Effect of pulsed electromagnetic fields on mesenchymal stem cell-derived exosomes in inhibiting chondrocyte apoptosis / 生物医学工程学杂志

The study aims to explore the effect of mesenchymal stem cells-derived exosomes (MSCs-Exo) on staurosporine (STS)-induced chondrocyte apoptosis before and after exposure to pulsed electromagnetic field (PEMF) at different frequencies. The AMSCs were extracted from the epididymal fat of healthy rats before and after exposure to the PEMF at 1 mT amplitude and a frequency of 15, 45, and 75 Hz, respectively, in an incubator. MSCs-Exo was extracted and identified. Exosomes were labeled with DiO fluorescent dye, and then co-cultured with STS-induced chondrocytes for 24 h. Cellular uptake of MSC-Exo, apoptosis, and the protein and mRNA expression of aggrecan, caspase-3 and collagenⅡA in chondrocytes were observed. The study demonstrated that the exposure of 75 Hz PEMF was superior to 15 and 45 Hz PEMF in enhancing the effect of exosomes in alleviating chondrocyte apoptosis and promoting cell matrix synthesis. This study lays a foundation for the regulatory mechanism of PEMF stimulation on MSCs-Exo in inhibiting chondrocyte apoptosis, and opens up a new direction for the prevention and treatment of osteoarthritis.

Application of platelet-rich plasma-based regenerative rehabilitation technology in the management of sports injury / 中华创伤杂志

The most common sports injury is trauma to the skeletal muscles, with injuries to ligaments, muscles, tendons, joint capsules or cartilage and minor injuries to other chronic soft tissues, accounting for 97% of all cases. These injuries directly affect athletes′ performance, shorten their athletic career, and also impede the daily life and work of the general public. Surgical and non-surgical interventions often fail to meet the demands for quick recovery, and patients with sports injury may experience joint stiffness, limited range of motion, and pain-related functional impairments. Platelet-rich plasma (PRP) has a role in the promotion of tissne regeneration, regulation of immune response and suppression of inflammation. PRP-based regenerative rehabilitation technology offers new possibilities for rapid recovery of patients with sports injury. However, there have been few reports on the combined application of PRP and principles/methods of rehabilitation medicine. To this end, the authors summarized the history of regenerative rehabilitation medicine, explored the feasibility of PRP-based regenerative rehabilitation technology in the treatment of sports injuries, and discussed the application prospects of PRP-based regenerative rehabilitation technology regarding the joint, muscle, tendon, and ligament injuries.

Early clinical efficacy of ultrasound-guided platelet-rich plasma technology in the treatment of lumbodorsal myofascial pain syndrome after sports injury / 中华创伤杂志

Objective:To explore the early clinical efficacy of ultrasound visualized platelet-rich plasma (PRP) in the treatment of lower back myofascial pain syndrome (MPS) after sports injury.Methods:A prospective cohort study was conducted to analyze the clinical data of 32 patients with lower back MPS after sports injury, who were admitted to West China Hospital of Sichuan University from January 2023 to March 2023. Ultrasound-guided PRP injection into the erector spinalis or quadratus psoas muscles was used for treatment. Before treatment, at 24 hours, 2 weeks, and 4 weeks after treatment, pain and function were evaluated using visual analogue scale (VAS), McGill pain questionnaire (McGill), Roland Morris dysfunction questionnaire (RMDQ), and Oswestry dysfunction index (ODI). Before treatment and 4 weeks after treatment, the quality of life was evaluated using the short-form 36 item health survey questionnaire (SF-36). The adverse reactions were observed during treatment and follow-up.Results:A total of 32 patients with lower back MPS after sports injury were enrolled, including 10 males and 22 females; aged 12-68 years [(47.3±16.3)years]. All the patients were followed up for 4 weeks. Before and at 24 hours, 2 weeks, and 4 weeks after treatment, the VAS was 5.0(4.0, 6.0)points, 3.5(3.0, 4.8)points, 2.0(2.0, 3.0)points, and 2.0(1.3, 3.0)points, respectively; the McGill score was 9.0(7.0, 11.0)points, 7.0(5.0, 9.0)points, 4.0(3.0, 5.0)points, and 3.0(3.0, 5.0)points, respectively; the RMDQ score was 8.0(5.3, 10.8)points, 5.5(3.0, 8.0)points, 4.0(3.0, 5.8)points, and 3.0(2.0, 4.8)points, respectively; the ODI was 22.0(14.5, 30.0), 20.0(14.5, 25.5), 9.0(6.0, 16.0), and 8.0(4.5, 14.0), respectively. Compared with the values before treatment, the VAS, McGill score, and RMDQ score were significantly decreased at 24 hours, 2 weeks, and 4 weeks after treatment (all P<0.05); the ODI had no significant difference at 24 hours after treatment ( P>0.05), but it was significantly decreased at 2 and 4 weeks after treatment (all P<0.05). Compared with the values at 24 hours after treatment, the VAS, McGill score, RMDQ score and ODI further decreased at 2 weeks after treatment (all P<0.05). Compared with the values at 2 weeks after treatment, there was no significant difference in the VAS, McGill score, RMDQ score, or ODI at 4 weeks after treatment (all P>0.05). In the SF-36, the scores of physiological function [77.5(60.0, 93.8)points], physiological role [50.0(0.0, 100.0)points], body pain [64.0(44.5, 74.0)points], vitality [75.0(65.0, 78.8)points], social function [87.5(75.0, 100.0)points], emotional role [66.7(33.3, 100.0)points] and mental health [72.0(68.0, 83.0)points] before treatment were increased to 90.0(80.0, 98.8)points, 100.0(56.3, 100.0)points, 84.0(74.0, 84.0)points, 75.0(70.0, 80.0)points, 100.0(87.5, 112.5)points, 100.0(66.7, 100.0)points, and 76.0(68.0, 84.0)points after 4 weeks of treatment, respectively ( P<0.05 or 0.01). However, there was no significant difference in the general health status or health changes before and after treatment (all P>0.05). During treatment and follow-up, no adverse reactions such as redness, swelling, pain, or subcutaneous bleeding were observed. Conclusion:Ultrasound-guided PRP treatment can improve the early pain, lumbar mobility and quality of life of patients with lower back MPS after sports injury, with no presence of adverse reactions.

Negative pressure wound therapy and functional dressings in primary repair of spinal cord injury complicated with lacunar soft tissue defects: a comparison of efficacies / 中华创伤杂志

Objective:To compare the efficacies of negative pressure wound therapy (NPWT) and functional dressings in primary repair of spinal cord injury complicated with lacunar soft tissue defects.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with spinal cord injury complicated with lacunar soft tissue defects. The patients were admitted to West China Hospital, Sichuan University from January 2020 to December 2022, including 20 males and 10 females; aged 23-54 years [(42.1±7.8)years]. Wound site was located at the sacrococcygeal region in 16 patients, the buttock in 11, and the femoral trochanter in 3. Wound area was 28-36 cm 2 [(32.1±2.1)cm 2]. Time of wound formation was at range of 1-4 months [(2.0±0.8)months]. Among them, 15 patients received functional dressing treatment after mechanical/ultrasonic debridement (dressing treatment group), and 15 patients received NPWT treatment on the basis of mechanical/ultrasonic debridement (negative pressure treatment group). The following items were compared between the two groups: the time of primary wound repair, results of bacterial culture of wound secretions before and at the end of primary wound repair, and levels of serum interleukin-6 (IL-6) and C-reactive protein (CRP) as well as Bates-Jensen wound assessment tool (BWAT) score before, at 5 days after the primary repair and at the end of the primary repair. Results:All the patients were followed up for 3-6 months [(4.1±0.9)months]. The time of primary wound repair in the negative pressure treatment group was (13.4±2.3)days, which was markedly shorter than that in the dressing treatment group [(22.8±2.5)days] ( P<0.01). Before the primary repair, 11 patients in the negative pressure treatment group showed positive bacterial culture of wound secretions [73.3% (11/15)], and 9 patients in the dressing treatment group were positive [60.0% (9/15)] ( P>0.05). At the end of primary repair, there was 1 patient with positive bacterial culture of wound secretions in the negative pressure treatment group [6.7% (1/15)], which was less than 7 patients in the dressing treatment group [46.7% (7/15)] ( P<0.05). The numbers of positive patients at the end of the primary repair were lower than those before the primary repair in both groups, and the difference in the negative pressure treatment group was statistically significant ( P<0.01), with no significant difference found in the dressing treatment group ( P>0.05). Before the primary repair, the IL-6, CRP and BWAT score were 20.5(8.4, 32.3)pg/ml, 24.2(14.7, 33.0)mg/L, and (37.1±4.8)points in the negative pressure treatment group, comparable with 13.8(11.8, 35.4)pg/ml, 23.6(13.1, 52.3)mg/L, and (35.2±4.7)points in the dressing treatment group (all P>0.05). At 5 days after primary repair, the IL-6, CRP and BWAT score in the negative pressure treatment group were 20.2(7.9, 28.6)pg/ml, 20.0(11.6, 30.5)mg/L, and (34.9±4.3)points, comparable with 11.6(8.9, 20.6)pg/ml, 25.3(10.0, 50.3)mg/L, and (35.2±4.5)points in the dressing treatment group (all P>0.05). At the end of primary repair, the IL-6, CRP and BWAT score were 2.3(1.5, 4.5)pg/ml, 4.8(3.7, 6.9)mg/L, and (23.6±1.8)points in the negative pressure treatment group, statistically different from 4.4(3.3, 6.9)pg/ml, 8.4(5.5, 31.4)mg/L, and (31.4±3.3)points in the dressing treatment group (all P<0.01). The IL-6, CRP and BWAT score at the end of the primary repair were significantly different compared with those before and at 5 days after the primary repair in the two groups ( P<0.05 or 0.01). However, no significant difference was found between the two groups before and at 5 days after the primary repair (all P>0.05). Conclusion:Compared with functional dressings, NPWT can shorten the time required for primary repair of spinal cord injury complicated with lacunar soft tissue defects, control the inflammatory state of the wound, improve the trend of wound healing, and create a good condition for secondary repair treatment of the wound.

Clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version) / 中华创伤杂志

Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.

The effectiveness of virtual reality therapy in relieving upper limb hemiparesis after stroke:A meta-analysis of randomized and controlled trials / 中华物理医学与康复杂志

Objective To analyze the clinical efficacy of using virtual reality ( VR) to improve the upper limb function of hemiplegic persons. Methods A search was conducted in the PubMed, Cochrane Library, EM-BASE, CNKI and Wanfang Data as well as VIP for reports of randomized and controlled studies of using VR in train-ing upper limb function after stroke. A meta-analysis was then performed using version 5. 3 of the Review Manager software. Results Ninety studies involving 879 patients were found and analyzed. The data showed that VR was sig-nificantly more effective than conventional training in improving Fugl-Meyer assessment scores. It was not superior, however, in improving average Functional Independence Measure scores or performance in the box and blocks test. Conclusion VR is superior to conventional training in promoting the recovery of upper limb function after a stroke.

Fine Management in Teaching of Clinical Practice of Rehabilitation Therapy / 中国康复理论与实践

For fine management of the clinical practice teaching in the rehabilitation therapy, a set of Rehabilitation Therapy Clinical Practice Examination was developed. It was used to assess the skill of rehabilitation evaluation, rehabilitation therapy and related knowledge of every internships, to avoid the arbitrary result of the practice examination, and has been well accepted in practice.

Whole body vibration training improves limb motor dysfunction in stroke patients:lack of evidence / 中国组织工程研究

BACKGROUND:Whole body vibration training, a recently developed method of neuromuscular training, is a useful method to improve muscle strength and postural control in the elderly. Recently, researchers attempt to explore whether whole body vibration training can reduce motor dysfunction for stroke patients. OBJECTIVE:To summarize clinical progress in whole body vibration treatment on stroke patients with limb motor dysfunction, including muscle strength of the affected limbs, muscle tension, balance and gait. METHODPubMed, EBSCO, Medline database were searched for articles relate to whole body vibration training intervention for stroke patients with motor dysfunction published from January 2002 to June 2014. Final y, 34 articles were included in result analysis. RESULTS AND CONCLUSION:Whole body vibration training is feasible and safe for stroke patients has the feasibility and safety. For therapeutic efficacy, we focus on the muscle strength, muscle tone, balance, posture control ability, but there is no sufficient evidence to support that the whole body vibration training can improve the motor dysfunction. There is also no recognized standard on specific intervention protocols, such as vibration type, treatment frequency, treatment amplitude, treatment time. Many researchers aim to observe the clinical curative effect at present, but rarely explore the intervention mechanism of the whole body vibration. Further large-sample, multi-center randomized control ed experiments are required to test the validity.

Effect of osteophytes on bone mineral density of female lumbar spine / 生物医学工程学杂志

Previous case-control studies have shown various degrees of inverse correlation between osteoarthritis (OA) and osteoporosis (OP). The aim of this study was to examine the relationship between osteophytes at the cervical , lumbar vertebrae and knee, and the bone mineral density (BMD) of lumbar spine. We analyzed the data on 4091 female patients (aged 13 to 92 years). Osteophyte was defined by X ray examination. BMD of the lumbar spine (LS) was measured by dual energy X-ray absorptiometry (Lunar DPX). The association of osteophytes with BMD and osteophytes at different sites and different degrees were assessed by covariance analysis. Adjustments were made for age and body mass index. The relationship between osteophytes and BMD was analyzed by Binary Logistic Regression. BMD at each site was greater in the female with osteophytes (L4 BMD: P < 0.01, Mean BMD: P < 0.05); the relationship between osteophytes and osteoporosis and that between duration of osteophytes and osteoporosis were inversely correlated (P < 0.01). It confirms the existence of an inverse relationship between osteophytes and OP while a positive relationship is between age, body mass index and osteoporosis.

Study on the relationship between body mass index and osteoporosis in males / 生物医学工程学杂志

There were 482 male patients with non-hyperostosis diagnosed by X-ray among 1207 males who visited West China Hospital because of pain and/or numbness in bone or/and in joints from August 2003 to December 2005; the base-line information in records included age, stature, body weight(calculated BMD, symptoms, co-morbidities, exercise frequency, and smoking. The bone mineral density of lumbar spine was determined and used to judge osteoporosis or non-osteoporosis. Comparison was made on the basic information between osteoporosis group and non-osteoporosis group by t test or chi2 test statistical analysis; the relationship of multiple factors with osteoporosis was analyzed by Logistic Regression. The results of comparison between osteoporosis group and non-osteoporosis group indicated, there were significant differences among BMI, exercise and smoking, but no significant differences were seen among age, complications of hypertension and diabetes mellitus. According to the results of multiple regression analysis, BMI and smoking are the risk factors of osteoporosis, yet exercise is the protection factors of osteoporosis; the risk of osteoporosis increases by 0.654 times in men with BMI scaling up by 1 kg/m2 (P = 0.004). Therefore, we conclude that BMI is a risk factor of osteoporosis in male, and it may be related to body fat distribution.

On correlation between body mass index and lumbar spine average bone mineral density: a study in male patients with osteopenia and those with osteoporosis / 生物医学工程学杂志

From among the patients who visited the Dept. of Rehabilitation of West China Hospital for arthalgia in the period from Aug. 2003 to Dec. 2005, we recruited 566 male patients who were over 40 years of age and did not have hyperostosis in the lumbar spine, and whose T scores were each less than--1. Their ages ranged from 40 to 93 years, and the average age was 62.93 +/- 13.50. The dual-energy X-ray absorptiometry from DMS Company in France was used to measure the bone density of the L2-4 anterior-posterior. The basic data about the subjects, containing the age, height, weight, diabetes mellitus, exercise and smoking or not, were recorded. Then the body mass index were calculated. In accordance to the T score, the subjects were separated into two groups: osteopenia group and osteoporosis group. In comparison of the basic data between groups, BMI of osteoporosis group was significantly higher than that of the osteopenia group, but the number of the subjects who exercised was smaller (P < 0.05). Multiple linear regression analysis revealed that in the case BMI increased by 1 kg/m2, BMD significantly decreased by 0.003 g/cm2 (P = 0.002), and the age negatively correlated with BMD (B = -0.001, P = 0.035). "Exercise or not" was positively related to BMD (B = 0.028, P = 0.000). "Smoking or not" and BMD were not significantly correlated (P = 0.837). In conclusion, increase of BMI, or we may say, increase of fat, would decrease the lumbar spine average BMD in the patients of osteoporosis or osteopenia. Some reports have pointed out that only by increasing BMI with increased amount of muscles, but not with increased amount of fat, would be beneficial to the prevention of osteoporosis. So we concluded that the muscle amount in the subjects should be taken into account when we probe into the relation between BMI and BMD.

The effect of pulsed electromagnetic fields on the biomechanical properties of the femur in ovariectomized rats / 中华物理医学与康复杂志

Objective To observe the effect of pulsed electromagnetic fields (PEMFs) of different intensities on the biomechanical properties of the femur in ovariectomized rats so as to determine the intensity for the best therapeutic efficacy. Methods Fifty female Sprague-Dawley rats were randomly divided into (1) a sham-operated control group (no PEMF treatment) , (2) ovariectomized control group (no PEMF treatment) (3) ovariectomized group Ⅰ (PEMF treatment at 8 Hz and 0.77 mT intensity, 40 min daily for 30 days) (4) ovariectomized group Ⅱ (PEMF treatment at 8 Hz and 3.82 mT intensity, 40 min daily for 30 days) and (5) ovariectomized group Ⅲ( PEMF treatment at 8 Hz and 9.87 mT intensity, 40 min daily for 30 days). Except for the 10 rats of the sham-operated control group, all the others received a standard ovariectomy. Serum estradiol (E2) and the biomechanical properties of one femur (peak load, maximum displacement, maximum energy absorption, maximum stress, maximum strain and modulus of elasticity) were assessed after 30 days of PEMF treatment. Results In group Ⅱ the biomechanical properties of the femur were significantly better than in group Ⅰ or the ovariectomized control group. In groups Ⅰ and Ⅲ the biomechanical properties of the femur were not significantly better than in the sham-operated group. In group Ⅱ the biomechanical properties of the femur were significantly better than in groups Ⅰ or Ⅲ. Conclusion PEMFs at 3.82 mT can improve the biomechanical properties of the femur significantly.

Effect of spinal stabilization training on the vertebral osteoporotic compression fracture: An individualized program / 中国组织工程研究

BACKGROUND: Surgery is a main method to reconstruct the stability of spine after compression fracture. But the reconstruction of spinal stability for patients undergoing conventional therapy remains unclear.OBJECTIVE: To explore whether spinal stability training is effective on improving pain and motor function of patients with vertebral osteoporotic fractures.METHODS: Patients with vertebral osteoporotic fractures were divided into two groups. The study group was treated with conventional treatments and individualized spinal stabilization training, while the control group received conventional treatments alone. All the subjects were evaluated before and after treatment by numeric pain rating scale (NPRS), 3-meter timed up and go (TUG) and Oswestry functional limitation index (OFLI). The results were compared between the two groups.RESULTS AND CONCLUSION: A total of 27 patients were included, including 16 patients in the study group and 11 in the control group. After 4-week treatment, TUG and OFLI in the study group decreased significantly compared with the control group (P < 0.05). But there was no statistical significance between the two groups in the level of NPRS and the amount of changes (P > 0.05). Symptoms and function of both groups were improved after treatments. Individualized spinal stability training is effective to restore the motor function and may be helpful for reducing pain for patients with vertebral osteoporotic fractures combined with conventional treatments.

Effect of body mass index on bone mass of lumbar spine of male patients with ostealgia and arthralgia but without osteoporosis / 生物医学工程学杂志

For the purpose of identifying the effect of body mass index on bone mineral density, an investigation was made in regard to the relationship between body mass index (BMI), bone mineral density (BMD) and bone mineral content (BMC) of lumbar vertebrals of men without osteoporosis. 838 male patients were diagnosed and treated in West China Hospital of Sichuan University because of ostealgia and arthralgia from Aug. 2003 to Dec. 2005. They were examined by dual-energy X-ray absorptiometry, their L2-L4 bone mineral density being < -2.5SD. Then they were graded by body mass index (Kg/m2) [1st group BMI > or =23, 454 cases (Group A BMI > or = 29, 46 cases; Group B 25 < or = BMI < 28.9, 201 cases; Group C 23 < or = BMI < 24, 9193 cases); 2nd group 18.5 < BMI < 22.9, 311 cases; 3rd group BMI < or = 18.5, 68 cases]. The relationships between BMI and BMD of lumbar spine were analyzed using SPSS 13.0. The results revealed their positions in series: (1) Among Groups 1-3, BMD, average BMD and aBMC of L2-L4 being 3rd group > 2nd group > 1st group, the differencs are statistically significant (P < 0.05 or P < 0.01); BMC, aBMC of L3 and L4 and aBMC of L2 being 3rd group > 2nd group > 2nd group, the differences are significant (P < 0.01); besides BMC of L2 and T-score,the differencs among three groups are not statistically significant (P > 0.05); (2) Among the 1st group, BMD and average BMD of L2-L4 being Group C > Group B > Group A,the differencs are significant (P < 0.05 or P < 0.01); BMC, aBMC of L and I being Group C > Group B > Group A,the differences among the three groups are significant (P < 0.05 or P < 0.01); BMC, aBMC of L3 and L4 and aBMC of L2 being Group C > Group B > Group A, the differences are significant, besides BMC of L2 and T-score,the differences among three groups are not significant (P > 0.05), (3) BMI correlated negatively (P < 0.01, r = -0.189) to the average BMD of lumbar spine. The average BMD of lumbar spine decreases when BMI increases in males without osteoporosis. When obesity is more obvious, the decrease in average BMD of lumbar spine bone is more evidently decreased. The decrease of BMD, BMC and total BMC in L3 and L may be greater than that in L2.