The Therapeutic Effects of Extracorporeal Shock Wave Therapy (ESWT) on the Rotator Cuff Lesions with Shoulder Stiffness: A Prospective Randomized Study.

Aim: We wish to investigate the therapeutic potential of a single-session high-energy extracorporeal shock wave therapy (ESWT) on the rotator cuff lesions with shoulder stiffness. Patients and Methods. Thirty-seven patients afflicted with rotator cuff lesions with shoulder stiffness were randomized to receive either shockwave or sham treatment based on statistical randomization. In the shockwave group, we used Orthospec™ Extracorporeal Shock Wave Therapy 3000 impulse 24 kV (0.32 mJ/mm2) focused at two points as one session. The sham intervention entailed the use of the device in which the silicone pad was removed from the stand-off device. The visual analogue scale (VAS), muscle power of the shoulder, Constant and Murley score (CMS), and range of motion (ROM) of the shoulder were assessed for all patients. Ten milliliters of peripheral venous blood was obtained from every participant for the measurements of markers for inflammation, tissue regeneration, angiogenesis, and substance P before and at 1 week and 4 weeks after intervention. Results: The ESWT group has significantly better VAS, muscle power, CMS, and ROM at 6 and 12 months after intervention. No between-group differences were observed before as well as 1 and 4 weeks after intervention in the selected biomarkers. Conclusion: ESWT may be a good adjuvant for the treatment of rotator cuff lesions with shoulder stiffness.

S100 Calcium Binding Protein A9 Represses Angiogenic Activity and Aggravates Osteonecrosis of the Femoral Head.

Ischemic damage aggravation of femoral head collapse is a prominent pathologic feature of osteonecrosis of the femoral head (ONFH). In this regard, S100 calcium binding protein A9 (S100A9) is known to deteriorate joint integrity, however, little is understood about which role S100A9 may play in ONFH. In this study, a proteomics analysis has revealed a decrease in the serum S100A9 level in patients with ONFH upon hyperbaric oxygen therapy. Serum S100A9 levels, along with serum vascular endothelial growth factor (VEGF), soluble vascular cell adhesion molecule-1 (sVCAM-1), interleukin-6 (IL-6), and tartrate-resistant acid phosphatase 5b levels were increased in patients with ONFH, whereas serum osteocalcin levels were decreased as compared to healthy controls. Serum S100A9 levels were increased with the Ficat and Arlet stages of ONFH and correlated with the patients with a history of being on glucocorticoid medication and alcohol consumption. Osteonecrotic tissue showed hypovasculature histopathology together with weak immunostaining for vessel marker CD31 and von Willrbrand factor (vWF) as compared to femoral head fracture specimens. Thrombosed vessels, fibrotic tissue, osteocytes, and inflammatory cells displayed strong S100A9 immunoreactivity in osteonecrotic lesion. In vitro, ONFH serum and S100A9 inhibited the tube formation of vessel endothelial cells and vessel outgrowth of rat aortic rings, whereas the antibody blockade of S100A9 improved angiogenic activities. Taken together, increased S100A9 levels are relevant to the development of ONFH. S100A9 appears to provoke avascular damage, ultimately accelerating femoral head deterioration through reducing angiogenesis. This study provides insight into the molecular mechanism underlying the development of ONFH. Here, analysis also highlights that serum S100A9 is a sensitive biochemical indicator of ONFH.

Early Recovery of Exercise-Related Muscular Injury by HBOT.

Early recovery from muscular injury is crucial for elite athletes. Hyperbaric oxygen therapy (HBOT) has been reported to be beneficial in terms of accelerating cell recovery and tissue repair, which are considered to be helpful for eliminating fatigue and recovering stamina. This study was performed to evaluate the efficacy of HBOT for exercise-related muscular injury. Forty-one athletes with exercise-related muscular injuries were recruited and randomized into an HBOT group and a control group. All participants received 10 sessions of either HBOT or placebo treatment. The brief pain inventory (BPI) was completed, and serum samples were analyzed. Data were collected before treatment (T1), at the end of the fifth treatment session (T2), at the end of the tenth treatment session (T3), and two weeks after T3 (T4). At T3, the HBOT group showed prominent reductions in the levels of creatine phosphokinase (CK), glutamic oxaloacetate transaminase (GOT), and myoglobin (MB), which lasted until T4. However, the control group did not present any statistical differences in levels from T1 to T4. In terms of pain intensity and interference, the HBOT group showed significant improvements at T3, while no improvements were observed in the control group. In conclusion, HBOT facilitates the early recovery of exercise-related muscular injury. This trial is registered with ISRCTN17817041.

Effect of Oral Nonionic Polymeric Micelles Delivered Parathyroid Hormone cDNA on Bone Density and Microarchitecture.

INTRODUCTION: Parathyroid Hormone (PTH) is an effective therapeutic agent for osteoporosis, but the treatment requires long-term daily injections. Oral gene delivery is a less invasive alternative to daily injections. OBJECTIVE: The aim of this study is to investigate the effect of orally administered nonionic polymeric micelles of plasmid cDNA containing human cytomegalovirus promoter (PCMV)-PTH (1-34) plus EDTA on body mineral density and bone microstructure in ovariectomized rats. MATERIAL AND METHODS: A total of 27 Spraque-Dawley female rats were subjected to a bilateral ovariectomy. One month following the ovariectomy, they were randomly assigned to three groups: (1) (PCMVPTH (1-34) cDNA in polyethylene oxide-polypropylene oxide-polyethylene oxide (PEO-PPO-PEO) polymeric micelle formations plus EDTA); (2) PCMV-PTH (1-34) cDNA and (3) drinking water. The treatment was administered by oral gavage on day 1, 2, 7, 14, and 21 at 8-hour intervals. Body mineral density, bone volume fraction, and trabecular thickness of the lumbar spine and femoral neck were examined with peripheral quantitative computed tomography at pre- and post-intervention (3 months after the start of the intervention) and analyzed using two-way repeated measures analysis of variance. RESULTS: Results showed that bone mineral density, bone volume fraction and trabecular thickness were significantly increased in Group 1 over time, compared with those in Group 2 and Group 3. CONCLUSION: In conclusion, significantly improved bone mineral density and bone microstructure were observed in ovariectomized rats treated with PTH (1-34) cDNA delivered by nonionic polymeric micelles.

Molecular changes in diabetic foot ulcers.

AIM: This study investigated the molecular changes of extracorporeal shockwave therapy (ESWT) and hyperbaric oxygen therapy (HBOT) in chronic diabetic foot ulcers. METHODS: A cohort study consisted of 39 patients (44 ulcers) in the ESWT group and 38 patients (40 ulcers) in the HBOT group with similar demographic characteristics. The ESWT group received shockwave therapy twice per week for total six treatments. The HBOT group received hyperbaric oxygen therapy daily for total 20 treatments. Biopsy was performed from the periphery of the ulcer before and after treatment. The specimens were immuno-stained, and the positive immuno-activities of vWF, VEGF, eNOS, PCNA, EGF and TUNEL expressions were examined and quantified microscopically. RESULTS: Significant increases in vWF, VEGF, eNOS, PCNA and EGF expressions and a decrease in TUNEL expression were noted after ESWT (P<0.05), whereas the changes after HBOT were statistically not significant (P>0.05). The differences of vWF, VEGF, eNOS, PCNA, EGF and TUNEL expressions between the two groups were comparable before treatment (P>0.05), however, the differences became statistically significant after treatment (P<0.05) favoring the ESWT group. CONCLUSION: ESWT showed significant increases in angiogenesis and tissue regeneration over HBOT in diabetic foot ulcers.

Treatment of diabetic foot infection with hyperbaric oxygen therapy.

BACKGROUND: This study was performed to evaluate the effectiveness of hyperbaric oxygen therapy (HBOT) in the treatment of the infected diabetic foot. METHODS: Forty-two patients with 44 infected diabetic feet receiving HBOT were divided into two groups. One group of 21 patients with 21 feet received <10 sessions of HBOT. The other 21 patients with 23 feet received >10 sessions of HBOT. RESULTS: In patients who received <10 sessions of HBOT, seven patients achieved satisfactory wound healing. Feet were preserved in 33.3%. In patients with >10 sessions of HBOT, 16 patients with 18 feet achieved good wound healing. Of these patients, 78.3% preserved their feet. This group of patients received an average of 22.8 HBOT treatments. CONCLUSIONS: Adjunctive HBOT has a positive effect on wound healing in diabetic foot with infection. The effect of HBOT seems dose dependent because the amputation rate is decreased in patients who receive adequate HBOT.

Results of chronic osteomyelitis of the femur treated with hyperbaric oxygen: a preliminary report.

BACKGROUND: Although only a few studies have shown the effectiveness, hyperbaric oxygen (HBO) therapy has been used as an adjunct in the management of chronic osteomyelitis in many hospitals in Taiwan. This retrospective study investigated the clinical results of HBO therapy for chronic refractory osteomyelitis of the femur. METHODS: From December 1999 through May 2002, 13 patients with chronic refractory osteomyelitis of the femur were treated with adjunctive HBO. The most common infecting microorganism was Staphylococcus aureus. All cases were classified as type III or IV osteomyelitis according to the Cierny-Mader classification. Adequate surgical debridement and parenteral antibiotic treatment were performed. The average number of operations before HBO therapy was 4.6 times. HBO therapy at 2.5 atmospheres absolute for 120 minutes was administered for 5 days per week in all patients for an average of 50 days. The average number of HBO treatments was 32.2 times. The average follow-up period was 22 months, ranging from 12 to 42 months. RESULTS: Complete eradication of infection with no recurrence of infection was noted in 12 of the 13 patients. One patient failed to respond to the treatment. The success rate of the treatment regimen was 92%. There were no HBO therapy related complications. CONCLUSION: Hyperbaric oxygen therapy is an effective and safe adjunctive therapy for the management of chronic refractory osteomyelitis of the femur provided that patients had received adequate surgical debridement and appropriate antibiotic treatment.