Evaluation of the effect of physical therapy on pain and dysfunction of knee osteoarthritis based on fNIRS: a randomized controlled trial protocol.

BACKGROUND: Knee osteoarthritis (KOA) is a chronic musculoskeletal disease that can cause joint pain and dysfunction, affecting the quality of life of patients. Nonsurgical treatment is the conventional treatment of KOA, among which physical therapy is widely used because of its simplicity, convenience and effectiveness. The functional biomarker will add to the clinical fidelity and diagnostic accuracy. Therefore, our study chose a more objective evaluation indicator, functional near-infrared spectroscopy (fNIRS), to identify between healthy people and KOA patients, and to detect the pain change before and after treatment of KOA patients. METHODS: The study will be conducted in the Rehabilitation Medical Center of West China Hospital of Sichuan University and divided into 2 stages. In the first stage, we will compare and determine the differences in baseline data between healthy volunteers and KOA patients. In the second stage, 72 KOA patients will be randomly divided into two groups: the drug therapy group (DT) and the combination therapy group (CT) for 10 treatments. Outcome measures will be measured at baseline and on the 5th and 10th days after the intervention, including the numerical rating scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain catastrophizing scale (PCS), the association of pain severity with task-state functional connectivity fNIRS and association of pain severity with task-activated fNIRS. DISCUSSION: By analyzing the fNIRS data of healthy volunteers and KOA patients, our study will be determined whether fNIRS can be used as a new indicator to reflect the severity of pain in KOA patients. Subsequently, the same fNIRS data for KOA patients before and after the intervention will be collected to provide an accurate evaluation criterion for the effect of physical therapy on KOA. TRIAL REGISTRATION: The study was registered on the Chinese Registry website (registered in ChiCTR.org with the identifiers ChiCTR2200064175 and 29/09/2022).

Effect of Internet-Based Rehabilitation Programs on Improvement of Pain and Physical Function in Patients with Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Osteoarthritis (OA) is a chronic, debilitating, and degenerative joint disease. However, it is difficult for patients with knee OA to access conventional rehabilitation when discharging from the hospital. Internet-based rehabilitation is one of the promising telemedicine strategies to provide a means combining monitoring, guidance, and treatment for patients with knee OA. OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis for assessing the effect of internet-based rehabilitation programs on pain and physical function in patients with knee OA. METHODS: Keywords related to knee OA and internet-based rehabilitation were systematically searched in the Web of Science, MEDLINE, EMBASE, CENTRAL, Scopus, PEDro (Physiotherapy Evidence Database), CNKI, SinoMed, and WANFANG databases from January 2000 to April 2020. Only randomized controlled trials were included. The authors independently screened the literature. The main outcome measures were focused on pain and physical function. A meta-analysis was performed on the collected data. Review Manager (RevMan, version 5.3) was used for all analyses. RESULTS: The systematic review identified 6 randomized controlled trials, 4 of which were included in the meta-analysis, comprising a total of 791 patients with knee OA. The meta-analysis with the fixed-effects model showed that the internet-based rehabilitation programs could significantly alleviate the osteoarthritic pain for patients compared with conventional rehabilitation (standardized mean difference [SMD] -0.21, 95% CI -0.4 to -0.01, P=.04). No significant difference was found in the improvement of physical function in patients with knee OA compared with conventional rehabilitation within 2 to 12 months (SMD -0.08, 95% CI -0.27 to 0.12, P=.43). CONCLUSIONS: This systematic review shows that internet-based rehabilitation programs could improve the pain but not physical function for patients with knee OA. However, there was a very small number of studies that could be included in the review and meta-analysis. Thus, further studies with large sample sizes are warranted to promote the effectiveness of internet-based rehabilitation and to develop its personalized design.

Effect of Repetitive Transcranial Magnetic Stimulation on Gait and Freezing of Gait in Parkinson Disease: A Systematic Review and Meta-analysis.

OBJECTIVE: The purpose of this review was to systematically assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) intervention on gait in individuals with Parkinson disease (PD). DATA SOURCES: We searched online electronic databases up to March 28, 2019, including MEDLINE, Embase, the Cochrane Library, and so on. STUDY SELECTION: The inclusion criteria for this review were randomized controlled trials (RCTs), exploring the effect of rTMS in patients diagnosed with idiopathic PD. DATA EXTRACTION: Data extraction was performed independently by 2 reviewers based on predefined criteria and the methodologic quality of included studies was quantified by the Physiotherapy Evidence Database scale. The outcome measure was walking performance, including walking time (short term and long term), Timed Up and Go (TUG) test, and so on. DATA SYNTHESIS: Among 14 eligible studies, including 298 participants (mean age ± SD [y], 63.24±9.71; 191 [64%] men) were analyzed in this meta-analysis. Walking time was improved with rTMS compared with sham rTMS (standardized mean difference [SMD] -0.30; 95% confidence interval [CI], -0.57 to -0.03; P=.03). The score for the freezing of gait questionnaire did not differ significantly between rTMS and no intervention. Four studies compared TUG between the 2 treatment groups and no significant differences were found between the rTMS and control group (SMD -0.45; 95% CI, -1.32 to 0.41; P=.30). During the off-state, there were no significant differences in estimated effect sizes (SMD=-0.29; 95% CI, -0.79 to 0.21; P=.25), which is significantly different in on-state (SMD -0.98; 95% CI, -1.78 to -0.18; P=.02) evaluation. CONCLUSIONS: The results of the meta-analysis propose the favorable effect of rTMS on walking performance in the short term but not over the long term in individuals with PD.

The safety and feasibility of a new rehabilitation robotic exoskeleton for assisting individuals with lower extremity motor complete lesions following spinal cord injury (SCI): an observational study.

STUDY DESIGN: A pre-post observational study. OBJECTIVES: To evaluate the safety and feasibility of a new rehabilitation robotic device for assisting individuals with lower extremity motor complete lesions following spinal cord injury (SCI). SETTING: Three hospitals in Sichuan Province, China. METHODS: Individuals aged 15-75 years with an SCI between vertebrae six (T6) and lumbar 1 (L1) and complete motor paralysis participated in an exoskeletal-assisted walking (EAW) programme (2 weeks, 5 days/week, 30 min/day). Data were collected pre-, mid- (week 1) and post-intervention (week 2). RESULTS: Twenty-eight individuals (mean age = 41.3, 71% males) participated in the EAW programme. The distance walked during the 6-min walking test (6MWT) increased relative to that at baseline, during week 1 (13.0 ± 5.3 m) and week 2 (16.2 ± 5.3 m) when wearing the exoskeleton. The walking speed during the 10-m walking test (10MWT) increased from 0.039 ± 0.016 to 0.045 ± 0.016 m/s. The Hoffer walking ability grade, the Spinal Cord Independence Measure (SCIM), and the Walking Index for SCI II (WISCI II) changed after 2 weeks of EAW. No improvement in lower extremity motor score (LEMS) was observed. The rates of adverse events and serious adverse events were 21% and 4%, respectively. CONCLUSIONS: The EAW programme with the new robotic exoskeleton provided potential meaningful improvements in mobility for individuals with SCI and had few adverse events.

[Three-dimensional Ultrasound Imaging of Coronal Curvature and Vertebral Rotation Changes from Supine to Standing in Patients with Adolescent Idiopathic Scoliosis].

OBJECTIVE: To investigate the gravitational effect on coronal curvature and vertebral rotation using 3-D ultrasound in patients with adolescent idiopathic scoliosis (AIS). METHODS: Sixteen female patients with AIS were recruited and examined using a 3-D ultrasound unit incorporated with SonixGPS system (Ultrasonix Medical Corporation, Canada). Ultrasound scanning was performed continuously along the coronal plane from C7 to S1, with a standing and a supine position, respectively. Coronal curvature and vertebral rotation were measured using the center of laminae (COL) method. Multivariate linear regression models were established to determine factors associated with changes of lateral curvature and vertebral rotation in different posture positions. The correlations of measurements between standing and supine were tested using Pearson correlation analyses. RESULTS: Changes of coronal curvature and vertebral rotation from a supine to a standing posture were within 1.9°-11.7° and 0.0°-5.9°, respectively. The changes increased with the severity of AIS. The 3-D ultrasound measurements of lateral curvature and vertebral rotation were highly correlated. CONCLUSION: 3-D ultrasound can reveal changes of coronal curvature and vertebral rotation from a supine to a standing posture in patients with AIS, which increase with the severity of AIS. Further studies in large samples are warranted.

[Three-dimensional Ultrasound Assessment on Apical Vertebral Rotation in Patients with Adolescent Idiopathic Scoliosis:Reliability and Validity Analyses].

OBJECTIVE: To assess reliability and validity of the three-dimensional (3-D) ultrasound measurement of apical vertebral rotation in patients with adolescent idiopathic scoliosis (AIS). METHODS: Sixteen female AIS patients were recruited. Ultrasound examinations were performed using a 3-D ultrasound unit with a SonixGPS system,which were compared with magnetic resonance imaging (MRI) examinations conducted on the same day. Two raters performed 3-D ultrasound scanning in supine position on angle measurements for vertebral rotation in the transverse plane three times,respectively. The center of laminae (COL) method was used to measure apical vertebral rotation in the 3-D ultrasound image,compared with the Aaro-Dahlborn results of MRI. Reliability of the 3-D ultrasound measurements was assessed using intra-class correlation coefficients (ICC),mean absolute deviation (MAD),standard deviation (SD) and standard error of measurement (SEM). Validity of the 3-D ultrasound measurements was assessed using paired Student t-tests,Bland-Altman statistics and Pearson correlation coefficients. The level of significance was set as 0.05. RESULTS: 3-D ultrasound had high intra- and inter-rater reliabilities (ICC [2,k]>0.9,P<0.05) for assessing vertebral rotation. There was no significant difference between the Aaro-Dahlborn results in MRI and the COL Results in 3-D ultrasound (P>0.05). High consistencies (Bland-Altman) and correlations (Pearson) were demonstrated between the two methods. CONCLUSION: Radiation-free 3-D ultrasound is a reliable and valid method for measuring apical vertebral rotation in the transverse plane of patients with AIS.

[Functional Outcome Assessment in Patients with Pelvic Fracture after Lushan Earthquake: a Punt Study using ICF-based Tool].

OBJECTIVE: The purpose of this pilot study was to assess the functional outcome of patients with pelvic fracture after Lushan earthquake using a newly developed tool based on the International Classification of Functioning, Disability and Health (ICF). METHODS: Ten patients diagnosed as pelvic fracture were recruited in this study from April 20th to 30th, 2013 in West China Hospital, Sichuan University. Data were collected using the international comprehensive version of ICF Core Set for patients with musculoskeletal conditions. Descriptive statistics analysis were used. RESULTS: Pelvic fracture caused by Lushan earthquake lead to a series of severe injuries complicated with multiple organ dysfunction. In the assessment of body functions, almost all the patients with pelvic fracture showed impairments including energy and drive, sleep, sensation of pain, mobility and repair function of skin. In the assessment of body structures, the damages were mainly distributed in pelvic region, lower extremity, trunk as well as areas of skin. In the assessment of activities and participations, limitations and restrictions were related to changing and maintaining basic body position, transferring, walking andself-care. CONCLUSION: ICF Core Set could provide a comprehensive, systematic and evidence-based assessments from the perspective of body function, body structure as well as activities and participations for patients with pelvic fracture after Lushan earthquake. Future study with large sample size is needed to validate the assessment of ICF Core Set for patients with musculoskeletal injuries after earthquake and other natural disasters.

[Correlations Between Joint Proprioception, Muscle Strength, and Functional Ability in Patients with Knee Osteoarthritis].

OBJECTIVE: To establish correlations between joint proprioception, muscle flexion and extension peak torque, and functional ability in patients with knee osteoarthritis (OA). METHODS: Fifty-six patients with symptomatic knee OA were recruited in this study. Both proprioceptive acuity and muscle strength were measured using the isomed-2000 isokinetic dynamometer. Proprioceptive acuity was evaluated by establishing the joint motion detection threshold (JMDT). Muscle strength was evaluated by Max torque (Nm) and Max torque/weight (Nm/ kg). Functional ability was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index physical function (WOMAC-PF) questionnaire. Correlational analyses were performed between proprioception, muscle strength, and functional ability. A multiple stepwise regression model was established, with WOMAC-PF as dependent variable and patient age, body mass index (BMI), visual analogue scale (VAS)-score, mean grade for Kellgren-Lawrance of both knees, mean strength for quadriceps and hamstring muscles of both knees, and mean JMDT of both knees as independent variables. RESULTS: Poor proprioception (high JMDT) was negatively correlated with muscle strength (P<0.05). There was no significant correlation between knee proprioception (high JMDT) and joint pain (WOMAC pain score), and between knee proprioception (high JMDT) and joint stiffness (WOMAC stiffness score). Poor proprioception (high JMDT) was correlated with limitation in functional ability (WOMAC physical function score r=0.659, P<0.05). WOMAC score was correlated with poor muscle strength (quadriceps muscle strength r = -0.511, P<0.05, hamstring muscle strength r = -0.408, P<0.05). The multiple stepwise regression model showed that high JMDT C standard partial regression coefficient (B) = 0.385, P<0.50 and high VAS-scale score (B=0.347, P<0.05) were significant predictors of WOMAC-PF score. CONCLUSION: Patients with poor proprioception is associated with poor muscle strength and limitation in functional ability. Patients with symptomatic OA of knees commonly endure with moderate to considerable dysfunction, which is associated with poor proprioception (high JMDT) and high VAS-scale score.

[Characteristics and Functional Status of Victims with Fractured Injury in Lushan Earthquake].

OBJECTIVE: To analyze the functional limitations and characteristics of victims with fractured injury in Lushan Earthquake. METHODS: A total of 113 patients admitted to the hospital from April 20th to 30th 2013 for treatment of fractured injury in Lushan Earthquake were recruited for this study. They were evaluated by the department of rehabilitation medicine in West China Hospital using a questionnaire. RESULTS: The most common cause of injury was falling (39.82%). Vertebral fractures (26.55%) was the most common type of injury. Most injure was light (80.53%), but incidence of complications was high (89.37%). Motor functional limitations included restricted range of motion (97.35%), balance functional limitation (89.38%) and decreased muscle force (87.61%). Limited cardiopulmonary function and limited circular function occurred in about 19.47% of patients. About 76. 11% patients had restricted activities of daily living capacities, predominantly in bathing (96.46%), stair climbing (86.73%), and walking (78.76%). Pain symptoms were common (97.35%), with 4-6 in visual analogue scale (VAS) values accounting for 40.71% of those reporting pains. Limited psychological function, professional function and social function was reported by 46.02%, 99.12% and 100% patients, respectively. CONCLUSION: Fractured injury of Lushan earthquake victims has its own characteristics. Increased attention should be paid to the restoration of psychological function, professional function and social function.

[Effect of Pulsed Electromagnetic Fields on Osteogenic Differentiation and Wnt/ß-catenin Signaling Pathway in Rat Bone Marrow Mesenchymal Stem Cells].

OBJECTIVE: To investigate the effect of pulsed electromagnetic tields (FEMFs) on osteogemc differentiation and Wnt/ß-catenin signaling pathway in rat bone marrow mesenchymal stem cells (BMSCs). METHODS: Rat BMSCs were isolated and the passage 3 cells were divided into 3 groups. Cells were cultured in LG-DMEM complete medium for 1 d to ensure fully adherent. Then, change the medium. Cells were maintained in complete medium (Control group) or in osteo-induction medium (OM group). The cells in PEMFs group were cultured in complete medium and exposed to 8 Hz, 3. 8 mT PEMF stimulation for 40 min/d. The intervention lasted for 21 d. Cell proliferation activity was determined by using MTT. The effects of PEMF onosteogenic differentiation were assessed by ALP and Alizarin Red S staining. Various osteoblast-relevant genes and genes of Wnt/ß-catenin signaling were analyzed by quantitative real-time RT-PCR. RESULTS: We. found that OM could significantly promote the proliferation of BMSC at 7 d, 14 d, 21 d (P<0. 05), but the effect was not obviously found in PEMFs group. For osteogenic differentiation, the positive rates of ALP or Alizarin Red S staining were detected higher in PEMFs/ OM group (P < 0. 05). Quantitative RT-PCR revealed PEMFs or OM could increase mRNA levels of Wnt1, Wnt3a, LRP5, ß-catenin, BMP-2, Runx2, ALP, OC at special time point (P<0. 05). Compared to OM group, PEMFs have a lower expression in each detection, but the trends were consistent. CONCLUSION: PEMFs (8 Hz, 3. 8 mT) could induce the osteogenic differentiation of rat BMSCs via activating Wnt/ß-catenin signaling pathway.

[Arguments and debates about physical therapies for osteoporosis and osteoarthritis].

Osteoarthritis (OA) and osteoporosis (OP) are primary bone and joint diseases affecting the quality of life of old people. The two diseases are different in pathogenesis but are closely associated from each other. Recent clinical guidelines have recommended physical therapies for OA and OP, which have attracted attentions and debates. This is because there is a lack of quality research into this topic. The available studies have used different measurements, and many have not been able to obtain evidence from human research apart from animal experiments. There is a need to undertake both animal and human studies with a stringent design so that the clinical efficacy and mechanism of physical therapy as well as its safety for OA and OP can be explored. We also need to pay attention to the interactions between various physical factors in order to find the best solutions in physical therapies for OA and OP.

[Pulsed electromagnetic field therapy inhibits chondrocyte apoptosis in rabbits with osteoarthritis].

OBJECTIVE: To determine the effect of pulsed electromagnetic field (PEMF) treatment on chondrocyte morphology, chondrocyte apoptosis, and the expression of apoptosis related proteins in rabbits. METHODS: 24 white New Zealand rabbits were randomly divided into three groups: normal control group (NC group), anterior cruciate ligament transection without treatment (ACLT group), and anterior cruciate ligament transection with pulsed electromagnetic field treatment (PEMF group). Six weeks after anterior cruciate ligament transection, the rabbits in the PEMF group were given 2 weeks of pulsed electromagnetic field treatment. RESULTS: Rabbits in the PEMF group had significantly lower Mankin scores than those in the ACLT group, although the scores were higher than that of the NC group. The rabbits in the PEMF groups also had significantly lower levels of apoptosis index of chondrocytes and expression of caspase-3 compared with those in the ACLT group. The expression of caspase-8 in the rabbits in the PEMF group was higher compared to the NC group, but no significant difference compared with that of the ACLT group. CONCLUSION: Pulsed electromagnetic field treatment has therapeutic effect on the experimental osteoarthritis, which is likely a result of inhibition of apoptosis in chondrocytes.

[The effect of elastic taping on patients with patellofemoral syndrome].

OBJECTIVE: To determine the effect of elastic taping on patients with patellofemoral pain and its impact on the onset time of vastusmedialis and vastuslateralis. METHODS: Eligible patients were assigned into the treatment and control groups randomly. Patients in the treatment group received a 5-day taping with therapeutic stretch. Patients in the control group were give placebo taping without therapeutic stretch. Ultrasound therapy was applied to all of the participants as a basic treatment. The levels of pain and surface electromyography were evaluated before treatment, after the first taping and on the Gh day (without taping). RESULTS: Patients in the treatment group experienced immediate improvement in pain and onset time of vastusmedialis and vastuslateralis compared with the controls. On the 6th day (without taping), further improvement was achieved in pain and onset time of vastusmedialis and vastuslateralis in the treatment group compared with the controls (P < 0.05). CONCLUSION: Elastic taping can effectively improve pain and onset time of vastusmedialis and vastuslateralis.

[The therapeutic effect of Neurac training on patients with cervical radiculopathy: a randomized control trial].

OBJECTIVE: To explore the therapeutic effect of Neurac training on patients with cervical radiculopathy (CR). METHODS: Sixty patients with CR were enrolled and randomly assigned into control group (CG) and Neurac training group (NG) with 30 patients for each group. The patients in CG group received conventional treatments for 2 weeks, including cervical traction, manual therapy and electrical therapy. The patients in NG group received Neurac training as well as conservative treatments for 2 weeks. The pain level and it impact on daily life were assessed by the numerical pain rating scale (NPRS) and the neck disability index (NDI) before the treatments and at the time of 1 week, 2 weeks after the treatments, respectively. RESULTS: Following the treatment, significant improvements for NPRS and NDI were observed in both the two groups at the end of the first and second week. The improvements for both NPRS and NDI were higher in the NG than those in the CG, with P < 0.05. CONCLUSION: The results of this study indicate that Neurac training can bring additional therapeutic benefits to conventional treatments for patients with CR.

[The estrogen-like and antioxidant effects of pilose antler blood wine in female rats with ovariectomy].

OBJECTIVE: To investigate whether pilose antler blood wine has the effects of estrogen-like activity and antioxidant in the ovariectomized (OVX) female rats. METHODS: The rat model of oxidative stress was established by ovariectomy. The female rats were divided into 6 groups: normal control group, OVX group, base wine group, and 3 pilose antler blood wine treated OVX groups (low, medium and high dose of wine at a dose of 4.5 g/kg, 9.1 g/kg and 13.6 g/kg respectively). After the feeding of pilose antler blood wine (saline in control and OVX group) for 31 days, the serum estrodial level, serum superoxide dismutase (SOD), and the content of methane dicarboxylic aldehyde (MDA) were measured. RESULTS: The one month treatment of daily drink of pilose antler blood wine could significantly promote the serum estrodial level in OVX rats (P < 0.05). Either low or medium dose could inhibit the decrease of serum SOD activity and the increase of MDA content in OVX rats, and the inhibition effects were more obvious in low dose group compared with high dose group (P < 0.05). CONCLUSION: The daily drink of pilose antler blood wine showed the effects on increasing estrodial level and antioxidation in OVX rats.

[Effects of whole body vibration on structural and functional remodeling of subchondral bones in rabbits with early osteoarthritis].

OBJECTIVE: To investigate the effects of whole body vibration therapy (WBVT) on structural and functional remodeling of subchondral bone in rabbits with early Osteoarthritis (OA). METHODS: Twenty-four adult rabbits received anterior cruciate ligament transaction (ACLT) to establish knee osteoarthritis model. The rabbits were randomly divided into two groups: ACLT group and WBVT+ ACLT group. The rabbits in the WBVT+ ACLT group received whole body vibration treatment (Frequency: 40 Hz; Amplitude: 2-4 mm; 40 min/d, 5 d/week, 4 weeks) two months after surgery. After interventions, the left femur and tibia of all rabbits were placed in a Micro-CT scanning system. The bone volume fraction (BVF), trabecular thickness (Tb. Th), trabecular spacing (Tb. Sp), trabecular number (Tb. N), volumetric BMD (vBMD), and tissue BMD (tBMD) of the bones of femoral condyle and tibia were analysed using three-dimensional reconstruction Micview V2.1.2 and ABA analysis software. Geomagic Studio 11.0 software were used to calculate modulus (EM), reaction force (RF) and average Von Miss stress (VMF). RESULTS: Higher levels of BVF, Tb. N, Tb. Th, EM, RF, VMF, vBMD and tBMD and lower levels of Tb. Sp were found in distal femora and tibia of the rabbits in the WBVT+ACLT group compared with the controls (P < 0.05). CONCLUSION: WBVT can effectively improve bone microstructure and mechanical properties of rabbits with early knee osteoarthritis.

[The effect of low-frequency pulsed electromagnetic fields on balance ability of patients with post-menopausal osteoporosis].

OBJECTIVE: To assess the effect of pulsed electromagnetic fields (PEMFs)on balance ability of postmenopausal women with osteoporosis. METHODS: 43 eligible patients were randomly divided into experimental (n = 24) and control (n = 19) groups. Patients in both groups received conventional drug therapy. Meanwhile, patients in the experimental group were given PEMFs once a day for 30 days. RESULTS: The Berg Balance Scale (BBS) scores increased and the timed upand to test (TUG) scores, sway index (forward-backward), rectangle area and sway path decreased in the patients in the experimental group (P < 0.05). In the patients in the control group, only changes in BBS scores and sway path were statistically significant (P < 0.05). The decrease of sway index (forward-backward) in the experimental group was greater than that of the control group (P < 0 01). CONCLUSION: PEMFs can improve the balance ability of patients with post-menopausal osteoporosis.

[Effect of extracorporeal shock wave therapy on cartilage and subchondral bone remodeling in rabbits with ACLT-induced osteoarthritis].

OBJECTIVE: To investigate the role of extracorporeal shock wave therapy on the protection of cartilage and subchondral bone remodeling in rabbits with osteoarthritis induced by anterior cruciate ligament transaction (ACLT). METHODS: Anterior cruciate ligament transaction was performed on 24 adult rabbits to establish knee osteoarthritis models. The rabbits were randomly divided into two groups, with one group receiving extracorporeal shock wave therapy (ESWT) and the other group serving as controls. The ESWT was set at energy 0.16 MPa/time, frequency 5 Hz, 1 200 shock per side, 3 times per week, and a total of 6 times in 4 weeks. Histological observations were undertaken with articular cartilages under mascroscope and microscope; bone mineral density (BMD) was measured. The subchondral bones of femoralcondyle and tibial plateau were given a bone histomorphometry analysis. The levels of interleukin-1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha) and nitric oxide (NO) were detected by ELISA. The expressions of matrix metalloproteinases (MMP-1, MMP 3, MMP-13) and tissue inhibitor of metalloproteinases 1 (TIMP-1) in cartilage were determined by RT-PCR. RESULTS: Lower levels of histological result in medial femoral condyles (by both mascroscope and microscope examinations) and higher levels of BMD (in distal femora) were found in the ESWT treated rabbits compared with the controls (P < 0.05). The ESWT treated rabbits also had decreased trabecular bone relative volume and trabecular bone thickness, increased bone separation, lower levels of expressions of MMP-1 and MMP-3, and higher levels of TIMP-1. CONCLUSION: ESWT can protect cartilage from damages and prevent subchondral sclerosis through regulating MMP-1, MMP-3 and TIMP-1 in cartilages and modulating subchondral bone metabolisms.

The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study.

BACKGROUND: Concerns have been raised regarding the impact of preoperative intravenous dexamethasone on postoperative glycemic control in diabetic patients undergoing total joint arthroplasty (TJA). This study aimed to determine relationships between preoperative different dexamethasone regimens and postoperative fasting blood glucose (FBG), as well as to identify risk factors for postoperative FBG ≥ 200 mg/dl in diabetic patients undergoing TJA. METHODS: This retrospective study included 1216 diabetic patients undergoing TJA and categorized into group A (dexamethasone = 0 mg), group B (dexamethasone = 5 mg), and group C (dexamethasone = 10 mg). All dexamethasone was administered before skin incision. FBG levels were monitored until postoperative day (POD) 3. Analyses were conducted for periprosthetic joint infection (PJI) and wound complications during 90 days postoperatively. And the risk factors for postoperative FBG ≥ 200 mg/dl were identified. RESULTS: Preoperative dexamethasone administration resulted in a transiently higher FBG on POD 0 and POD 1 (all P < 0.001). However, no differences were observed on POD 2 (P = 0.583) and POD 3 (P = 0.131) among three groups. While preoperative dexamethasone led to an increase in postoperative mean FBG and postoperative maximum FBG (all P < 0.001), no differences were found in wound complications (P = 0.548) and PJI (P = 1.000). Increased HbA1c and preoperative high FBG, but not preoperative dexamethasone, were identified as risk factors for postoperative FBG ≥ 200 mg/dl. Preoperative HbA1c level of ≥ 7.15% was associated with an elevated risk of postoperative FBG ≥ 200 mg/dl. CONCLUSIONS: Although preoperative intravenous administration of 5 mg or 10 mg dexamethasone in diabetic patients showed transient effects on postoperative FBG after TJA, no differences were found in the rates of PJI and wound complications during 90 days postoperatively. Notably, patients with a preoperative HbA1c level of ≥ 7.15% and elevated preoperative FBG may encountered postoperative FBG ≥ 200 mg/dl.