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Treatment

During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries.

Many famous athletes — golfer Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.

Even though PRP has received extensive publicity, there are still lingering questions about it, such as:

• What exactly is platelet-rich plasma?
• How does it work?
• What conditions are being treated with PRP?
• Is PRP treatment effective?

What Is Platelet-rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets). The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors that are very important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. These platelets are then injected into the injured site.

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How Does PRP Work?

Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.

To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:

• PRP can be carefully injected into the injured area. For example, in Achilles tendinitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue. Afterwards, the pain at the area of injection may actually increase for the first week or two, and it may be several weeks before the patient feels a beneficial effect.
• PRP may also be used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.

What Conditions are Treated with PRP? Is It Effective?

Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. Recent research has shown that certain tendon problems can have improved outcomes with PRP injections. Additionally, more and more literature is showing the significant effectiveness of PRP in the treatment of mild to moderate knee osteoarthritis. Factors that can influence the effectiveness of PRP treatment include:

• The area of the body being treated
• The overall health of the patient
• Whether the injury is acute (such as from a fall) or chronic (an injury developing over time)
• The preparation of the PRP, including the cellular makeup of the material that is injected

Chronic Tendon Injuries

According to the research studies currently reported, PRP is effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.

The use of PRP for other chronic tendon injuries — such as chronic Achilles tendinitis or inflammation of the patellar tendon at the knee (jumper's knee) is promising. However, it is difficult to say at this time that PRP therapy is any more effective than traditional treatment of these problems.

Acute Ligament and Muscle Injuries

Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains.

Surgery

More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures. Recent research has been dedicated to the benefit of PRP in meniscus healing after meniscus repair; however, these studies are only in their infancy.

Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be little or no benefit from using PRP in this instance.

Knee Arthritis

More and more literature is showing the effectiveness of low-leukocyte PRP in treating low- to moderate-grade knee osteoarthritis. Some studies have shown that these results can last up to two years.

Fractures

PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.

Conclusion

Treatment with PRP could hold promise, however, current research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of certain chronic tendon injuries and low- to moderate-grade knee osteoarthritis, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions

Even though the success of PRP therapy is still questionable, the risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.

If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including workers' compensation plans, provide even partial reimbursement.

Datum	Größe	Downloads	Mirrors
30.11.2011	29 MB	4446	Mirror 1

World of Warcraft PTR Patch 4.3.0

Notes for all World of Warcraft patches can be found here.

These notes will be updated through the course of the testing process. Please be aware some changes may not go live until a new PTR build is released.'

Table of Contents

Click a link to be taken directly to the corresponding section of the patch notes.

• Classes: General
  • Death Knights, Druids, Hunters, Mages, Paladins,
  • Priests, Rogues, Shaman, Warlocks, Warriors
• General Bug Fixes (fixes pertaining specifically to the sections listed above are noted within those sections)

• New Dungeon & Raid Content
  • End Time is now available for testing. Your participation and feedback here is appreciated.
  • Hour of Twilight is now available for testing. Your participation and feedback here is appreciated.
  • The new Baradin Hold boss, Alizabal, is now available for testing. Your participation and feedback here is appreciated.
  • Dragon Soul is now available for testing. Your participation and feedback is appreciated. For the latest testing schedule, please visit the PTR Discussion forum here.
  • Well of Eternity is now available for testing. Your participation and feedback here is appreciated.
• Raid Finder
  • This new grouping feature allows players to quickly and easily form a pick-up raid for a specially tuned version of the current tier of endgame content: the Dragon Soul raid. Raid Finder is now available for testing. Your participation and feedback here is appreciated.
• Transmogrification
  • This new feature allows players to customize their gear like never before. You'll find Transmogrification, Void Storage, and Reforging vendors in Cathedral Square, Stormwind and The Drag, Orgrimmar. The costs associated with this service are not yet final.
• Void Storage
  • In addition to the bank, players will now have access to a new 'deep storage' system, allowing characters to free bag space by setting aside coveted gear. You'll find Transmogrification, Void Storage, and Reforging vendors in Cathedral Square, Stormwind and The Drag, Orgrimmar. The costs associated with this service are not yet final.
• Reforging
  • The former Reforging vendors have been... retired. The ethereals have chosen to take over the business and joined their Transmogrification and Void Storage service providers. You'll find them in Cathedral Square, Stormwind and The Drag, Orgrimmar.
• Outland & Northrend Quest Flow
  • The amount of experience needed to gain levels 71 through 80 has been reduced by approximately 33%.
  • Many Group quests in Outland and Northrend have been re-tuned to allow players to complete them solo. They are no longer labeled as Group quests.
  • Relevant questgivers have been moved into Outland and Northrend dungeons. The majority of dungeon quests for these zones are now available from within their respective dungeons.
• North American realms (excluding Brazilian, Latin American, and Oceanic realms) no longer permit letters with accents in character or guild names. Existing character and guild names with special characters will be unaffected by this change.

• The achievement Master of Alterac Valley no longer requires the Alterac Valley Blitz achievement.

• All raid and party buffs which grant group members 10% increased attack power have been changed slightly. They continue to provide 10% increased ranged attack power, but now provide 20% increased melee attack power.
  • Abomination's Might: The melee attack power bonus from this raid buff has been increased to 10/20%, up from 5/10%. The ranged attack power bonus remains 5/10%.
  • Blessing of Might: The melee attack power bonus from this raid buff has been increased to 20%, up from 10%. The ranged attack power bonus remains 10%.
  • Runescroll of Might: The melee attack power bonus from this consumable has been increased to 16%, up from 8%. The ranged attack power bonus remains 8%.
  • Trueshot Aura: The melee attack power bonus from this raid buff has been increased to 20%, up from 10%. The ranged attack power bonus remains 10%.
  • Unleashed Rage: The melee attack power bonus from this raid buff has been increased to 10/20%, up from 5/10%. The ranged attack power bonus remains 5/10%.
• Vengeance for Protection warriors, Protection paladins, Blood death knights, and Feral druids has been redesigned slightly. It no longer ramps up slowly at the beginning of a fight. Instead, the first melee attack taken by the tank generates Vengeance equal to 33% of the damage taken by that attack. In addition, as it updates periodically during the fight, it's always set to at least 33% of the damage taken by the tank in the last 2 seconds. It still climbs from that point at the rate it did previously, still decays when damage is not taken, and still cannot exceed a maximum based on the health and Stamina of the tank.
• Threat generated by classes in active tanking modes has been increased to 500% damage done, up from 300%. This applies to druids in Bear Form, death knights in Blood Presence, warriors in Defensive Stance, and paladins with Righteous Fury active.
• Spells which have an effect broken by taking damage past a threshold (Entangling Roots, Fear, Frost Nova, etc.) now count damage that was prevented by damage absorbs or other damage reducing effects.

• Death Strike now heals the death knight whether or not the attack misses, or is dodged/parried. As a result of this change, Death Strike no longer refunds its rune cost if it fails to hit the target, as the death knight will still receive the healing effect.
• Blood Presence now provides an armor bonus of 55%, up from 30%.
• Talent Specializations
  • Blood
    • Blade Barrier has been redesigned. It now passively reduces damage taken.
    • Bone Shield now has 6 charges, up from 4.
    • Veteran of the Third War now reduces the cooldown of Outbreak by 30 seconds.
  • Unholy
    • Unholy Might now increases Strength by 25%, up from 20%.

• Wrath has a new spell effect.
• Hurricane has a new updated visual effect.
• Swipe (Cat) has been reduced to 340% weapon damage, down from 415%.
• Bear Form now provides an armor bonus of 120% at all levels, up from 65% for characters below level 40, making it easier for lower level druids to tank dungeons.
• Bear Form now provides a Stamina bonus of 20%, up from 10%.
• Talent Specializations
  • Balance
    • Celestial Focus now also reduces Cyclone spell pushback.
  • Restoration
    • Wild Growth healing has been reduced by 20%.
    • Nature’s Focus now also reduces Cyclone and Entangling Roots spell pushback.
• Glyphs
  • Glyph of Shred has been renamed Glyph of Bloodletting, and now also causes Mangle (Cat) to extend the duration of Rip, in addition to its existing Shred functionality.
  • Glyph of Wild Growth now also increases the cooldown on Wild Growth by 2 seconds.

• Monstrous Bite now reduces the target’s healing received by 25%, up from 10%.
• Talent Specializations
  • Beast Mastery
    • Animal Handler now increases Attack Power by 30%, up from 25%.
    • Widow Venom now reduces the target’s healing received by 25%, up from 10%.
    • Burrow Attack now does approximately 20% more damage, and has an increased area of effect.
    • Froststorm Breath now does approximately 20% more damage, and has an increased area of effect.
  • Survival
    • Explosive Shot damage has been increased by 15%.

• Mages
  • Pyroblast’s initial damage has been increased by approximately 26%, and its damage over time has been increased by approximately 100%.
  • Fireball damage has been increased by approximately 17%.
  • Talent Specializations
    • Fire
      • Living Bomb damage over time has been increased by approximately 10%, and explosion damage has been increased by approximately 120%.

• Holy Radiance now has a 3.0-second cast time, no cooldown, and requires a player target. That target is imbued with Holy Radiance, which heals them and all group members within 10 yards instantly, and continues to heal them by a smaller amount every 1 second for 3 seconds.
• Seal of Insight, when Judged, no longer returns 15% base mana to the paladin. Judging Seal of Insight still causes damage, and melee attacks will still restore 4% of base mana.
• Seal of Truth, when Judged, now benefits from a multiplier of 20% per stack of Censure, up from 10%.
• Talent Specializations
  • Holy
    • Clarity of Purpose now also reduces the cast time of Holy Radiance.
    • Illuminated Healing (mastery) now also applies to Holy Radiance.
    • Infusion of Light now applies its cast time reduction from Holy Shock critical effects to Holy Radiance, in addition to its current effects.
    • In addition to providing haste, the effect from Judgements of the Pure now increases mana regeneration from Spirit by 10/20/30% for 60 seconds.
    • Light of Dawn now affects 6 targets (base effect), up from 5.
    • Paragon of Virtue now lowers the cooldown of Divine Protection by 15/30 seconds, up from 10/20 seconds.
    • Speed of Light no longer triggers from Holy Radiance and no longer lowers the Holy Radiance cooldown. Speed of Light now only triggers from Divine Protection.
    • Tower of Radiance, in addition to its current effects, now also causes Holy Radiance to always generate 1 charge of Holy Power at all times.
    • Beacon of Light is triggered by Word of Glory, Holy Shock, Flash of Light, Divine Light and Light of Dawn at 50% transference and Holy Light at 100% transference. It does not transfer Holy Radiance, Protector of the Innocent or other sources of healing.
  • Retribution
    • Sanctified Retribution now increases the critical hit chance of Hammer of Wrath by 2/4/6%, down from 20/40/60%.
    • Two-Handed Weapon Specialization (passive) now increases damage by 25%, up from 20%.
• Glyphs
  • Glyph of Light of Dawn now lowers the number of targets to 4, instead of increasing targets to 6, but increases healing by 25%.

• Divine Hymn now affects 5 targets, up from 3.
• Talent Specializations
  • Discipline
    • Atonement will now account for the target enemy's combat reach when calculating proper range, enabling it to be used on large creatures such as Ragnaros and Ala'kir.
    • Divine Aegis has a new spell effect.
  • Holy
    • Spirit of Redemption has been rebuilt to address a few functionality issues and make it more responsive. Spirit of Redemption otherwise remains unchanged.
    • State of Mind has been redesigned and is now called Heavenly Voice. Heavenly Voice increases the healing done by Divine Hymn by 50/100%, and reduces the cooldown of Divine Hymn by 2.5/5 minutes.
    • Guardian Spirit’s healing bonus has been increased to 60%, up from 40%.
    • Holy Word: Serenity now has a cooldown of 10 seconds, down from 15 seconds.
• Glyphs
  • Glyph of Circle of Healing now also increases the mana cost of Circle of Healing by 20%.

• Wound Poison now reduces the target’s healing received by 25%, up from 10%.

• Flametongue Weapon no longer increases spell damage. It now increases all non-physical damage done by the wielder by 5%.
• Lightning Bolt has a new spell effect.
• Wind Shear’s base cooldown has been adjusted to 15 seconds, up from 6 seconds.
• Talent Specializations
  • Elemental
    • Call of Flame no longer causes Fire Nova to extend the duration of Flame Shock.
    • Earthquake damage has been increased by roughly 75%.
    • Elemental Fury now removes the cooldown from Chain Lightning.
    • Reverberation now reduces the cooldown of Wind Shear by 5/10 seconds, up from 0.5/1 second.
  • Enhancement
    • Improved Lava Lash now causes Lava Lash to spread a Flame Shock debuff from the target to up to 4 nearby targets. This excludes crowd-controlled targets and those who already have a Flame Shock debuff from the shaman.
    • Improved Lava Lash no longer increases base Lava Lash damage by 15/30%. This increase has been rolled into the base Lava Lash skill.
    • Mental Quickness has been redesigned. Instead of granting the shaman spell power, Mental Quickness now causes Enhancement shaman spells to behave as though the shaman has spell power equal to 55% of attack power. Enhancement shaman spells no longer benefit from spell power from other sources.
    • Maelstrom Weapon can now also proc from fully absorbed melee attacks.
  • Restoration
    • Ancestral Healing now also causes the shaman's heals to increase the target's maximum health by 5/10% of the amount healed, up to a maximum of 10% of the target's maximum health, for 15 seconds. This effect does not stack if multiple Restoration shaman are present, and does not apply to heals from procs.
    • Riptide's periodic healing coefficient has been increased by 50%. The initial direct heal is unchanged.

• Shadow Bolt has a new spell effect.
• Soul Fire now scales with 72.6% of spell power, up from 62.5%.
• The Voidwalker ability Suffering now works like the hunter pet talent Taunt.
• Talent Specializations
  • Demonology
    • Demonic Knowledge now provides a damage bonus of 20%, up from 15%.
    • Master Demonologist now grants a base bonus of 20%18.4% and 2.5%2.3% per mastery, up from 16% and 2% per mastery.
    • Impending Doom is now also activated by Soul Fire.
  • Destruction
    • Cataclysm now increases Fire damage by 30%, up from 25%.
    • Fire and Brimstone now increases the damage of Incinerate and Chaos Bolt on Immolated targets by 5/10/15%, up from 2/4/6%.
    • Burning Embers now deals damage equal to 25/50% of Soul Fire and Imp’s Firebolt, up from 15/30%.
    • Buning Embers damage cap has been raised.
    • Shadowburn now deals Shadowflame damage, instead of Shadow damage.
    • Improved Soul Fire now lasts 20 sec, up from 15sec.
• Bug Fixes
  • Fixed a bug that caused Doomguard and Infernal to benefit dramatically more than intended from Demonology Mastery.

• Charge (and related abilities) should now correctly path to a target even if the target moves during the Charge. This change should decrease the likelihood of the warrior Charging to a different location than the target.
• Slam now uses a new character attack animation.
• Colossus Smash now uses a new character attack animation.
• Talent Specializations
  • Arms
    • Mortal Strike now reduces the target’s healing received by 25%, up from 10%.
  • Fury
    • Dual Wield Specialization no longer increases Physical damage by 5%. It continues to increase off-hand attack damage by 25%.
    • Furious Attacks now reduces the target’s healing received by 25%, up from 10%.

• Dungeon Journal entries have been added for the new dungeons: End Time, Well of Eternity, Hour of Twilight, and Dragon Soul.
• Players who use Dungeon Finder for a random Heroic dungeon will no longer be locked to that instance. Previously, players who entered an instance via the Random Dungeon option were then prohibited from queuing for that dungeon or entering the instance manually via the portal. Players should now always be able to complete a specific Heroic dungeon once per day regardless of any random dungeons completed.
• Ruins of Ahn'qiraj
  • Bosses in Ruins of Ahn'qiraj now drop a rare-quality Scarab Coffer Key which can be used to open the Scarab Coffers found within. These keys are zone-bound to Ruins of Ahn'qiraj and have a 17-hour expiration. This change also applies to Greater Scarab Coffer Keys used to open Large Scarab Coffers.
• Zul’Gurub
  • Players now only have to kill two of the four initial dungeon bosses (High Priest Venoxis, Broodlord Mandokir, High Priestess Kilnara, and Zanzil) to face Jin’do the Godbreaker.
• Zul’Aman
  • Players now only have to kill two of the four Troll avatars before they may face Hex Lord Malacrass.

• Guild Standards are again useable in Firelands. Duration has been increased to 15 minutes, the effect has a 100 yard radius, and now affects dead players.

• Dragonwrath, Tarecgosa’s Rest: The chance for this item’s effect to be triggered has been reduced.

Des Blood English Patch Reviews

• The orc racial Blood Fury now increases spell power rather than only spell damage.

Des Blood English Patch Free

• Archaeology areas of interest will now show on the mini-map, in addition to the World Map.
• Bag Search
  • A search field has been added to allow players to search bag, bank, guild bank, and Void Storage inventories for specific items.
• Guilds with inactive guild leaders can now usurp the leader under specific conditions. More information on this coming soon.
• The Reforging interface has been updated and improved.
• Quest Tracking areas or points of interest will now show on the mini-map, in addition to the World Map.
• The World Map now displays the expected character levels for each zone.
• Added a “promote everyone” checkbox that will automatically make all raid members, Raid assistants. This checkbox can be found in the Raid Frame and the Unit Frame “pull-out” tab.
• There are now commands for world markers & unit markers.
• Added new rotation, zoom, and pan controls are now available in all windows with player models in UI frames.
• Players can now unlearn profession specialization without unlearning the profession (Engineering & Alchemy).
• [Mac] Added functionality to allow using the Command key instead of the Control key on Apple keyboards. This can be enabled in Mac Options.
• [Mac] Added functionality to disable Mac OS system keyboard shortcuts so that they do not interfere with keyboard shortcuts in WoW. This can be enabled in Mac Options.
• Added a feature to interact with NPCs, game objects (mailbox, mining nodes, etc.), and corpses on left-click as well as right-click. There is now an option under Interface:Controls to turn this feature off.

• Coming soon.

Des Blood English Patch Review

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