Therapeutic effect of platelet-rich plasma on glucocorticoid-induced rat bone marrow mesenchymal stem cells in vitro.

BACKGROUND: Glucocorticoid-induced osteonecrosis of the femoral head (GIONFH) is a progressive and disabling disease caused by long-term or high-dose glucocorticoid use. Decreased osteogenesis and proliferation of bone marrow mesenchymal stem cells (BMSCs) are the main pathogenesis of GIONFH. Platelet-rich plasma (PRP) has been shown to play a promising role in bone regeneration. However, the effects of PRP on glucocorticoid-induced BMSCs inhibition remains elusive. The objective of this study was to explore whether PRP could improve the in vitro biological activities of BMSCs inhibited by high-dose glucocorticoid in vitro. METHODS: In this study, a dexamethasone (Dex)-induced in vitro cell model was established. The effects of PRP on proliferation, migration, cell cycle and apoptosis of rat BMSCs induced with high-dose Dex compared to BMSCCTRL, using CCK-8 assay, transwell, flow cytometry and TUNEL assay, respectively. We further performed the alkaline phosphatase (ALP) and alizarin red (ALR) staining to explore the influence of PRP on osteogenic differentiation. Western Blot was used to detect the expression of Bcl-2, Caspase-3, RUNX2 apoptosis, and osteogenic-related proteins. RESULTS: We observed increased apoptosis rate and Caspase-3 expression, and the decreased migration and osteogenic differentiation, and down-regulation of RUNX-2 and Bcl-2 expression in Dex-induced BMSCs. PRP could reverse these inhibitory effects of Dex, and enhance the BMSCs proliferation, migration, and osteogenic ability in vitro. CONCLUSION: Our vitro study showed that PRP significantly protected BMSCs from Dex-induced apoptosis, and further promoted BMSCs proliferation, migration, and osteogenic differentiation. This study provides a scientific basis for the prevention and treatment of GIONFH with PRP. Meanwhile, it also lays the foundation for the application of PRP in other musculoskeletal diseases.

Comparison of the effectiveness of resistance training in women with chronic computer-related neck pain: a randomized controlled study.

BACKGROUND: Chronic computer-related neck pain is common among office workers. Studies have proposed neck strengthening exercise as a therapy to pain relieving and function improvement. The aim of this study was to compare the efficacy of different loading resistance trainings and we hypothesized that women with work-related neck pain could benefit more from progressive resistance training for pain and function recovery. METHODS: A randomized controlled trial was conducted and subjects characterized by monotonous jobs were recruited. One hundred and nine employed women with chronic neck pain were randomly allocated into three groups, namely, progressive resistance training (PRT), fixed resistance training (FRT), and control group (CG). In PRT and FRT, four exercises for neck muscles with an elastic rubber band were performed on regular basis for 6 weeks. The therapeutic effectiveness was then evaluated at pretreatment, 2, 4, and 6 weeks during training period, and 3-month posttreatment. Assessment tools included visual analog scale (VAS), Neck Disability Index (NDI), pressure pain threshold (PPT), and maximal isometric neck strength. RESULTS: The outcomes were significantly better in PRT and FRT than those in CG at 6-week timepoint and 3-month follow-up (p = 0.000), in terms of VAS, NDI, PPT, and neck muscle strength. Besides, there were statistically significant decreases observed in VAS scores of PRT group compared with those in FRT at 4-, 6-week timepoints, and 3-month follow-up (p < 0.05). CONCLUSIONS: The neck resistance training was an effective method for pain relieving, mobility improving, pain threshold, and neck muscle strength enhancing in women with chronic computer-related neck pain. Thus, our study provided evidence that women with work-related neck pain might benefit more from PRT, which may have important implications for future clinical practice. TRIAL REGISTRATION: The study was qualified and registered in the Chinese Clinical Trial Registry as ChiCTR-TRC-12002723.

CT-guided nucleoplasty with radiofrequency energy for the treatment of lumbar disk herniation.

STUDY DESIGN: A clinical randomized controlled trial. OBJECTIVE: This study sought to compare the clinical effectiveness of CT-guided nucleoplasty, CT-guided nucleoplasty combined with nerve root injection, and CT-guided transforaminal lumbar epidural injections in treating patients with contained lumbar disk herniation and leg pain, which are caused by radicular encroachment. SUMMARY OF BACKGROUND DATA: Lumbar disk herniation is the most common cause of nerve root pain. The conservative treatment is proved to be effective for the majority of these patients, and the remaining patients are not ideal surgical candidates. Studies have found that minimally invasive percutaneous disk procedures may be preferable to open surgery in certain clinical situations. However, nucleoplasty in treating contained lumbar disk herniation and leg pain caused by radicular encroachment is still a controversy. DESIGN: A total of 97 patients with leg pain and MRI evidence of small-sized or medium-sized herniated disks correlating with the symptoms participated in the study. The patients were randomly allocated into 3 groups: the CT-guided nucleoplasty group (N=33), the CT-guided nucleoplasty with nerve root injection group (N=35), and CT-guided transforaminal lumbar epidural injections group (N=29). Numeric Rating Scale (NRS) pain score and Oswestry Disability Index (ODI) values were applied at pretreatment and 1 week, 1 month, 3 months, and 12 months at posttreatment. RESULTS: There were statistically significant decreases (P=0.000) in the NRS and ODI scores for all posttreatment time points when compared with the pretreatment values in all the 3 groups. The average NRS and ODI results for the transforaminal lumbar epidural injections group were significantly higher than those for the other 2 groups at 3 and 12 months posttreatment (P<0.05). The combination of nucleoplasty with nerve root injection produced a significantly greater reduction in the NRS and ODI scores when compared with nucleoplasty at 1 week (P=0.000 for NRS and P=0.004 for ODI) and 1 month (P=0.000 for NRS and P=0.007 for ODI) after the treatment. CONCLUSIONS: The results of this study suggest that CT-guided nucleoplasty with radiofrequency energy is a relative effective and safe technique for treating leg pain caused by radicular encroachment. Furthermore, nucleoplasty combined with nerve root injection had achieved a significant greater improvement in pain management and functional level in short term (within 1 mo) after treatment than nucleoplasty alone.

Running exercise alleviates pain and promotes cell proliferation in a rat model of intervertebral disc degeneration.

Chronic low back pain accompanied by intervertebral disk degeneration is a common musculoskeletal disorder. Physical exercise, which is clinically recommended by international guidelines, has proven to be effective for degenerative disc disease (DDD) patients. However, the mechanism underlying the analgesic effects of physical exercise on DDD remains largely unclear. The results of the present study showed that mechanical withdrawal thresholds of bilateral hindpaw were significantly decreased beginning on day three after intradiscal complete Freund's adjuvant (CFA) injection and daily running exercise remarkably reduced allodynia in the CFA exercise group beginning at day 28 compared to the spontaneous recovery group (controls). The hindpaw withdrawal thresholds of the exercise group returned nearly to baseline at the end of experiment, but severe pain persisted in the control group. Histological examinations performed on day 70 revealed that running exercise restored the degenerative discs and increased the cell densities of the annulus fibrosus (AF) and nucleus pulposus (NP). Furthermore, immunofluorescence labeling revealed significantly higher numbers of 5-bromo-2-deoxyuridine (BrdU)-positive cells in the exercise group on days 28, 42, 56 and 70, which indicated more rapid proliferation compared to the control at the corresponding time points. Taken together, these results suggest that running exercise might alleviate the mechanical allodynia induced by intradiscal CFA injection via disc repair and cell proliferation, which provides new evidence for future clinical use.

Transport of glial cell line-derived neurotrophic factor into liposomes across the blood-brain barrier: in vitro and in vivo studies.

Glial cell line-derived neurotrophic factor (GDNF) was encapsulated into liposomes in order to protect it from enzyme degradation in vivo and promote its permeability across the blood-brain barrier (BBB). In this study, GDNF conventional liposomes (GDNF-L) and GDNF target sterically stabilized liposomes (GDNF-SSL-T) were prepared. The average size of liposomes was below 90 nm. A primary model of BBB was established and evaluated by transendothelial electrical resistance (TEER) and permeability. This BBB model was employed to study the permeability of GDNF liposomes in vitro. The results indicated that the liposomes could enhance transport of GDNF across the BBB and GDNF-SSL-T had achieved the best transport efficacy. The distribution of GDNF liposomes was studied in vivo. Free GDNF and GDNF-L were eliminated rapidly in the circulation. GDNF-SSL-T has a prolonged circulation time in the blood and favorable brain delivery. The values of the area under the curve (AUC(0-1 h)) in the brain of GDNF-SSL-T was 8.1 times and 6.8 times more than that of free GDNF and GDNF-L, respectively. These results showed that GDNF-SSL-T realized the aim of targeted delivery of therapeutic proteins to central nervous system.

Comparison of Leukocyte-Rich and Leukocyte-Poor Platelet-Rich Plasma on Pressure Ulcer in a Rat Model.

Pressure ulcer (PU) is a common type of chronic wound that is difficult to treat. Platelet-rich plasma (PRP) is rich in cytokines and growth factors, and it can be divided into two categories according to its leukocyte content: leukocyte-poor PRP (P-PRP) and leukocyte-rich PRP (L-PRP). PRP has been applied in a variety of wound treatments, due to its strong ability to promote repair. This study aims to investigate the therapeutic effects of PRP on PU and elucidate the role of leukocytes in the treatment process. Sprague-Dawley rats were used to establish PU models of ischemia-reperfusion injury by applying magnets externally. L-PRP, P-PRP, and saline were injected into the dermal wounds. Wound healing analysis and sampling were performed on days 3, 7, 11, and 15 after treatment. Histological examinations, real-time PCR, immunohistochemical examinations, and biomechanical assay were carried out on the wound samples. The PRP groups exhibited greater wound inflammatory response than the control group in the early stage but the response reduced rapidly as the wound healed. On days 7, 11, and 15, the PRP groups also yielded better wound healing rates and histological outcomes than the control group, with superior biomechanical properties observed on day 15. Among both PRP groups, the L-PRP group attained a higher wound healing rate than the P-PRP group on day 7, with greater significant early inflammatory responses, and more prominent angiogenesis. Therefore, PRP is proven to accelerate the healing of PU, with L-PRP being more effective in regulating inflammation and promoting angiogenesis than P-PRP.

Comparisons of Ultrasound-Guided Platelet-Rich Plasma Intra-Articular Injection and Extracorporeal Shock Wave Therapy in Treating ARCO I-III Symptomatic Non-Traumatic Femoral Head Necrosis: A Randomized Controlled Clinical Trial.

BACKGROUND AND OBJECTIVE: Osteonecrosis of the femoral head (ONFH) is a devastating disease, and there is some evidence that extracorporeal shock wave therapy (ESWT) and intra-articular platelet-rich plasma (PRP) injection might alleviate pain and improve joint function in individuals with ONFH. The objective of this study was to compare the effectiveness and safety of PRP and ESWT in symptomatic ONFH patients. METHODS: A total of 60 patients aged 40-79 with unilateral ONFH at Association Research Circulation Osseous (ARCO) stages I, II, and III were randomly assigned to the PRP (N=30) or the ESWT group (N=30). Four treatment sessions were provided in both groups. Assessments were performed at baseline, and 1-, 3-, 6-, and 12-month. Primary outcomes were measured by the visual analogue scale (VAS), and pressure pain thresholds (PPTs). Secondary outcomes were assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and magnetic resonance imaging (MRI). The linear mixed-model analysis was used to evaluate the differences between groups and within groups and the "group by time" interaction effects. RESULTS: There were significant differences between groups in terms of changes over time for VAS, PPTs, WOMAC, and HHS since 3-month and maintained up to 12-month (P<0.05, except for PPTs at 12-month). The simple main effects showed that the patients in PRP group had greater improvements in VAS (mean difference = -0.82, 95% CI [-1.39, -0.25], P=0.005), WOMAC (mean difference = -4.19, 95% CI [-7.00, -1.37], P=0.004), and HHS (mean difference = 5.28, 95% CI [1.94, 8.62], P=0.002). No related adverse events were reported. CONCLUSION: This study supported the effectiveness and safety of both the PRP injection and ESWT in treating ONFH patients. For symptomatic patients with ONFH, intra-articular PRP injection appeared superior to ESWT in pain relief and functional improvement.

Comparing biofeedback with active exercise and passive treatment for the management of work-related neck and shoulder pain: a randomized controlled trial.

OBJECTIVES: To compare the effects of biofeedback with those of active exercise and passive treatment in treating work-related neck and shoulder pain. DESIGN: A randomized controlled trial with 3 intervention groups and a control group. SETTING: Participants were recruited from outpatient physiotherapy clinics and a local hospital. PARTICIPANTS: All participants reported consistent neck and shoulder pain related to computer use for more than 3 months in the past year and no severe trauma or serious pathology. A total of 72 potential participants were recruited initially, of whom a smaller group of individuals (n=60) completed the randomized controlled trial. INTERVENTIONS: The 3 interventions were applied for 6 weeks. In the biofeedback group, participants were instructed to use a biofeedback machine on the bilateral upper trapezius (UT) muscles daily while performing computer work. Participants in the exercise group performed a standardized exercise program daily on their own. In the passive treatment group, interferential therapy and hot packs were applied to the participants' necks and shoulders. The control group was given an education booklet on office ergonomics. MAIN OUTCOME MEASURES: Pain (visual analog scale), neck disability index (NDI), and surface electromyography were assessed preintervention and postintervention. Pain and NDI were reassessed after 6 months. RESULTS: Postintervention, average pain and NDI scores were reduced significantly more in the biofeedback group than in the other 3 groups, and this was maintained at 6 months. Cervical erector spinae muscle activity showed significant reductions postintervention in the biofeedback group, and there were consistent trends of reductions in the UT muscle activity. CONCLUSIONS: Six weeks of biofeedback training produced more favorable outcomes in reducing pain and improving muscle activation of neck muscles in patients with work-related neck and shoulder pain.

Platelet-rich plasma for the treatment of adolescent late-stage femoral head necrosis: a case report.

Osteonecrosis of femoral head (ONFH) is a disabling and intractable disease. Previous studies reported the increasing failure rates of total hip arthroplasty in younger patients, thus there should be special considerations for the adolescents. In this paper, we present a case of an adolescent female with late-stage glucocorticoid-induced ONFH (according to the Association Research Circulation Osseous classification system, Association Research Circulation Osseous IV). The patient received five consecutive ultrasound-guided intra-articular injections of platelet-rich plasma, and the therapeutic effects were assessed by visual analog scale, joint range of motion, Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score and magnetic resonance imaging. At 9-month follow-up, clinical and radiological reassessments demonstrated favorable outcomes. This case highlights the therapeutic potential of platelet-rich plasma injections for the late-stage ONFH, especially for adolescent patients.

Effect of Core Stability Training Monitored by Rehabilitative Ultrasound Image and Surface Electromyogram in Local Core Muscles of Healthy People.

Background: The purpose of this study is to investigate the influence of transverses abdominis and lumbar multifidus thickness activation and electromyogram signal characteristics after core stability training monitored by rehabilitative ultrasound imaging and surface electromyogram. Methods: 60 healthy volunteers were allocated randomly into two groups, one of which received monitoring training and the other participated identical training without monitoring. Ultrasound image and surface electromyogram signal were collected at 0, 4, and 8 weeks during training. The muscle thickness activation ratio value and integrated electromyogram value were then extracted. During the training, the monitoring group was monitored by real-time rehabilitative ultrasound imaging and surface electromyogram while the control group was not. Results: There are no differences in performance of local core muscles between both groups before training (p > 0.05). Compared with the control group, the thickness contraction ratio value and integrated electromyogram value of core muscles in the monitoring group were higher after 8 weeks' training (p < 0.05). Conclusion: Together, the core stability training monitored by rehabilitative ultrasound imaging and surface electromyogram can markedly activate and enhance local core muscles in healthy people, providing a potential strategy to treat low back pain more effectively.

The Effectiveness of Ultrasound-Guided Steroid Injection Combined with Miniscalpel-Needle Release in the Treatment of Carpal Tunnel Syndrome vs. Steroid Injection Alone: A Randomized Controlled Study.

OBJECTIVES: Carpal tunnel syndrome (CTS) is one of the most common nerve entrapment syndromes, which has a serious impact on patients' work and life. The most effective conservative treatment is steroid injection but its long-term efficacy is still not satisfactory. The aim of this study was to evaluate the effectiveness of steroid injection combined with miniscalpel-needle (MSN) release for treatment of CTS under ultrasound guidance versus steroid injection alone. We hypothesized that combined therapy could be more beneficial. METHODS: Fifty-one patients with CTS were randomly allocated into two groups, namely, steroid injection combined with MSN release group and steroid injection group. The therapeutic effectiveness was evaluated using Boston Carpal Tunnel Questionnaire (BCTQ), cross-sectional area (CSA) of the median nerve, and four electrophysiological parameters, including distal motor latency (DML), compound muscle action potential (CMAP), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) at baseline, 4 and 12 weeks after treatment. RESULTS: Compared with baseline, all the parameters in both groups showed statistically significant improvement at week 4 and week 12 follow-up, respectively (P<0.05). When compared with steroid injection group, the outcomes including BCTQ, DML, CMAP, SNCV, and CSA of the median nerve were significantly better in steroid injection combined with MSN release group at week 12 after treatment (P<0.05). CONCLUSIONS: The effectiveness of steroid injection combined with MSN release for CTS is superior to that of steroid injection alone, which may have important implications for future clinical practice. This Chinese clinical trial is registered with ChiCTR1800014530.

Randomized Trial on Comparison of the Efficacy of Extracorporeal Shock Wave Therapy and Dry Needling in Myofascial Trigger Points.

OBJECTIVE: The aim of the study was to compare the efficacy of radial extracorporeal shock wave therapy and dry needling in the treatment of myofascial trigger points in the upper trapezius muscle. DESIGN: A total of 65 patients with myofascial trigger points were randomly divided into extracorporeal shock wave therapy group (n = 32) and dry needling group (n = 33). Patients received 3 wks of treatment at 1-wk intervals (in both groups). Visual analog scale, pressure pain threshold, Neck Disability Index, and shear modulus were evaluated before treatment, immediately after the first therapy, 1 mo, and 3 mos after the completion of the third therapy. RESULTS: Significant improvements of visual analog scale, pressure pain threshold, and Neck Disability Index scores were observed at all time points after treatment (P < 0.01) in both treatment groups. The shear modulus of myofascial trigger points was reduced in both dry needling group (P < 0.05) and extracorporeal shock wave therapy group (P < 0.01) immediately after the first treatment. Significant reductions in shear modulus were maintained up to 3-mo posttreatment in both groups (P < 0.01). There were no significant differences between the radial extracorporeal shock wave therapy group and dry needling group. CONCLUSIONS: The extracorporeal shock wave therapy is as effective as dry needling for relieving pain, improving function, and reducing shear modulus for patients with myofascial trigger points after a series of three treatments.

Yes-associated protein mediates angiotensin II-induced vascular smooth muscle cell phenotypic modulation and hypertensive vascular remodelling.

OBJECTIVES: Yes-associated protein (YAP) has been reported to regulate cell proliferation and differentiation. We aimed to characterize the role of YAP in angiotensin II (Ang II)-induced hypertensive vascular remodelling (HVR) and vascular smooth muscle cells (VSMCs) phenotypic modulation and to explore the underlying mechanisms. MATERIALS AND METHODS: An HVR rat model was established by continuous Ang II infusion for 2 weeks. Western blotting, qRT-PCR, and confocal microscopy were conducted to assess YAP expression. YAP-shRNA interfering plasmid and adenovirus were constructed to knock down YAP. We used cell proliferation and migration assays, accompanied by pathway inhibitors, to evaluate the biological function and underlying mechanisms. RESULTS: Ang II upregulated YAP expression in the media of carotid artery; however, in vivo YAP silencing significantly mitigated HVR, independent of the blood pressure level. Ang II upregulated YAP expression and promoted YAP nuclear accumulation in a dose- and time-dependent manner in rat VSMCs. YAP knockdown ameliorated Ang II-induced VSMCs phenotypic modulation. The regulation of YAP by Ang II could be blocked by pretreatment with angiotensin receptor type 1 antagonist losartan or F-actin depolymerizing agent latrunculin B but not the AT2R antagonist PD 123319. Disrupting the YAP-TEA domain (TEAD) interaction with verteporfin inhibited Ang II-induced VSMCs phenotypic modulation. CONCLUSIONS: Yes-associated protein mediated angiotensin II-induced VSMCs phenotypic modulation and vascular remodelling. YAP is a potential therapeutic target for HVR beyond blood pressure control.

Ultrasonography-Guided Lumbar Periradicular Injections for Unilateral Radicular Pain.

Objective. The aim of this study was to compare the accuracy and efficacy of sonographically guided lumbar periradicular injections through in-plane or out-of-plane approach techniques for patients with unilateral lower lumbar radicular pain. The feasibility and accuracy of these techniques were studied by means of computed tomography (CT). Methods. A total of 46 patients with chronic unilateral lumbar radicular pain were recruited and randomly assigned to either the in-plane or out-of-plane injection group. A mixture of 3 mL 1% lidocaine and 7 mg betamethasone was injected. The visual analog scale (VAS) was used to assess pain before and after treatment. Results. The pain intensity, as measured by VAS, significantly decreased in both in-plane and out-of-plane injection groups. Conclusions. The sonographically guided periradicular injections are feasible and effective in treating lumbar unilateral radicular pain.

Ultrasound-Guided versus Fluoroscopy-Guided Deep Cervical Plexus Block for the Treatment of Cervicogenic Headache.

Objective. The aim of this study was to compare the efficacy of ultrasound-guided deep cervical plexus block with fluoroscopy-guided deep cervical plexus block for patients with cervicogenic headache (CeH). Methods. A total of 56 patients with CeH were recruited and randomly assigned to either the ultrasound-guided (US) or the fluoroscopy-guided (FL) injection group. A mixture of 2-4 mL 1% lidocaine and 7 mg betamethasone was injected along C2 and/or C3 transverse process. The measurement of pain was evaluated by patients' ratings of a 10-point numerical pain scale (NPS) before and 2 wks, 12 wks, and 24 wks after treatments. Results. The blocking procedures were well tolerated. The pain intensity, as measured by NPS, significantly decreased at 2 wks after injection treatment in both US and FL groups, respectively, compared with that of baseline (P < 0.05). The blocking procedures had continued, and comparable pain relieving effects appeared at 12 wks and 24 wks after treatment in both US and FL groups. There were no significant differences observed in the NPS before and 2 wks, 12 wks, and 24 wks after treatment between US and FL groups. Conclusions. The US-guided approach showed similar satisfactory effect as the FL-guided block. Ultrasonography can be an alternative method for its convenience and efficacy in deep cervical plexus block for CeH patients without radiation exposure.

Cross-cultural adaptation, reliability, and validity of the Chinese version of the STarT Back Screening Tool in patients with low back pain.

STUDY DESIGN: Translation and psychometric testing. OBJECTIVE: The study aims to investigate the reliability and validity of the Chinese version of the STarT Back Screening Tool (STarT) in Chinese-speaking patients with low back pain (LBP) after translation and cultural adaptation. SUMMARY OF BACKGROUND DATA: To date, no previous studies exist on the translation process and validation of the Chinese version of the STarT. METHODS: The procedure of translation, which included 6 stages, was performed according to the current recommended guidelines. Psychometric testing included face validity, test-retest reliability, and discriminant validity. A total of 307 patients completed a questionnaire booklet containing the Chinese version of the STarT, Roland-Morris Disability Questionnaire, Coping Strategies Questionnaire, Tampa Scale for Kinesiophobia-17, and Hospital Anxiety and Depression Scale. Seventy-four randomly selected patients were asked to finish the STarT a second time within 24 to 48 hours. The demographic characteristics and outcomes of psychometric testing were compared with the original English cohort. RESULTS: No items of the final version had reported ambiguity after the face validation and no floor or ceiling effects were noted. The intraclass correlation coefficient was 0.933 (95% confidence interval, 0.896-0.957), demonstrating very good reliability. Discriminant validity was established, with area under curve results in the range from 0.751 to 0.893 (95% confidence interval, 0.697-0.930) in the Chinese cohort compared with 0.840 to 0.925 (95% confidence interval, 0.772-0.948) in the original English cohort. CONCLUSION: The results confirm the successful translation and adaptation of the STarT into Chinese, with appropriate reliability and validity. Therefore, this version can be recommended for clinical and research use for Chinese patients with LBP.