultrasound guidance to compare the efficacy of percutaneous release combined with intra-tendon sheath injection (PR-ITSI) and percutaneous release only (PR-ONLY) in the treatment of adult trigger finger (TF) patients.

MATERIALS AND METHODS

A total of 48 patients were randomly divided into PR-ITSI group and PR-ONLY group. The thickness of the A1 pulley was measured prior to surgery and 1-year after surgery. Visual Analogue Scale (VAS) score and Patient Global Impression of Improvement (PGI-I) scale score of affected fingers were evaluated at 1 day, 1 month, and 1 year after surgery.

RESULTS

The overall difference of VAS score between the two groups after treatment was statistically significant (p<0.001), while the VAS scores gradually decreased in both groups at different time-points after treatment. The VAS scores in the PR-ITSI group at 1 day and 1 month after surgery were 1.475 and 0.904 (p<0.001), respectively, which were lower than those in the PR-ONLY group. Different treatment methods had no effect on the VAS score at 1 year after surgery (p=0.055). The thickness of the A1 pulley at 1 year after surgery was lower than that before surgery (p<0.001), whereas there was no significant difference in A1 pulley thickness between the two groups (p=0.095). The rate of PGI-I scale improvement by one grade at 1 day, 1 month, and 1 year after surgery in the PR-ITSI group was 15.322 times (95%CI: 4.466-52.573, p<0.001), 14.807 times (95%CI: 2.931-74.799, p=0.001), and 15.557 times (95%CI: 1.119-216.307, p=0.041), respectively, than that in the PR-ONLY group.

CONCLUSION

Ultrasound-guided PR-ITSI is superior to PR-ONLY in the VAS score and PGI-I scale for adult TF patients.

Deliver protein across bio-barriers via hexa-histidine metal assemblies for therapy: a case in corneal neovascularization model

Because of their high specificity and low side effects, protein drugs possess a substantial global market. However, the low bioavailability of protein is still a major obstacle to their expanded applications, which is expected to be answered with proper protein formulations. Taking corneal neovascularization (CNV) as an example, we demonstrated a co-assembled system of hexa-histidine and Ava (Avastin) with metal ions (HmA@Ava) could cross the cornea, the most important bio-barrier during the treatment of most diseases of the anterior segment in clinics. We found that the nanosized HmA@Ava efficiently encapsulated Ava with impressive loading capacity without destroying the bioactivity of Ava and assisted Ava penetration through the corneal barriers to effectively inhibit CNV development in an alkali burn rat model with sustained and pH-dependent Ava release. Our results suggested that the co-assembled strategy of protein and HmA is a proper formulation to protein drugs, with promising penetration ability to deliver protein across bio-barriers, which could open a path for topical administration of protein drugs for treatment of various ocular diseases and hold enormous potential for delivery of therapeutic proteins not only for ocular diseases but also for other diseases that require protein treatment.

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HmA@Ava can bring protein drug, Ava, across over the primary bio-barrier of the anterior segment ​and efficiently treat CNV.

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HmA@Ava was nanoparticles, with impressive loading capacity without destroying bioactivity of Ava ​and strong pH-dependent release.

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HmA can open a path for the treatment of eye diseases and hold huge potential to protein drugs to other diseases.