Platelet Rich Plasma Treatment Group (PRP): The blood is drawn from the antecubital vein to the 10cc line of EasyPRP syringe consisted 1.5ml of anticoagulant. The syringe is centrifuged at a rate of 1200 g for 2 minutes. Then the syringe is rotated and the lower chamber filled with erythrocytes is discharged. The connector is inverted and the air gap is discharged. The injector is again centrifuged at 1200G for 10 minutes. Then the injector is rotated in the direction of the arrow, the lower stopper is removed. The application injector of 3cc with connector is placed in the EasyPRP injector. 1 ml of the PRP containing Buffycoat is separated for content analysis, the remaining 2 ml of the string is injected. Injection is repeated one month interval

Hyaluronic Acid Treatment Group (HA): 2 ml HA (32mg / ml) containing 1.6% sodium hyaluronate is injected intraarticular. The molecular weight is 800 - 1200 K Dalton. The viscosity is 20 pascal / s. The pH of the product is 7-7.5.Injection is repeated one month interval.

Knee Osteoarthritis

EASY PRP is in category IIa and manufactured by Neotec Biotechnology Industry and Foreign Trade Company. (Item No. 8680976403603; UNSPSC 42295470; GMDN 46923; certificate no: M.2016.106.7294).

Platelet Rich Plasma Treatment Group (PRP)

REGENFLEX STARTER is a class III intraarticular viscosupplementation device (Art. No. 8681065100076; UNSPSC 42295509). Sodium hyaluronate is obtained by bacterial fermentation (STREPTOCOCCUS EQUI) method. The product is in disposable packages, sterile and contained in a 2 ml pyrogen-free syringe.

Hyaluronic Acid Treatment Group (HA)

Naciye Fusun Toraman

Knee Osteoarthritis: Platelet Rich Plasma or Hyaluronic Acid

Efficacy of Intra-articular Injections of Hyaluronic Acid and Platelet-rich Plasma for Patients With Knee Osteoarthritis: Changes in Function, Quality of Life and Cartilage Loss as Assessed by Magnetic Resonance Imaging

The validated and reliable Turkish version of WOMAC consisted of three subscales- pain, stiffness, and physical function. Subscale of pain score range is between 0-20; stiffness score range is between 0-8; physical function score range is between 0-68. Values are summed up and the correction factors are used which are 0.50 for pain, 1.25 for stiffness, 0.147 for physical function to obtain total score. Total WOMAC score is between 0-100 and the higher scores indicate the greater disease severity.

Activity and rest pain is evaluated on a straight line of fixed length, 100 mm (0 = no pain, 100 = the most severe pain). (Creamer et al., 1999)

The patient stands up completely up from the sitting position, then completely backs down. The score is the total number of stands executed correctly within 30 seconds. The time in seconds is recorded using stop-watch (McAlindon et al., 2015).

The patient ascends and descends a flight of stairs (10-step stair) separately as soon as possible without handrail. The time in seconds is recorded using stop-watch (McAlindon et al., 2015).

The patient sitting in the chair, gets up, walks 3 meters without aid, walks back to the chair, then sits down. The score is the shortest time to rise from a chair, and return to the seated position. The time in seconds is recorded using stop-watch (McAlindon et al., 2015).

The patient is asked to walk as fast and as possible in six minutes, between the two cones placed at a distance of 25 meters. The patient may be allowed to stop and then walk within the test period. Time of stop is recorded. The time in seconds is recorded using stop-watch (McAlindon et al., 2015).

Test measures absolute muscle strength of the quadriceps and hamstring muscles and is applied in concentric modality in speed of 60 degrees per second (5 repetitions) and 180 degrees per second (10 repetitions) in knee flexion and extension at 10-90 degrees of range of movement with gravity correction for both of the extremities. Absolute peak torque is recorded as Newtonmeter (Nm).

Test measures relative strength of the quadriceps and hamstring muscles and is applied in concentric modality in speed of 60 degrees per second (5 repetitions) and 180 degrees per second (10 repetitions) in knee flexion and extension at 10-90 degrees of range of movement with gravity correction for both of the extremities. Relative peak torque is recorded as peak torque-to body weight ratio (Nm/kg)

Test measures average power of the quadriceps and hamstring muscles and is applied in concentric modality in speed of 60 degrees per second (5 repetitions) and 180 degrees per second (10 repetitions) in knee flexion and extension at 10-90 degrees of range of movement with gravity correction for both of the extremities. Muscular average power is recorded as Watt (W).

NHP is a scale developed to measure perceived health. Turkish version of the scale used consists of two parts (Kucukdeveci et al, 2000). Part I contains 38 yes/no items that assess 6 subscales (pain, physical mobility, emotional reactions, energy, social isolation and sleep). The each question answered by yes is assigned a weighted value. Scores for each subscale can range from 0 to 100. Total score range of NHP is between 0-600. Part II contains 7 general yes/no questions concerning daily living problems and score range is between 0-7, with a higher score indicating greater distress for Part I and II.

Magnetic Resonance Images are scored with respect to 14 independent features of patellofemoral joint (PFJ),medial femorotibial joint(MFTJ), lateral femorotibial joint (LFTJ), and non-articulating portion of the tibial plateau (S). Total cartilage score range is between 0-84; total marrow abnormality and bone cysts range are between 0-45; total bone attrition range is between 0-42; total osteophyte range is between 0-98; total compartment range is 0-35 for MFTJ, LFTJ, and 0-28 for PFJ; total menisci score range is between 0-12,ligaments score range is between 0-12, synovitis score range is between 0-3. Subscales are summed for the total WORMS score whic is between 0-332 and the higher values represent a worse outcome.Additionally tendon abnormalities, avascular necrosis,stress fracture,insufficiency fracture,osteochondral fracture,tumors, and technical limitations that interfered with the reliability of the scoring are specified and noted. (Peterfy et al, 2004).

The patient's global satisfaction related with the treatment is evaluated with a 6-point scale showing that the patient extremely satisfied from the treatment (1 point) and the patient extremely dissatisfied from the treatment (6 point) (Hoeksma et al, 2006).

BW is evaluated using TANITA MC-180MA and is recorded as kg.

% fat is evaluated using TANITA MC-180MA and is recorded as percentile value.

BMI is evaluated using TANITA MC-180MA and is recorded kg/square meter.

Professor

Antalya Training and Research Hospital

The Scientific and Technological Research Council of Turkey

The volunteer, sedanter patients with Kellgren Lawrence (KL) radiological grade II-III knee OA, unilateral knee pain, aged 50-70 years will be selected. Exclusion criterias are; KL radiological grade ≥2 of contrlateral knee, thrombocytopenia, coagulopathy, OA of multiple joints, acute exacerbation of any joint, intraarticular steroid, PRP or HA injection within 6 months, non-steroidal anti inflammatory drugs or steroid use within 6 weeks; diabetes and cancer; severe anemia (Hb <10), presence of heart and lung disease that can not perform physical function tests, secondary inflammatory arthritis; knee surgery or knee injury; planning for joint replacement within the next 3 months, difficulty in answering the questionnaires, limitation in joint range of motion, presence of genu varum/valgum >50. Patients will be divided into two groups: Group 1: HA group, Group 2: PRP group, using covariate adaptive randomization as age and osteoarthritis severity covariate.

There are five investigators in this study. N.Fusun Toraman is project manager and blind for the study groups. Yasemin Karaman and Sevim Yıldız are radiologists and blind for the study groups. Meral Bilgilisoy Filiz and Aslı Karadag Ozdemir know the groups, they will select the participants, and Meral Bilgilisoy Filiz will apply intraarticular injections via ultrasound. The participants of the groups do not know each other.

Uterine Artery Embolization for Uterine Leiomyomata

Patients will receive with patient controlled background infusion of 0.125% bupivacaine plus 2 μg/ml fentanyl that will be set between 4-6 ml/hour (to maintain visual analog scale (VAS) of ≥ 50 mm), intermittent bolus of 10 ml on demand by the women with lockout interval of 20 min with a four-hour maximum dose of 100 mL, irrespective of their age. The epidural infusions will be maintained for the first 24 postoperative hours

Patient-controlled epidural analgesia

Patients will receive continuous epidural infusion of 0.125% bupivacaine plus 2 μg/ml fentanyl at rate of 6-15 ml/hour (to maintain visual analog scale (VAS) of ≥ 50 mm).

Continuous epidural analgesia

King Fahd Hospital of Dammam University

King Fahd Hospital of the University

Patient-Controlled Epidural Analgesia After Uterine Artery Embolization

Does Patient-Controlled Epidural Bupivacaine-Fentanyl Offer Advantages Over Continuous Epidural Infusion After Uterine Arteries Embolization? A Controlled Prospective Study

The cumulative consumption of bupivacaine-fentanyl for 24 hours after uterine artery embolization (UAE) will be recorded

The patients will be asked to rate their experienced pain using the postoperative pain visual analogue scale (VAS) from 0 to 100 mm with 0 representing no pain and 100 representing the worst imaginable pain, for both parietal and visceral pain during rest and upon coughing

The time for first request for rescue analgesia (i.e. visual analog scale (VAS) ≥ 50)

number of supplementary top-up doses required

Cumulated amounts of local anesthetic and tramadol consumption for 24-hours after UAE

using 100-mm visual analog scale (VAS) (0 very unsatisfied and 100 very satisfied)

codeine/atrophy

Knee Osteoarthritis: Platelet Rich Plasma or Hyaluronic Acid

Patient-Controlled Epidural Analgesia After Uterine Artery Embolization

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