Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus.

OBJECTIVE: To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. DATA SOURCES: A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. REVIEW METHODS: Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. RESULTS: Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. CONCLUSIONS: The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.

[Guilu Erxian Glue Induced Osteogenic Differentiation of BMMSCs and Its Effects on Wnt Signal Pathway].

Objective To observe the effects of Guilu Erxian Glue (GEG) containing serum on osteogenin differentiation of bone marrow mesenchymal stem cells (BMMSCs) and Wnt signal pathway related factors. Methods Totally 100 three months old female SD rats had their bilateral ovaries excised peritoneally They were divided into the low, middle, high GEG groups, and the blank control group by random digit table, 25 in each group. The dose of GEG was calculated according to body surface area, and GEG containing serum was administered by gastrogavage for 7 successive days. Blood was collect- ed by abdominal aorta to prepare drug containing serum. F3 passage BMMSCs of 1-month SD rats were i- solated by whole bone marrow adherent method, and cultured in vitro for 3 passages. The cell surface markers (CD45 and CD90) of F3 passage were detected by flow cytometry (FCM). BMMSCs were trea- ted with different concentrations GEG containing serum for 72 h. Then the cell cycle was determined by FCM, and the proliferation index calculated. The optimal intervention concentration was determined. Then F3 passage BMMSCs were divided into four groups, i.e., the fetal bovine serum (FBS) group, the blank control group, the GEG group, the classical induction group. After they were treated with corresponding medium for 21 days, BMMSCs were dyed with alizarin red staining (ARS) to observe their osteogenin dif- ferentiation. mRNA expressions of alkaline phosphatase (ALP) and osteocalcin (OC) of BMMSCs were detected by RT-PCR. mRNA and protein expressions of Wnt5a, ß-catenin, and lymphoid enhancer factor- 1 (Lef-1) were detected by RT-PCR and Western blot. Results The ratio of CD45 positive expression was 1. 46% ?0. 23%, and the ratio of CD90 positive expression was 96. 97% ±3. 21%. Middle EGE contai- ning serum (10%) could significantly stimulate the proliferation of BMMSCs. In ARS citrus red calcium nodules could be seen in the GEG group and the classical induction group. Compared with the FBS group and the blank control group, mRNA expressions of OC and ALP were up-regulated, mRNA and protein expressions of Wnt5a and p-catenin were up-regulated in the GEG group and the classical induction group (P<0. 05). Compared with the FBS group, the blank control group, and the classical induction group, mRNA and protein expressions of Lef-1 were up-regulated in the EGE group (P <0. 05). Compared with the FBS group and the blank control group, protein expressions of Lef-1 increased in the classical induc- tion group (P <0. 05). Conclusions GEG containing serum had the functions of stimulating the prolifera- tion of BMMSCs, and inducing the osteogenic differentiation of BMMSCs. Its mechanism might be possi- bly related with regulating Wnt signal pathway related factors.

Lithium accelerates functional motor recovery by improving remyelination of regenerating axons following ventral root avulsion and reimplantation.

Brachial plexus injury (BPI) often involves the complete or partial avulsion of one or more of the cervical nerve roots, which leads to permanent paralysis of the innervated muscles. Reimplantation surgery has been attempted as a clinical treatment for brachial plexus root avulsion but has failed to achieve complete functional recovery. Lithium is a mood stabilizer drug that is used to treat bipolar disorder; however, its effects on spinal cord or peripheral nerve injuries have also been reported. The purpose of this study was to investigate whether lithium can improve functional motor recovery after ventral root avulsion and reimplantation in a rat model of BPI. The results showed that systemic treatment with a clinical dose of lithium promoted motor neuron outgrowth and increased the efficiency of motor unit regeneration through enhanced remyelination. An analysis of myelin-associated genes showed that the effects of lithium started during the early phase of remyelination and persisted through the late stage of the process. Efficient remyelination of the regenerated axons in the lithium-treated rats led to an earlier functional recovery. Therefore, we demonstrated that lithium might be a potential clinical treatment for BPI in combination with reimplantation surgery.

FIM-A, a phosphorus-containing sirolimus, inhibits the angiogenesis and proliferation of osteosarcomas.

The mTOR pathway is a central control of cell growth, proliferation, metabolism, and survival, and is deregulated in most cancers. Cancer cells are addicted to increased activity of mTOR kinase-mediated signaling pathways, leading to numerous inhibitors of mTOR signaling in preclinic and clinical trials for cancer therapy. Phosphorus-containing sirolimus (FIM-A), which targets mTOR signaling, inhibits cancer cell growth in vitro. Here we report that FIM-A reduces the angiogenesis and proliferation of osteosarcoma both in vitro and in vivo. In cultured osteosarcoma cell lines, FIM-A inhibited cell proliferation and arrested cells in the G1 phase of the cell cycle, accompanied with reduction of VEGF and HIF-1alpha. With in vivo mouse osteosarcoma xenografts, FIM-A treatment resulted in the inhibition of mTORC1 signaling as demonstrated by the decreased phosphorylation of p70S6K1 and 4E-BP1. Consistent with this finding, FIM-A significantly decreased the average tumor volume, nuclei staining of PCNA, and the number of intratumoral microvessels. Our data demonstrated that targeting mTORC1 by FIM-A inhibited the growth of osteosarcoma in vitro and in vivo, providing the basis for further development of FIM-A as a therapy for osteosarcoma patients.

The effectiveness of Long's manipulation on patients with chronic mechanical neck pain: a randomized controlled trial.

Long's manipulation (LM) is a representative Chinese manipulation approach incorporating both spinal manipulation and traditional Chinese massage (TCM) techniques. This randomized controlled trial (RCT) aimed to compare the immediate and short-term relative effectiveness of LM to TCM on patients with chronic neck pain. Patients were randomly assigned to either LM group or TCM group. LM group was treated with Long's manipulation, while the TCM group received TCM therapy. Patients attended 8 sessions of treatment (one session every three days). Outcome measures included neck disability (Northwick Park Neck Pain Questionnaire; NPQ), pain intensity (Numeric Pain Rating Scale; NPRS), patient perceived satisfaction of care (PPS) (11-point scale), craniovertebral angle (CV angle) and cervical range of motion (ROM). A blinded assessor performed assessment at baseline, immediate after treatment and 3 months post treatment. LM group achieved significantly greater improvement than TCM group in pain intensity (p < 0.001), neck disability (p = 0.049) and satisfaction (p < 0.001) up to 3-month follow-up. There was no significant difference in improvements in CV angle and most of cervical ROM between groups (p = 0.169 ∼ 0.888) with an exception of flexion at 3-month follow-up (p = 0.005). This study shows that LM could produce better effects than TCM in relieving pain and improving disability in the management of patients with chronic mechanical neck pain.

Chinese manipulation for mechanical neck pain: a systematic review.

OBJECTIVE: To assess whether Chinese manipulation improves pain, function/disability and global perceived effect in adults with acute/subacute/chronic neck pain. DATA SOURCES: CAJ Full-text Database (Chinese), Wanfang Database (Chinese), Cochrane Database (English) and Medline (English). REVIEW METHODS: Literature searching was performed with the following keywords and their combination: 'manual therapy/bone setting/Chinese manipulation', 'neck/cervical pain', 'cervical vertebrae', 'cervical spondylosis/radiculopathy' and 'randomized controlled trial/review.' Two independent reviewers selected studies, extracted data and assessed risk of bias for each included study. Randomized controlled trials or quasi-randomized controlled trials on the effect of Chinese manipulation in treating adult patients with neck pain were selected. Mean differences with 95% confidence intervals (CI) were calculated. Quality of the evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Four studies (610 participants) were included in this review. There was very low-quality evidence suggesting that, compared to cervical traction in sitting, Chinese manipulation produced more immediate post-intervention pain relief (mean difference: -1.06; 95% CI: -1.37~ -0.75; P < 0.001) and improvement of global signs and symptoms (mean difference: -3.81; 95% CI: -4.71 ~ -2.91; P < 0.001). Very low-quality evidence showed that Chinese manipulation alone was superior to Chinese traditional massage in immediate post-intervention pain relief (mean difference: -2.02; 95% CI: -2.78~ -1.26; P < 0.001). CONCLUSIONS: There was limited evidence showing Chinese manipulation could produce short-term improvement for neck pain.

Effect of antioxidants on amelioration of high-risk factors inducing hypertensive disorders in pregnancy.

BACKGROUND: This is a prospective clinical study based on a large sample gathered from multiple centers in China, subordinating to 10th Five-Year Plan of National Science & Technology Progression. We analyzed the high-risk factors inducing hypertensive disorders in pregnancy (HDP) and estimated the potential effect of anti-oxidants administration, including vitamin C (VC), vitamin E (VE) and Salvia Miltiorrhiza L (SML), a Chinese herb medicine, in amelioration of the high-risk factors in pregnancy. METHODS: From April 2005 to July 2006, 4814 pregnant women from 24 national wide cooperative hospitals were involved in this prospective research. The participants were randomly divided into two groups: 1607 cases were in anti-oxidants group with administration of vitamins and SML; 3207 cases were in control group without any medicine given. Every participant was under monitoring for the morbidity of HDP and the high-risk factors were investigated in HDP cases in each group. RESULTS: (1) The morbidity of HDP was 3.55% in anti-oxidants group vs. 4.18% in control group. No statistical difference existed between the two groups (P > 0.05). (2) In anti-oxidants group, the HDP morbidities among three subgroups: VC + VE + SML, VC + VE and SML only, were 5.51%, 3.05% and 5% respectively. It showed no statistical difference among three remedies (P > 0.05). (3) The related index of factors affecting HDP showed in intensity sequence as follows: family HDP history > profession > education level > age > body weight. The incidence of HDP in normal population was 3.51%, and the incidence of HDP in high-risk pregnant women (family HDP history, heavy physical labor, low education level (middle school and below), age ≥ 40, body mass index ≥ 24) was 5.84%, which was obviously higher than that in normal population (P < 0.01). In anti-oxidants group, the probability of HDP in women with high-risk factors was 3.81%, which was obviously lower than that in control group with high-risk factors at 7.14% (P < 0.01). (4) In control group, the morbidity of HDP in women with family HDP history (especially with sisters'), heavy physical labor, middle school and below, age ≥ 35 was: 50.00%, 15.22%, 6.33%, 26.28% and 5.75%, respectively, and that in anti-oxidants group was 0, 7.69%, 3.74%, 9.27% and 2.67%, respectively, which was obviously lower than that in control group. CONCLUSIONS: The high-risk factors prone to induce HDP included: family history of HDP, heavy physical labor, low education level, aging and obesity. No impressive effect of anti-oxidants application was found in preventing HDP in general population but the remedy demonstrated positive effect on preventing HDP in pregnant women with high-risk factors.

Tai chi improves physical function in older Chinese women with knee osteoarthritis.

BACKGROUND: Tai chi (TC) is proposed as a potential option for the management of osteoarthritis (OA), however, its beneficial effect on patients with knee OA has not been convincing. OBJECTIVES: To evaluate the effect of a 24-week TC program on physical functions in older Chinese women with knee OA. METHODS: Thirty-five older Chinese women with knee OA were randomized into TC group (n = 18) and attention control (wellness education and stretching) group (n = 17). Subjects in the TC group practiced the 24-form simplified Yang-style TC 2 to 4 times a week for 24 weeks with frequency gradually increased. Physical function was assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 6-minute walk distance and stair climb time. RESULTS: Compared with the control group, the participants in TC group had statistically significant improvements in changes of the WOMAC total score (6.18 +/- 2.13 vs. 1.71 +/- 2.73, P = 0.000), the WOMAC pain subscale (1.36 +/- 0.22 vs. 0.07 +/- 1.00, P = 0.001), the WOMAC stiffness subscale (0.66 +/- 0.25 vs. 0.05 +/- 0.38, P = 0.043), the WOMAC function subscale (6.17 +/- 1.96 vs. 1.72 +/- 2.63, P = 0.000), the 6-minute walk distance (32.43 +/- 14.20 vs. 6.67 +/- 16.76, P = 0.003), and the stair climb time (2.27 +/- 0.74 vs. 0.27 +/- 1.24, P = 0.001). CONCLUSIONS: This study suggests that TC provides a safe, feasible and useful exercise option for older Chinese female patients with knee OA.

[Multi-center study of motherwort injection to prevent postpartum hemorrhage after caesarian section].

OBJECTIVE: To evaluate the efficacy and safety of motherwort (herba leonuri/leonurus heterophyllus sweet) injection for preventing postpartum hemorrhage after caesarian section. METHODS: The prospective study was designed as a randomized and single blind multi-center research matched with positive agent as controls from Apr 2007 to Aug 2007. 440 women underwent caesarian section (CS) indicated by obstetric factors were enrolled from 15 teaching hospitals in China and assigned into three groups: group of motherwort: 147 cases were administered by motherwort 40 mg uterine injection during CS and 20 mg intramuscular injection per 12 hours 3 times after CS; group of motherwort+oxytocin: 144 cases were administered by motherwort 40 mg and oxytocin 10 U uterine injection during CS and motherwort 20 mg intramuscular injection per 12 hours 3 times after CS and group of oxytocin: 149 cases were administered by oxytocin 10 U uterine injection and oxytocin 10 U+5% glucose 500 ml intravenously injection during operation and oxytocin 10 U intramuscular injection per 12 hours 3 times after CS. The following clinical parameter were collected and analyzed: (1) The amount of blood loss during operation, at 2, 6, 12, 24, 48 hours after operation. (2) The total amount of blood loss in 24 hours after CS and the incidence of postpartum hemorrhage. (3) The change of level of hemoglobin (Hb) and counting of red blood cell (RBC) from prepartum to postpartum. (4) Adverse reaction. RESULTS: (1) The mean amount of blood loss during operation were (368+/-258) ml in group of motherwort, (255+/-114) ml in group of motherwort+oxytocin and (269+/-141) ml in group of oxytocin, which exhibited significant difference among three groups (P<0.01). Meanwhile, no statistical different amount of blood loss among three groups were observed at 2, 6, 12, 24, 48 hours after CS. (2) The amount of blood loss of postpartum at 24 hours were (480+/-276) ml in group of motherwort, (361+/-179) ml in group of motherwort+oxytocin, (381+/-179) ml in group of oxytocin, which showed significant difference among 3 groups (P<0.01). (3) The incidence of postpartum hemorrhage were 32.0% (47/147) in group of motherwort, 11.1% (16/144) in group of motherwort+oxytocin, and 18.8% in (28/149) in group of oxytocin. When comparing the lowest rate of postpartum blood loss in group of motherwort+oxytocin and the highest rate in group of motherwort, it displayed statistical difference (P<0.01). (4) The decreased level of RBC and Hb were shown that RBC (0.3+/-0.5)x10(12)/L and Hb (9+/-13) g/L in group of motherwort, RBC (0.2+/-0.4)x10(12)/L and Hb (6+/-10) g/L in group of motherwort+oxytocin and RBC (0.2+/-0.4)x10(12)/L and Hb (7+/-30) g/L in group of oxytocin respectively. However, the comparison of different value of RBC and Hb in group of oxytocin and motherwort+oxytocin showed significant difference (P<0.05). (5) Two cases with allery reaction was observed. CONCLUSION: It is safe and efficacious that combined use of motherwort injection and oxytocin was to prevent postpartum hemorrhage during or after caesarian section.

[Apoptosis induction of traditional Chinese herb pianzihuang ([Chinese characters: see text]) in human osteosarcoma U-20S cells].

OBJECTIVE: To study the effect of apoptosis induction of pianzihuang in human osteosarcoma U-20S cells. METHODS: Sixth SD rats were randomly divided into group A (8 rats) and group B (8 rats) in the study. Among them, 8 rats (group A) were treated with PBS and 8 rats (group B) treated with pianzihuang. (2) Human osteosarcoma U-2OS cells were cultured in nutrient solution (including fetal calf serum of 10%, penicillin of 100 IU/ml, streptomycin of 100 microg/ml), the environmental condition in saturated humidity 5% CO2, 37 degrees C. The osteosarcoma U-2OS cell proliferation effect by different saturation of blood serum was measured by MTT method. And the optimal concentration of the serum (including Pianzihuang) could be obtained. (3) The morphous of osteosarcoma U-2OS cell were observed by inverted phase contrast microscope and electron microscope. (4) Apoptosis cell was detected by TUNEL in situ end labeling. (5) Extracted DNA,agarose gel electrophoresis (AGE) to detect apoptosis cell by transmission electron microscope (TEM). RESULTS: (1) It was best that osteosarcoma U-2OS cell proliferation effect by 20% of the concentration of the serum (including Pianzihuang). (2) On inverted phase contrast microscope showed that the cells of group A were fusiform adherence growth; the cyton transform shrind and circle in 20% of the concentration of the serum (including Pianzihuang). Follow lasting time,the cell turning circle gradually increased. Necrosis cell and fragment were found by microscope. (3) The detected result of apoptosis cell in 20% of the concentration of the serum(including Pianzihuang) was positive by TUNEL assays. (4) AGE showed "ladder" strand of DNA, a special phenomenon of cellular apoptosis. (5) Chromatin aggregated along corrugativus caryotheca and apoptotic body appeared on cell surface by observation of TEM. CONCLUSION: Pianzihuang can inhibit proliferation and induce apoptosis for osteosarcoma U-2OS cell.