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Ardeshiri A, Amann M, Thomson S, Gilligan CJ. Application of restorative neurostimulation for chronic mechanical low back pain in an older population with 2-year follow up. Reg Anesth Pain Med 2025; 50:231-236. [PMID: 38460963 PMCID: PMC12015028 DOI: 10.1136/rapm-2023-105032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/26/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Data on the Medicare-aged population show that older patients are major consumers of low back pain (LBP) interventions. An effective approach for patients with mechanical LBP that has been refractory to conservative management is restorative neurostimulation. The efficacy of restorative neurostimulation has been demonstrated in multiple prospective studies, with published follow-up over 4 years, showing a consistent durable effect. METHODS To further examine the effect of restorative neurostimulation in an older demographic, data from three clinical studies were aggregated: ReActiv8-B prospectively followed 204 patients, ReActiv8-C study prospectively followed 87 patients and ReActiv8-PMCF prospectively followed 42 patients.Two hundred and sixty-one patients were identified with complete 2-year follow-up and divided into cohorts of equal size based of age quartiles.At 2 years from device activation, patients in either cohort were classified by change in disability (Oswestry Disability Index (ODI)) or change in pain score(NRS/VAS) and assessed as proportion of patients per group at each time point. Additionally, health-related quality of life (HRQoL) (EQ5D-5L) was longitudinally compared with baseline. Differences in proportions were assessed using χ2 and continuous variables by repeated measures analysis of variance. RESULTS The oldest quartile (n=65) had a median age of 60 (56-82) years compared with the entire population (n=261) who had a median age of 49 (22-82) years. The completer analysis on patients with 2 years of continuous data showed improvement of a 50% in pain was achieved by 62% and 65% and a 15-point ODI improvement in 48% and 60% in the oldest quartile and entire population, respectively. HRQoL (EuroQol 5-Dimension) improved from baselines of 0.568 and 0.544 to 0.763 and 0.769 in the oldest quartile and entire population respectively. All age quartiles improved statistically and clinically over baseline. CONCLUSIONS This aggregate analysis of three independent studies provides insight into the performance of restorative neurostimulation in an older population. Patients derived significant and clinically meaningful benefit in disability, pain and HRQoL. When compared with a similarly indicated cohort of younger patients, there were no statistically or clinically significant differences.
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Affiliation(s)
- Ardeshir Ardeshiri
- Department for Trauma Surgery and Orthopaedics, Klinikum Itzehoe, Itzahoe, Germany
| | - Marco Amann
- Orthopädisches Krankenhaus Schloss Werneck, Werneck, Germany
| | - Simon Thomson
- Pain and Neuromodulation, Mid and South Essex University NHSFT, Orsett Hospital, Essex, UK
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Roehm KD, Chiesa I, Haithcock D, Gottardi R, Prabhakarpandian B. A vascularized microfluidic model of the osteochondral unit for modeling inflammatory response and therapeutic screening. LAB ON A CHIP 2025; 25:370-382. [PMID: 39715348 DOI: 10.1039/d4lc00651h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2024]
Abstract
Osteoarthritis (OA) has long been considered a disease of the articular cartilage. Within the past decade it has become increasingly clear that OA is a disease of the entire joint space and that interactions between articular cartilage and subchondral bone likely play an important role in the disease. Driven by this knowledge, we have created a novel microphysiological model of the osteochondral unit containing synovium, cartilage, bone, and vasculature in separate compartments with molecular and direct cell-cell interaction between the cells from the different tissue types. We have characterized the model in terms of differentiation by molecule and matrix secretion and shown that it demonstrates morphology and functionality that mimic the native characteristic of the joint space. Finally, we induced inflammation and subsequently rescued the model constructs by a known compound as proof of concept for anti-inflammatory drug screening applications.
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Affiliation(s)
- Kevin D Roehm
- CFD Research Corporation, 6820 Moquin Dr. N.W., Huntsville, AL 35806, USA.
| | - Irene Chiesa
- Department of Information Engineering and Research Center "Enrico Piaggio", University of Pisa, Italy
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dustin Haithcock
- CFD Research Corporation, 6820 Moquin Dr. N.W., Huntsville, AL 35806, USA.
| | - Riccardo Gottardi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Division of Otolaryngology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Ri.MED Foundation, Palermo, Italy
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Deidda M, Grieve E, Krauth S, Hsieh PH, Yongolo N, Siebert S, Halliday J, Biswaro SM, Kilonzo K, Walker R, Kelly C, Msoka EF, Kiula K, Mmbaga B, McIntosh E. Economic burden of musculoskeletal disorders in Tanzania: results from a community-based survey. BMJ Open 2025; 15:e087425. [PMID: 39819935 PMCID: PMC11751939 DOI: 10.1136/bmjopen-2024-087425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 12/09/2024] [Indexed: 01/19/2025] Open
Abstract
OBJECTIVES To identify, measure and value the economic burden of musculoskeletal (MSK) disorders in the Kilimanjaro region, Tanzania. DESIGN Community-based cross-sectional survey (undertaken between January and September 2021). SETTING Hai district, Kilimanjaro, Tanzania. PARTICIPANTS Households resident in the Hai district. METHODS A two-stage cluster sampling was used to select a representative sample of all Hai district residents. Clinical screening tools were used to identify and measure MSK disorders through a tiered approach. An economic questionnaire measuring healthcare costs, out-of-pocket costs, absenteeism, presenteeism and work productivity loss was administered to those with likely MSK disorders and selected controls (individuals without MSK disorders, matched by age and gender). Resource use was valued using country-specific costs. Two-part model regressions were fitted. A descriptive analysis of catastrophic expenditure was also conducted. MAIN OUTCOME MEASURE Healthcare costs, productivity costs and total costs. RESULTS Annual average productivity and healthcare costs were, respectively, 3.5 and 3 times higher for those with likely MSK disorders than controls. Productivity costs of individuals with MSK disorders were Int$487 vs Int$132 in the control group (difference: Int$355, 95% CI Int$222 to Int$488). Healthcare costs in those with MSK were Int$269 vs Int$88 in the control group (difference: Int$181, 95% CI Int$34 to Int$327). The difference in terms of out-of-pocket expenses was economically substantial in magnitude, although not statistically significant. CONCLUSION The evidence will be used to inform policies addressing MSK disorders, by promoting the design of interventions, service provision, health promotion and awareness activities at local, regional and national level.
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Affiliation(s)
- Manuela Deidda
- Health Economics and Health Technology assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- Health Economics and Health Technology assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stefanie Krauth
- General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Ping-Hsuan Hsieh
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | | | - Stefan Siebert
- School of Infection & Immunity, University of Glasgow, Glasgow, UK
| | - Jo Halliday
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Kajiru Kilonzo
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Clive Kelly
- Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth F Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kiula Kiula
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Blandina Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emma McIntosh
- Health Economics and Health Technology assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Bruder AM, Haberfield MJ, O'Brien MJM, Kemp JL. Women are disproportionately impacted by knee and hip osteoarthritis: why does this happen and how can we address it? Br J Sports Med 2024; 58:756-757. [PMID: 38889957 DOI: 10.1136/bjsports-2024-108688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Andrea M Bruder
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Latrobe Sport Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- Latrobe Sport Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Michael J M O'Brien
- Latrobe Sport Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Joanne L Kemp
- Latrobe Sport Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Zu Y, Zhang Z, Hao Z, Jiang Z, Chen K, Wang Y, Zou C, Ge L, Yu Q, Zheng F, Wang C. Changes in brain structure and function during early aging in patients with chronic low back pain. Front Aging Neurosci 2024; 16:1356507. [PMID: 38912520 PMCID: PMC11190087 DOI: 10.3389/fnagi.2024.1356507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To explore the structural and functional changes in cognition-related brain regions in patients with chronic low back pain (CLBP) at earlier ages, and explore the impact of the interaction between CLBP and age on the brain. Methods Seventy-six patients with CLBP were recruited and divided into "younger" age group (20-29 years, YA), "middle" age group (30-39 years, MA), and "older" age group (40-49 years, OA). All patients underwent functional magnetic resonance imaging (fMRI) as well as clinical psychological and pain-related symptoms assessments. Results Structural analysis showed that patients in OA group had lower gray matter (GM) volumes in the orbitofrontal cortex (OFC) bilaterally and the right superior frontal gyrus (SFG) compared to YA group. The resting-state brain activity analysis showed that amplitude of low-frequency fluctuation (ALFF) values in the bilateral postcentral gyrus and left ventral medial prefrontal cortex (mPFC) were significantly different in the OA group. The functional connectivity (FC) in the right ventral dorsolateral prefrontal cortex (DLPFC) and the right insula was significantly decreased in the OA group compared to the YA and MA groups. Likewise, the FC in the left caudal parahippocampal gyrus (PHG) and left inferior parietal lobule (IPL) were significantly lower in the MA and OA groups compared to the YA group. In addition, both the structural properties and the FC values of these brain regions were significantly correlated with age. Conclusion This preliminary study concludes that CLBP affects the aging process. The synergistic effects of CLBP and aging accelerate the functional and structural decline of certain areas of the brain, which not only affects pain processing, but are also may be associated with cognitive declines.
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Affiliation(s)
- Yao Zu
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhou Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zengming Hao
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zimu Jiang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yu Wang
- College of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Changcheng Zou
- College of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Le Ge
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fuming Zheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Allen HN, Hestehave S, Duran P, Nelson TS, Khanna R. Uncoupling the CRMP2-Ca V2.2 interaction reduces pain-like behavior in a preclinical osteoarthritis model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.05.596514. [PMID: 38895294 PMCID: PMC11185632 DOI: 10.1101/2024.06.05.596514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Osteoarthritis (OA) represents a significant pain challenge globally, as current treatments are limited and come with substantial and adverse side effects. Voltage-gated calcium channels have proved to be pharmacologically effective targets, with multiple FDA-approved CaV2.2 modulators available for the treatment of pain. Although effective, drugs targeting CaV2.2 are complicated by the same obstacles facing other pain therapeutics-invasive routes of administration, narrow therapeutic windows, side effects, and addiction potential. We have identified a key regulator of CaV2.2 channels, collapsing response mediator protein 2 (CRMP2), that allows us to indirectly regulate CaV2.2 expression and function. We developed a peptidomimetic modulator of CRMP2, CBD3063, that effectively reverses neuropathic and inflammatory pain without negative side effects by reducing membrane expression of CaV2.2. Using a rodent model of OA, we demonstrate the intraperitoneal administration of CBD3063 alleviates both evoked and non-evoked behavioral hallmarks of OA pain. Further, we reveal that CBD3063 reduces OA-induced increased neural activity in the parabrachial nucleus, a key supraspinal site modulating the pain experience. Together, these studies suggest CBD3063 is an effective analgesic for OA pain.
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Affiliation(s)
- Heather N. Allen
- Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Sara Hestehave
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, New York 10010, USA
| | - Paz Duran
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, New York 10010, USA
| | - Tyler S. Nelson
- Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, Florida 32610, USA
| | - Rajesh Khanna
- Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, Florida 32610, USA
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Nouwens SPH, Veldwijk J, Pilli L, Swait JD, Coast J, de Bekker-Grob EW. A socially interdependent choice framework for social influences in healthcare decision-making: a study protocol. BMJ Open 2024; 14:e079768. [PMID: 38458790 PMCID: PMC10928740 DOI: 10.1136/bmjopen-2023-079768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/26/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Current choice models in healthcare (and beyond) can provide suboptimal predictions of healthcare users' decisions. One reason for such inaccuracy is that standard microeconomic theory assumes that decisions of healthcare users are made in a social vacuum. Healthcare choices, however, can in fact be (entirely) socially determined. To achieve more accurate choice predictions within healthcare and therefore better policy decisions, the social influences that affect healthcare user decision-making need to be identified and explicitly integrated into choice models. The purpose of this study is to develop a socially interdependent choice framework of healthcare user decision-making. DESIGN A mixed-methods approach will be used. A systematic literature review will be conducted that identifies the social influences on healthcare user decision-making. Based on the outcomes of a systematic literature review, an interview guide will be developed that assesses which, and how, social influences affect healthcare user decision-making in four different medical fields. This guide will be used during two exploratory focus groups to assess the engagement of participants and clarity of questions and probes. The refined interview guide will be used to conduct the semistructured interviews with healthcare professionals and users. These interviews will explore in detail which, and how, social influences affect healthcare user decision-making. Focus group and interview transcripts will be analysed iteratively using a constant comparative approach based on a mix of inductive and deductive coding. Based on the outcomes, a social influence independent choice framework for healthcare user decision-making will be drafted. Finally, the Delphi technique will be employed to achieve consensus about the final version of this choice framework. ETHICS AND DISSEMINATION This study was approved by the Erasmus School of Health Policy and Management Research Ethics Review Committee (ESHPM, Rotterdam, The Netherlands; reference ETH2122-0666).
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Affiliation(s)
- Sven P H Nouwens
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Jorien Veldwijk
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Luis Pilli
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Joffre D Swait
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
| | - Joanna Coast
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Esther W de Bekker-Grob
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, Netherlands
- Erasmus Choice Modeling Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics, Rotterdam, The Netherlands
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Killingmo RM, Tveter AT, Pripp AH, Tingulstad A, Maas E, Rysstad T, Grotle M. Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: findings from an occupational cohort study. BMJ Open 2024; 14:e080567. [PMID: 38431296 PMCID: PMC10910429 DOI: 10.1136/bmjopen-2023-080567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES The objective was to identify modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders, and to identify modifiable prognostic factors of high costs related to separately healthcare utilisation and productivity loss. DESIGN A prospective cohort study with a 1-year follow-up. PARTICIPANTS AND SETTING A total of 549 participants (aged 18-67 years) on sick leave (≥ 4 weeks) due to musculoskeletal disorders in Norway were included. OUTCOME MEASURES AND METHOD The primary outcome was societal costs aggregated for 1 year of follow-up and dichotomised as high or low, defined by the top 25th percentile. Secondary outcomes were high costs related to separately healthcare utilisation and productivity loss aggregated for 1 year of follow-up. Healthcare utilisation was collected from public records and included primary, secondary and tertiary healthcare use. Productivity loss was collected from public records and included absenteeism, work assessment allowance and disability pension. Nine modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression analyses were performed to identify associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and having high costs. RESULTS Adjusted for selected covariates, six modifiable prognostic factors associated with high societal costs were identified: pain severity, disability, self-perceived health, sleep quality, return to work expectation and long-lasting disorder expectation. Depressive symptoms, work satisfaction and health literacy showed no prognostic value. More or less similar results were observed when high costs were related to separately healthcare utilisation and productivity loss. CONCLUSION Factors identified in this study are potential target areas for interventions which could reduce high societal costs among people on sick leave due to musculoskeletal disorders. However, future research aimed at replicating these findings is warranted. TRIAL REGISTRATION NUMBER NCT04196634, 12 December 2019.
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Affiliation(s)
- Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Anne Therese Tveter
- Center for treatment of rheumatic and musculoskeletal diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Oslo Centre of Biostatistics and Epidemiology Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Alexander Tingulstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Esther Maas
- Department of Health Sciences, Vrije University Amsterdam, Amsterdam, The Netherlands
- The Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Agger N, Desmeules F, Christiansen DH. Predicting outcomes across treatment settings in patients with shoulder pain referred to physiotherapy: a secondary analysis of two comparable prospective cohort studies. BMJ Open Sport Exerc Med 2023; 9:e001770. [PMID: 38156241 PMCID: PMC10753741 DOI: 10.1136/bmjsem-2023-001770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/30/2023] Open
Abstract
Objective Previous studies have examined factors that may contribute to predicting outcomes for patients with shoulder pain. However, there is still a lack of consensus on which factors predict the results and whether there are differences based on the treatment setting. Thus, this study aimed to analyse and compare how baseline variables are associated with future outcomes in patients with shoulder pain in primary and secondary care settings. Methods This study conducted a secondary analysis of two observational prospective cohort studies involving patients with shoulder pain in primary care (n=150) and secondary care (n=183). Multiple regression analyses were employed, with one interaction term at a time, to examine potential differences in association with baseline characteristics and future outcomes between the two settings. Results Changes in pain and function were statistically significant at 6 months for patients in primary care and secondary care. However, associations for most baseline variables and outcomes did not differ significantly across these two treatment settings. The only statistically significant interactions observed were for the associations between baseline level of pain, function and fear avoidance beliefs and change in pain scores at 6 months, with lower change scores observed among patients in the secondary care. Conclusion This study revealed that the association with outcomes did not differ across settings for most baseline characteristics. These findings suggest that it could be feasible to generalise the prognostic value of most baseline variables for patients with shoulder, irrespective of the treatment setting.
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Affiliation(s)
- Nikolaj Agger
- Centre for Research in Health and Nursing, Regional Hospital Central Jutland Viborg, Viborg, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - François Desmeules
- School of Rehabilitation, Medicine Faculty, University of Montreal, Montreal, Quebec, Canada
- Maisonneuve-Rosemont Hospital Research Center, Montreal, Quebec, Canada
| | - David Høyrup Christiansen
- Centre for Research in Health and Nursing, Regional Hospital Central Jutland Viborg, Viborg, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Huang Z, Bucklin MA, Guo W, Martin JT. Disease progression and clinical outcomes in latent osteoarthritis phenotypes: Data from the Osteoarthritis Initiative. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.14.23299525. [PMID: 38168330 PMCID: PMC10760291 DOI: 10.1101/2023.12.14.23299525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The prevalence of knee osteoarthritis (OA) is widespread and the heterogeneous patient factors and clinical symptoms in OA patients impede developing personalized treatments for OA patients. In this study, we used unsupervised and supervised machine learning to organize the heterogeneity in knee OA patients and predict disease progression in individuals from the Osteoarthritis Initiative (OAI) dataset. We identified four distinct knee OA phenotypes using unsupervised learning that were defined by nutrition, disability, stiffness, and pain (knee and back) and were strongly related to disease fate. Interestingly, the absence of supplemental vitamins from an individual's diet was protective from disease progression. Moreover, we established a phenotyping tool and prognostic model from 5 variables (WOMAC disability score of the right knee, WOMAC total score of the right knee, WOMAC total score of the left knee, supplemental vitamins and minerals frequency, and antioxidant combination multivitamins frequency) that can be utilized in clinical practice to determine the risk of knee OA progression in individual patients. We also developed a prognostic model to estimate the risk for total knee replacement and provide suggestions for modifiable variables to improve long-term knee health. This combination of unsupervised and supervised data-driven tools provides a framework to identify knee OA phenotype in a clinical scenario and personalize treatment strategies.
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Joint and soft tissue injections in Irish primary care: a survey of GPs' attitudes and practices. BJGP Open 2023:BJGPO.2022.0093. [PMID: 36720561 DOI: 10.3399/bjgpo.2022.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/20/2022] [Accepted: 11/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Musculoskeletal conditions are common in primary care, causing significant morbidity. Intra-articular and soft tissue corticosteroid injections are commonly performed by GPs internationally. It is unknown how commonly they are performed by GPs in the Republic of Ireland. AIM To determine the frequency and type of joint and soft tissue injections performed by GPs in the Republic of Ireland and investigate factors affecting their use. DESIGN & SETTING A cross-sectional online questionnaire, which was based on previous international research, was devised for completion by GPs practising in the Republic of Ireland. METHOD GPs were invited to electronically complete a questionnaire on their practices and attitudes regarding joint and soft tissue injections. RESULTS A total of 147 of 204 GPs (72.1%) had performed an intra-articular or soft tissue injection in the preceding year. GPs who were principals or partners, male, or worked in a rural or mixed urban and rural practice setting were more likely to perform these procedures. The most common injection sites were the shoulder and knee. Participants were confident about performing joint and soft tissue injections. It was found that 80.4% had received prior training in this treatment modality, most commonly during their GP training programme. A prolonged wait for secondary care intervention, symptom duration, and symptom severity were factors that increased the likelihood of performing injections. Difficulty maintaining skills and medicolegal concerns were common barriers to performing joint and soft tissue injections. CONCLUSION Most GPs surveyed carried out joint and soft tissue injections, most commonly injecting the shoulder and knee. Irish GPs experience many of the same barriers to performing intra-articular injection as experienced internationally.
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Fan H, Xu P, Chen X, Li Y, Hsu J, Le M, Zhang Z, Ye E, Gao B, Ye T. Measuring chondrocyte viability of articular cartilage based on label-free two-photon microscopy and deep learning image analysis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.13.527931. [PMID: 36824870 PMCID: PMC9949096 DOI: 10.1101/2023.02.13.527931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Objective Chondrocyte viability (CV) is an important indicator of articular cartilage health. Two-photon excitation autofluorescence (TPAF) and second harmonic generation (SHG) microscopy provide a label-free method for imaging chondrocytes. In this study, we propose an automated assessment of CV using deep learning cell segmentation and counting based on acquired TPAF/SHG images. Design Label-free TPAF/SHG images of cartilage samples from rats and porcine were acquired using both commercial and home-built two-photon microscopes, respectively. TPAF/SHG images were merged to form RGB color images with red, green, and blue channels assigned to TPAF (two channels) and SHG signals, respectively. To make the training datasets for the deep learning networks, individual chondrocyte areas on the RGB color images were manually circled and live or dead chondrocytes were validated by using Calcein-AM and Ethidium homodimer-1 dye labeling. We first built a chondrocyte viability network (MCV-Net) using the Mask R-CNN architecture, which could provide individual segmented cellular areas with live or dead status. Wiener deconvolution preprocessing was added before the input of MCV-Net to improve the accuracy of the CV analysis, forming the Wiener deconvolution CV network (wMCV-Net). Results Training (300 images) and test (120 images) datasets were built for rats and porcine cartilage respectively. Wiener deconvolution could improve the Peak Signal-to-Noise Ratio (PSNR) for 30-40%. We demonstrated that both MCV-Net and wMCV-Net significantly improved the accuracy of the CV measurement. Conclusion A custom desktop TPAF/SHG microscope was used in collaboration with deep learning algorithm wMCV-Net based label-free method to assess the CV and get 95% accuracy with both rats and porcine samples.
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Tang H, Qin K, Wang A, Li S, Fang S, Gao W, Lu M, Huang W, Zhang H, Yin Z. 3,3'-diindolylmethane inhibits LPS-induced human chondrocytes apoptosis and extracellular matrix degradation by activating PI3K-Akt-mTOR-mediated autophagy. Front Pharmacol 2022; 13:999851. [PMID: 36438802 PMCID: PMC9684728 DOI: 10.3389/fphar.2022.999851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/10/2022] [Indexed: 09/08/2024] Open
Abstract
Osteoarthritis (OA) is a chronic degenerative joint disease characterized by articular cartilage destruction. The pathological mechanisms are complex; in particular, inflammation, autophagy, and apoptosis are often involved. 3,3-Diindolylmethane (DIM), a phytoconstituent extracted from cruciferous vegetables, has various effects such as anti-inflammatory, antioxidant and anti-apoptotic. However, the effects of DIM on osteoarthritic chondrocytes remain undetermined. In this study, we simulated a lipopolysaccharide (LPS)-induced osteoarthritis model in human primary chondrocytes. We found that LPS stimulation significantly inhibited autophagy, induced chondrocyte apoptosis and extracellular matrix (ECM) degradation, which could be ameliorated by DIM. DIM inhibited the expression of a disintegrin and metalloproteinase with thrombospondin motif 5 (ADAMTS-5), matrix metalloproteinase 13 (MMP13), cleaved caspase-3, Bax, and p62, and increased the expression level of collagen II, aggrecan, Bcl-2, light chain 3 Ⅱ (LC3 Ⅱ), and beclin-1. Mechanistic studies showed that DIM increased chondrocyte autophagy levels by inhibiting the activation of PI3K/AKT/mTOR pathway. In mice destabilization of the medial meniscus (DMM) model, immunohistochemical analysis showed that DIM inhibited the expression of p-PI3K and cleaved caspase-3, increased the expression of LC3 Ⅱ. Furthermore, DIM relieved joint cartilage degeneration. In conclusion, our findings demonstrate for the first time that DIM inhibits LPS-induced chondrocyte apoptosis and ECM degradation by regulating the PI3K/AKT/mTOR-autophagy axis and delays OA progression in vivo.
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Affiliation(s)
- Hao Tang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- The Key Laboratory of Microbiology and Parasitology of Anhui Province, The Key Laboratory of Zoonoses of High Institutions in Anhui, Anhui Medical University, Hefei, China
| | - Kunpeng Qin
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Anquan Wang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shuang Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sheng Fang
- Department of Orthopedics, The Second People’s Hospital of Hefei, Hefei, China
| | - Weilu Gao
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ming Lu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hui Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zongsheng Yin
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Cai J, Wang J, Sun C, Dai J, Zhang C. Biomaterials with Stiffness Gradient for Interface Tissue Engineering. Biomed Mater 2022; 17. [PMID: 35985317 DOI: 10.1088/1748-605x/ac8b4a] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/19/2022] [Indexed: 11/11/2022]
Abstract
Interface tissue engineering is a rapidly growing field that aims to develop engineered tissue alternates with the goal of promoting integration between multiple tissue types. Engineering interface tissues is a complex process, which requires a specialized biomaterials with organized material composition, stiffness, cell types, and signaling molecules. Among these, stiffness-controllable substrates have been developed to investigate the effect of stiffness on cell behavior. Especially these substrates with graded stiffness are advantageous since they allow the differentiation of multiple cell phenotypes and subsequent tissue development. In this review, we highlight the various types of manufacturing techniques that can be leveraged to fabricate scaffolds with stiffness gradient, discuss methods to characterize them, and gradient biomaterials for controlling cellular behavior including attachment, migration, proliferation, and differentiation. We also address fundamentals of interface tissue organization, and stiffness gradient biomaterials for interface tissue regeneration. Potential challenges and future directions in this emerging field are also discussed.
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Affiliation(s)
- Jialun Cai
- Hunan University, #27 Tianma Road, Changsha, Hunan, 410082, CHINA
| | - Junjuan Wang
- Hangzhou Medical College, Binwen Road, Hangzhou, Zhejiang, 310053, CHINA
| | - Chenxuan Sun
- Hunan University, 27# Tianma Road, ChangSha, Hunan, 410000, CHINA
| | - Jianwu Dai
- Institute of Genetics and Developmental Biology Chinese Academy of Sciences, No 1 West Beichen Road, Chaoyang District, Beijing, 100101, Beijing, 100101, CHINA
| | - Can Zhang
- Biomedical Engineering, Hunan University, #27 Tianma Road, Changsha, 410000, CHINA
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15
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Liu XH, Ding JY, Zhu ZH, Wu XC, Song YJ, Xu XL, Ding DF. Recent advances in enzyme-related biomaterials for arthritis treatment. Front Chem 2022; 10:988051. [PMID: 36051622 PMCID: PMC9424673 DOI: 10.3389/fchem.2022.988051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/21/2022] [Indexed: 12/27/2022] Open
Abstract
Arthritis is a group of highly prevalent joint disorders, and osteoarthritis (OA) and rheumatoid arthritis are the two most common types. The high prevalence of arthritis causes severe burdens on individuals, society and the economy. Currently, the primary treatment of arthritis is to relieve symptoms, but the development of arthritis cannot be effectively prevented. Studies have revealed that the disrupted balance of enzymes determines the pathological changes in arthritis. In particular, the increased levels of matrix metalloproteinases and the decreased expression of endogenous antioxidant enzymes promote the progression of arthritis. New therapeutic strategies have been developed based on the expression characteristics of these enzymes. Biomaterials have been designed that are responsive when the destructive enzymes MMPs are increased or have the activities of the antioxidant enzymes that play a protective role in arthritis. Here, we summarize recent studies on biomaterials associated with MMPs and antioxidant enzymes involved in the pathological process of arthritis. These enzyme-related biomaterials have been shown to be beneficial for arthritis treatment, but there are still some problems that need to be solved to improve efficacy, especially penetrating the deeper layer of articular cartilage and targeting osteoclasts in subchondral bone. In conclusion, enzyme-related nano-therapy is challenging and promising for arthritis treatment.
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Affiliation(s)
- Xin-Hao Liu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Ying Ding
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhi-Heng Zhu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xi-Chen Wu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yong-Jia Song
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiao-Ling Xu
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
- *Correspondence: Xiao-Ling Xu, ; Dao-Fang Ding,
| | - Dao-Fang Ding
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xiao-Ling Xu, ; Dao-Fang Ding,
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Measurement of Lower Extremity Alignment Using a Smartphone Application. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12146834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Identification of lower extremity misalignment requires radiation exposure and complex imaging. We developed and tested a smartphone application to facilitate quick identification of misalignment using photographs. Lower extremity alignment was measured by two independent researchers using a proprietary smartphone application and conventional radiographs. The results were compared between the methods and evaluators for interrater and intrarater reliability. Ninety datasets were obtained from 45 patients, with 90 lower extremity alignment angles measured via radiographs and the smartphone application. The intrarater reliability of the hip–knee–ankle angle (HKAA), measured twice by evaluator A using the radiographic imaging program, was 0.985, whereas that measured by evaluator B was 0.995. The intrarater reliability of the predicted lower extremity alignment angle (PLEAA) measured using the smartphone application was 0.970 and 0.968 for evaluators A and B, respectively. Thus, all results showed excellent reliability. In validity analysis, the correlation between PLEAA and HKAA measured twice by evaluators A and B was analyzed using Pearson’s correlation coefficient. HKAA (A) and PLEAA (A) had a positive correlation coefficient of 0.608 (p < 0.01), whereas HKAA (B) and PLEAA (B) had a positive correlation coefficient of 0.627 (p < 0.01). Thus, our smartphone application can facilitate for self-diagnosis of lower extremity misalignment.
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Bender A, Damm P, Hommel H, Duda GN. Overstretching Expectations May Endanger the Success of the “Millennium Surgery”. Front Bioeng Biotechnol 2022; 10:789629. [PMID: 35237570 PMCID: PMC8882767 DOI: 10.3389/fbioe.2022.789629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Total hip arthroplasty (THA) is an extremely successful treatment strategy. Patient expectations, however, have increased; if not properly guided by surgeons, at present, patients expect next to pain-free restoration of the joint and a fast return to work and sports. While the revision rates after THA also increased in younger patients, knowledge on musculoskeletal loads still remains sparse, and the current recommendations on postoperative rehabilitation are based on expert opinions only. The aim of this study was to unravel biomechanical contact conditions in “working age” (<60 years, 53.5 ± 3.0 years) and “retirement age” (>60 years, 67.7 ± 8.6 years) patients during activities recommended post-THA. We hypothesized that working age patients would show substantially increased hip contact loads compared to older patients. The in vivo joint contact force (Fres) and torsion torque (Mtors), reflecting the main contact load situation, experienced during activities of daily living and sports activities were measured in a unique group of 16 patients with instrumented THA. We summarized patient activities and sports recommendations after THA mentioned within the literature using PubMed (without claim of completeness). The measurements showed that younger working age patients experienced significant (p = 0.050) increased Mtors (21.52 ± 9.11 Nm) than older retirement age patients (13.99 ± 7.89 Nm) by walking. Bowling, as a recommended low-impact sport, was associated with Fres of up to 5436 N and Mtors of up to 108 Nm in the working age group, which were higher than the Fres (5276 N) and Mtors (71 Nm) during high-impact soccer. Based on our results, age was proven to be a discriminator in joint loading, with working age patients presenting with increased loads compared to retirement age patients, already during daily activities. The current patient recommendations have led to further increased joint loadings. If THA cannot be delayed in a patient, we propose counselling patients on a carefully considered return to sports, focusing on low-impact activities, as indicated hereby. The findings from this work illustrate the need to provide critical feedback to patient expectations when returning to work and sports activities. Patients returning to more intensive sports activities should be carefully monitored and advised to avoid as much overloading as possible.
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Affiliation(s)
- Alwina Bender
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
- *Correspondence: Philipp Damm,
| | - Hagen Hommel
- Department of Orthopaedics, Märkisch-Oderland Hospital, Brandenburg Medical School Theodor Fontane, Wriezen, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius-Wolff-Institute, Berlin, Germany
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18
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Lu R, Yu X, Liang S, Cheng P, Wang Z, He ZY, Lv ZT, Wan J, Mo H, Zhu WT, Chen AM. Physalin A Inhibits MAPK and NF-κB Signal Transduction Through Integrin αVβ3 and Exerts Chondroprotective Effect. Front Pharmacol 2021; 12:761922. [PMID: 34925020 PMCID: PMC8678602 DOI: 10.3389/fphar.2021.761922] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/15/2021] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis (OA) is a common articular ailment presented with cartilage loss and destruction that is common observed in the elderly population. Physalin A (PA), a natural bioactive withanolide, exerts anti-inflammatory residences in more than a few diseases; however, little is known about its efficacy for OA treatment. Here, we explored the therapeutic effects and potential mechanism of PA in mouse OA. After the in vitro administration of PA, the expression of inflammation indicators including inducible nitric oxide synthase and cyclooxygenase-2 was low, indicating that PA could alleviate the IL-1β-induced chondrocyte inflammation response. Moreover, PA reduced IL-1β-induced destruction of the extracellular matrix by upregulating the gene expression of anabolism factors, including collagen II, aggrecan, and sry-box transcription factor 9, and downregulating the gene expression of catabolic factors, including thrombospondin motif 5 and matrix metalloproteinases. In addition, the chondroprotective effect of PA was credited to the inhibition of mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) signaling pathways. Furthermore, in vivo experiments showed that intra-articular injection of PA could alleviate cartilage destruction in a mouse OA model. However, the anti-inflammatory, anabolism enhancing, catabolism inhibiting, and MAPK and NF-κB signaling pathway inhibiting properties of PA on IL-1β-induced chondrocytes could be reversed when integrin αVβ3 is knocked down by siRNA. In conclusion, our work demonstrates that PA exhibits a chondroprotective effect that may be mediated by integrin αVβ3. Thus, PA or integrin αVβ3 might be a promising agent or molecular target for the treatment of OA.
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Affiliation(s)
- Rui Lu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuang Liang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Cheng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenggang Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Zhi-Yi He
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng-Tao Lv
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junlai Wan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haokun Mo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Tao Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An-Min Chen
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yan W, Yu Y, Wang Y, Jiang X, Wan R, Ji C, Shi L, Wang X, Wang Y. Research Relating to Low Back Pain and Physical Activity Reported Over the Period of 2000-2020. J Pain Res 2021; 14:2513-2528. [PMID: 34447266 PMCID: PMC8384348 DOI: 10.2147/jpr.s312614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a highly prevalent musculoskeletal disorder that contributes to the greatest degree of disability worldwide. It has become a very serious public health problem that has attracted considerable research interest. The number of publications associated with LBP and physical activity (PA) is gradually increasing. Nevertheless, few studies have utilised visualisation in analysing the general aspects of this field. Therefore, we aimed to provide a systematic overview of global scientific research related to low back pain and physical activity from 2000 to 2020. It has significant benefits in terms of providing researchers with the status and trends of research on low back pain and physical activity. METHODS Publications on Science Citation Index-Expanded of Web of Science from 2000 to 2020 were searched, and publications relevant to LBP and PA were analysed using Citespace and SPSS. Analyses mainly included cooperation amongst authors, countries and institutions; co-occurrence analysis of keywords; and co-citation analysis of references, revealing productive researchers and contributing institutions tracking the status and trend of research fields. RESULTS Results of linear regression analysis showed that the number of publications on LBP and PA studies increased significantly (p<0.001). The subject categories predominantly focused on orthopaedics (2579, 26.54%), rehabilitation (2544, 26.18%) and sport sciences (2015, 25.44%). The United States had the highest number of published papers (2700, 27.789%) and citations (86, 958). In terms of the number of publications, amongst the top 20 journals, Spine contributed the most, whilst the British Journal of Sports Medicine had the highest impact factor (IF2019, 12.022). The University of Sydney had the highest number of publications (330 publications). Maher published the most papers (123 papers) and had the highest H-index (41). Several citation articles and keywords (such as aerobic, obesity and fear-avoidance beliefs) can be used to provide frontier clues for research on LBP and PA. CONCLUSION The results of our study may provide information, such as research trends and frontiers of research and collaborating partners, institutions and countries, on LBP and PA.
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Affiliation(s)
- Wangwang Yan
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, People’s Republic of China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, People’s Republic of China
| | - Yanling Yu
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, People’s Republic of China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, People’s Republic of China
| | - Yafei Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Xue Jiang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, People’s Republic of China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, People’s Republic of China
| | - Ruihan Wan
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, People’s Republic of China
- Department of Sport Rehabilitation, Shenyang Sport University, Shenyang City, Liaoning Province, People’s Republic of China
| | - Chang Ji
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, People’s Republic of China
- Postgraduate Research Institute, Guangzhou Sport University, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Le Shi
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, People’s Republic of China
| | - Xueqiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, People’s Republic of China
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province, People’s Republic of China
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The Effects of Tgfb1 and Csf3 on Chondrogenic Differentiation of iPS Cells in 2D and 3D Culture Environment. Int J Mol Sci 2021; 22:ijms22062978. [PMID: 33804138 PMCID: PMC8000805 DOI: 10.3390/ijms22062978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/01/2023] Open
Abstract
Mesenchymal stem (MS) cells, embryonic stem (ES) cells, and induced pluripotent stem (iPS) cells are known for their ability to differentiate into different lineages, including chondrocytes in culture. However, the existing protocol for chondrocyte differentiation is time consuming and labor intensive. To improve and simplify the differentiation strategy, we have explored the effects of interactions between growth factors (transforming growth factor β1 (Tgfb1) and colony stimulating factor 3 (Csf3), and culture environments (2D monolayer and 3D nanofiber scaffold) on chondrogenic differentiation. For this, we have examined cell morphologies, proliferation rates, viability, and gene expression profiles, and characterized the cartilaginous matrix formed in the chondrogenic cultures under different treatment regimens. Our data show that 3D cultures support higher proliferation rate than the 2D cultures. Tgfb1 promotes cell proliferation and viability in both types of culture, whereas Csf3 shows positive effects only in 3D cultures. Interestingly, our results indicate that the combined treatments of Tgfb1 and Csf3 do not affect cell proliferation and viability. The expression of cartilaginous matrix in different treatment groups indicates the presence of chondrocytes. We found that, at the end of differentiation stage 1, pluripotent markers were downregulated, while the mesodermal marker was upregulated. However, the expression of chondrogenic markers (col2a1 and aggrecan) was upregulated only in the 3D cultures. Here, we report an efficient, scalable, and convenient protocol for chondrogenic differentiation of iPS cells, and our data suggest that a 3D culture environment, combined with tgfb1 and csf3 treatment, promotes the chondrogenic differentiation.
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Lang AE, Hendrick PA, Clay L, Mondal P, Trask CM, Bath B, Penz ED, Stewart SA, Baxter GD, Hurley DA, McDonough SM, Milosavljevic S. A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain. BMC Musculoskelet Disord 2021; 22:206. [PMID: 33607979 PMCID: PMC7896363 DOI: 10.1186/s12891-021-04060-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. METHODS Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. RESULTS N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. CONCLUSIONS Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. TRIAL REGISTRATION United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).
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Affiliation(s)
- Angelica E Lang
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Paul A Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Lynne Clay
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prosanta Mondal
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Brenna Bath
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Erika D Penz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Samuel A Stewart
- Faculty of Medicine, Dalhousie University, Halifax Regional Municipality, Nova Scotia, Canada
| | - G David Baxter
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Deidre A Hurley
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Lu MC, Livneh H, Yen CT, Huang HL, Lin MC, Yen SW, Lai NS, Tsai TY. Association of Use of Rehabilitation Services With Development of Dementia Among Patients With Rheumatoid Arthritis: Analysis of Domestic Data in Taiwan. Front Med (Lausanne) 2020; 7:446. [PMID: 32923448 PMCID: PMC7456933 DOI: 10.3389/fmed.2020.00446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/06/2020] [Indexed: 12/19/2022] Open
Abstract
Objectives: Rheumatoid arthritis (RA) was found to trigger the higher risk of dementia. Limited information, however, is available on whether the use of rehabilitation services (RS), an integral part of healthcare programs, can lessen dementia risk for RA subjects. The aim of this study was to determine the relationship of RS use to the development of dementia in RA patients. Methods: We identified 2,927 newly diagnosed patients with RA, 20–70 years of age between 1998 and 2007, from a national health insurance database. 965 patients from this sample received RS, and 1,962 patients were designated as a control group (non-RS users). Patients were followed to the end of 2012 to identify dementia incident as the end point. Cox proportional hazards regression was performed to calculate the hazard ratio (HR) of dementia risk associated with the use of RS. Results: During the study period, 388 patients with RS and 1,224 controls developed dementia, representing incidence rate of 75.46 and 115.42 per 1,000 person-years, respectively. After adjusting for potential confounders, RS was found to significantly reduce dementia risk, with the adjusted HR of 0.60 (95% confidence interval [CI] = 0.53–0.67). Those who used the high intensity of RS (≧15 courses) had the greatest benefit. Conclusions: Integrating RS into the conventional treatment may reduce the sequent risk of dementia for RA patients.
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Affiliation(s)
- Ming-Chi Lu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hanoch Livneh
- Rehabilitation Counseling Program, Portland State University, Portland, OR, United States
| | - Chieh-Tsung Yen
- Department of Neurology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan
| | - Hua-Lung Huang
- Department of Rehabilitation, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan
| | - Miao-Chiu Lin
- Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan
| | - Shu-Wen Yen
- Department of Rehabilitation, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tzung-Yi Tsai
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.,Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
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23
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Therapeutic Manipulation of Macrophages Using Nanotechnological Approaches for the Treatment of Osteoarthritis. NANOMATERIALS 2020; 10:nano10081562. [PMID: 32784839 PMCID: PMC7466380 DOI: 10.3390/nano10081562] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
Abstract
Osteoarthritis (OA) is the most common joint pathology causing severe pain and disability. Macrophages play a central role in the pathogenesis of OA. In the joint microenvironment, macrophages with an M1-like pro-inflammatory phenotype induce chronic inflammation and joint destruction, and they have been correlated with the development and progression of the disease, while the M2-like anti-inflammatory macrophages support the recovery of the disease, promoting tissue repair and the resolution of inflammation. Nowadays, the treatment of OA in the clinic relies on systemic and/or intra-articular administration of anti-inflammatory and pain relief drugs, as well as surgical interventions for the severe cases (i.e., meniscectomy). The disadvantages of the pharmacological therapy are related to the chronic nature of the disease, requiring prolonged treatments, and to the particular location of the pathology in joint tissues, which are separated anatomical compartments with difficult access for the drugs. To overcome these challenges, nanotechnological approaches have been investigated to improve the delivery of drugs toward macrophages into the diseased joint. This strategy may offer advantages by reducing off-target toxicities and improving long-term therapeutic efficacy. In this review, we describe the nanomaterial-based approaches designed so far to directly or indirectly manipulate macrophages for the treatment of osteoarthritis.
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Mei R, Lou P, You G, Jiang T, Yu X, Guo L. 17β-Estradiol Induces Mitophagy Upregulation to Protect Chondrocytes via the SIRT1-Mediated AMPK/mTOR Signaling Pathway. Front Endocrinol (Lausanne) 2020; 11:615250. [PMID: 33613450 PMCID: PMC7888342 DOI: 10.3389/fendo.2020.615250] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/15/2020] [Indexed: 12/22/2022] Open
Abstract
Increasing evidence reveals that estrogen, especially 17β-estradiol (17β-E2), is associated with articular cartilage metabolism disorder and postmenopausal osteoarthritis (OA). SIRT1, AMPK, and mTOR are regarded as critical mitophagy regulators. Recent studies have shown that mitophagy displays a protective effect against OA, but the molecular mechanism is not well known. This study aimed to investigate the effect of 17β-E2 on Sirtuin-1 (SIRT1) expression and the induction of mitophagy upregulation by 17β-E2 via the SIRT1-mediated AMP-activated protein kinase (AMPK)/mammalian target of the rapamycin (mTOR) signaling pathway to protect chondrocytes. ATDC5 chondrocytes were treated with different concentrations of 17β-E2 (0 M, 1 × 10-9 M, 1 × 10-8 M, and 1 × 10-7 M) for 24 h or pretreatment with or without NAM (SIRT1 inhibitor), Compound C (AMPK inhibitor) and S1842 (mTOR inhibitor) for 30 min prior to treatment with 17β-E2 (1 × 10-7 M) for 24 in each groups. Expression of SIRT1 was evaluated by real-time PCR, Western blotting and confocal immunofluorescence staining. Then, the mitophagosomes in cells were observed under a transmission electron microscopy (TEM), and the AMPK/mTOR signaling pathway was detected by Western blotting. The mitophagy-related proteins, p-AMPK, p-mTOR, p-JNK, and p-p38 were also identified by Western blot analysis. The chondrocytes viability and proliferation were determined by MTT and 5-Bromo-2'-deoxyuridine (BrdU) assay. These experiments were independently repeated 3 times The study found that 17β-E2 increased the expression level of SIRT1, p-AMPK, and mitophagy-related proteins but decreased p-mTOR expression, and then induced mitophagy upregulation in chondrocytes. More mitochondrial autophagosomes were observed in 17β-E2-treated chondrocytes under a transmission electron microscope. Also, 17β-E2 improved cell viability and proliferation with the higher expression of SIRT1 and activation of the AMPK/mTOR signaling pathway. However, SIRT1 inhibitor nicotinamide (NAM) and AMPK inhibitor Compound C blocked the beneficial effect of 17β-E2. In summary, this study was novel in demonstrating that 17β-E2 induced mitophagy upregulation to protect chondrocytes via the SIRT1-mediated AMPK/mTOR signaling pathway.
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Affiliation(s)
- Runhong Mei
- Department of Orthopaedics, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Peng Lou
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Guanchao You
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Tianlong Jiang
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Xuefeng Yu
- Department of Orthopaedics, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Xuefeng Yu, ; Lei Guo,
| | - Lei Guo
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Xuefeng Yu, ; Lei Guo,
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25
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Zamanzadeh V, Ahmadi F, Foolady M, Behshid M, Irajpoor A. The Health Seeking Behaviors and Perceptions of Iranian Patient with Osteoarthritis about Pain Management: A Qualitative Study. J Caring Sci 2017; 6:81-93. [PMID: 28299300 PMCID: PMC5348666 DOI: 10.15171/jcs.2017.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 11/30/2016] [Indexed: 12/23/2022] Open
Abstract
Introduction: Pain is the main reason for patients with
osteoarthritis (OA) to visit health clinics. Health seeking behaviors indicate unmet
patient needs and lack of understanding of OA pain patterns. This study aimed to describe
the experiences of Iranian patients with OA and explore their health seeking behaviors and
perceptions on pain management related to osteoarthritis. Methods: Using a qualitative approach, data was collected
by interviewing 19 patients, 2 family members, and 5 health care providers from the
in-patient and out-patient clinics, and physicians’ offices. Data saturation was reached
after 31 in-depth and semi-structured interviews (five second interviews). Data were
analyzed by qualitative content analysis, using comparison, reflection and interpretation
techniques. The criteria used to enhance rigor included credibility, transferability,
dependability, and confirmability. Results: Two main categories and six subcategories emerged
from data analysis. The first main category included "adapting to the reality" which had
three subcategories: Facing OA pain, seeking health care, and accepting pain as a part of
life. The second main category included "behavior fluctuation" with three subcategory of
role conflict, responsibility for self-care and, adherence to prescribed treatment versus
self-treatment. Conclusion: Care seeking behaviors for chronic pain
sufferers are void of cultural, emotional, social and financial situation and patient
expectations. Some misconceptions emerged about the health problem and its management,
which may lead to negative attitudes toward treatment and therapists and finally lead to
non-adherence to treatment. Patients need for education to enhance appropriate health care
utilization.
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Affiliation(s)
- Vahid Zamanzadeh
- Department of Medical Surgical Nursing, Tabriz Health Services Management Research Centre, Nursing & Midwifery Faculty, Tabriz University of Medical Sciences ,Tabriz, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Medical Sciences Faculty, Tarbiat Modares University, Tehran, Iran
| | - Marjaneh Foolady
- Fulbright Scholar, Jordan University and Founder of WWNSN, Jordan
| | - Mozhgan Behshid
- Department of Medical Surgical Nursing, Tabriz Health Services Management Research Centre, , Nursing & Midwifery Faculty, Tabriz University of Medical Sciences , International Branch Aras, Iran
| | - Alireza Irajpoor
- Nursing& Midwifery Care Research Center, Department of Critical Care Nursing, Faculty of Nursing &Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Adaptation of the osteoarthritis-specific quality of life scale (the OAQoL) for use in Germany, Hungary, Italy, Spain and Turkey. Rheumatol Int 2017; 37:727-734. [PMID: 28197718 DOI: 10.1007/s00296-017-3664-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 01/20/2017] [Indexed: 11/26/2022]
Abstract
The Osteoarthritis Quality of Life scale (OAQoL) is specific to individuals with osteoarthritis. The present study describes the adaptation of the OAQoL for use in the following five European languages: German, Hungarian, Italian, Spanish and Turkish. The study involved three stages in each language; translation, cognitive debriefing (face and content validity) and validation. The validation stage assessed internal consistency (Cronbach's alpha), reproducibility (test-retest reliability using Spearman's rank correlations), convergent and divergent validity (correlations with the Health Assessment Questionnaire, The Western Ontario and McMaster Universities Index of osteoarthritis and Nottingham Health Profile) and known group validity. The OAQoL was successfully translated into the target languages with minimal problems. Cognitive debriefing interviewees found the measures easy to complete and identified few problems with content. Internal consistency ranged from 0.94 to 0.97 and test-retest reliability (reproducibility) from 0.87 to 0.98. These values indicate that the new language versions produce very low levels of measurement error. Median OAQoL scores were higher for patients reporting a current flare of osteoarthritis in all countries. Scores were also related, as expected, to perceived severity of osteoarthritis. The OAQoL was successfully adapted for use in Germany, Hungary, Italy, Spain and Turkey. The addition of these new language versions will prove valuable to multinational clinical trials and to clinical practice in the respective countries.
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Abstract
Age is the strongest independent risk factor for the development of osteoarthritis (OA) and for many years this was assumed to be due to repetitive microtrauma of the joint surface over time, the so-called 'wear and tear' arthritis. As our understanding of OA pathogenesis has become more refined, it has changed our appreciation of the role of ageing on disease. Cartilage breakdown in disease is not a passive process but one involving induction and activation of specific matrix-degrading enzymes; chondrocytes are exquisitely sensitive to changes in the mechanical, inflammatory and metabolic environment of the joint; cartilage is continuously adapting to these changes by altering its matrix. Ageing influences all of these processes. In this review, we will discuss how ageing affects tissue structure, joint use and the cellular metabolism. We describe what is known about pathways implicated in ageing in other model systems and discuss the potential value of targeting these pathways in OA.
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28
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Nencini S, Ivanusic JJ. The Physiology of Bone Pain. How Much Do We Really Know? Front Physiol 2016; 7:157. [PMID: 27199772 PMCID: PMC4844598 DOI: 10.3389/fphys.2016.00157] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/11/2016] [Indexed: 01/23/2023] Open
Abstract
Pain is associated with most bony pathologies. Clinical and experimental observations suggest that bone pain can be derived from noxious stimulation of the periosteum or bone marrow. Sensory neurons are known to innervate the periosteum and marrow cavity, and most of these have a morphology and molecular phenotype consistent with a role in nociception. However, little is known about the physiology of these neurons, and therefore information about mechanisms that generate and maintain bone pain is lacking. The periosteum has received greater attention relative to the bone marrow, reflecting the easier access of the periosteum for experimental assessment. With the electrophysiological preparations used, investigators have been able to record from single periosteal units in isolation, and there is a lot of information available about how they respond to different stimuli, including those that are noxious. In contrast, preparations used to study sensory neurons that innervate the bone marrow have been limited to recording multi-unit activity in whole nerves, and whilst they clearly report responses to noxious stimulation, it is not possible to define responses for single sensory neurons that innervate the bone marrow. There is only limited evidence that peripheral sensory neurons that innervate bone can be sensitized or that they can be activated by multiple stimulus types, and at present this only exists in part for periosteal units. In the central nervous system, it is clear that spinal dorsal horn neurons can be activated by noxious stimuli applied to bone. Some can be sensitized under pathological conditions and may contribute in part to secondary or referred pain associated with bony pathology. Activity related to stimulation of sensory nerves that innervate bone has also been reported in neurons of the spinoparabrachial pathway and the somatosensory cortices, both known for roles in coding information about pain. Whilst these provide some clues as to the way information about bone pain is centrally coded, they need to be expanded to further our understanding of other central territories involved. There is a lot more to learn about the physiology of peripheral sensory neurons that innervate bone and their central projections.
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Affiliation(s)
- Sara Nencini
- Department of Anatomy and Neuroscience, University of Melbourne Melbourne, VIC, Australia
| | - Jason J Ivanusic
- Department of Anatomy and Neuroscience, University of Melbourne Melbourne, VIC, Australia
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29
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Tribological efficacy and stability of phospholipid-based membrane lubricants in varying pH chemical conditions. Biointerphases 2016; 11:019002. [PMID: 26727914 DOI: 10.1116/1.4939246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this study, the authors examine the influence of joint chemical environment by measuring changes in the tribological properties (friction coefficient and charge density) of contacting surfaces of normal and degenerated cartilage samples in bath solutions of varying pH (2.0-9.0). Bovine articular cartilage samples (n = 54) were subjected to several surface measurements, including interfacial energy, contact angle, and friction coefficient, at varying pH. The samples were delipidized and then subjected to the same measurement protocols. Our results reveal that the interfacial energy and charge density, which have been shown to be related to friction coefficient, decrease with pH in the acidic range and approach constant values at physiological (or synovial fluid) pH of 7.4 and beyond it, i.e., toward basic pH domain. The authors conclude that this rather complex response explains the long-term efficacy with respect to ageing and associated pH changes, of the phospholipid layers that facilitate the almost frictionless, hydration-lubrication involving contact in the mammalian musculoskeletal system.
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30
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Hofstetter CP, Hofer AS, Wang MY. Economic impact of minimally invasive lumbar surgery. World J Orthop 2015; 6:190-201. [PMID: 25793159 PMCID: PMC4363801 DOI: 10.5312/wjo.v6.i2.190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/31/2014] [Accepted: 10/16/2014] [Indexed: 02/06/2023] Open
Abstract
Cost effectiveness has been demonstrated for traditional lumbar discectomy, lumbar laminectomy as well as for instrumented and noninstrumented arthrodesis. While emerging evidence suggests that minimally invasive spine surgery reduces morbidity, duration of hospitalization, and accelerates return to activites of daily living, data regarding cost effectiveness of these novel techniques is limited. The current study analyzes all available data on minimally invasive techniques for lumbar discectomy, decompression, short-segment fusion and deformity surgery. In general, minimally invasive spine procedures appear to hold promise in quicker patient recovery times and earlier return to work. Thus, minimally invasive lumbar spine surgery appears to have the potential to be a cost-effective intervention. Moreover, novel less invasive procedures are less destabilizing and may therefore be utilized in certain indications that traditionally required arthrodesis procedures. However, there is a lack of studies analyzing the economic impact of minimally invasive spine surgery. Future studies are necessary to confirm the durability and further define indications for minimally invasive lumbar spine procedures.
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31
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Garip Y. Functional assessment measures in rheumatologic disorders. World J Rheumatol 2014; 4:6-13. [DOI: 10.5499/wjr.v4.i2.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/12/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
Rheumatologic disorders cause functional impairment and significantly affect health-related quality of life. Functional assessment and health-related quality of life scales are increasingly being used as outcome measures to assess the influence of the diseases and health outcome in clinical studies of patients with rheumatologic diseases. In this article, we review the functional assessment and health-related quality of life measures which have been commonly used as outcome measures in rheumatologic disorders. These measures are Short form-36 (SF-36), SF-12, Nottingham Health Profile, Sickness Impact Profile, EuroQol, SF-6D, Health Utilities Index mark 2 and 3, Stanford Health Assessment Questionnaire, Rheumatoid Arthritis Quality of Life Questionnaire, Arthritis Impact Measurement Scales, McMaster Toronto Arthritis Patient Preference Disability Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, Lequesne Index, Knee Disability and Osteoarthritis Outcome Score, Knee Disability and Osteoarthritis Outcome Score-Physical Function Short-form, Hip Disability and Osteoarthritis Outcome Score, Hip Disability and Osteoarthritis Outcome Score-Physical Function SF, Fibromyalgia Impact Questionnaire, Psoriatic Arthritis Quality of Life Scale, Gout Assessment Questionnaires, Dougados Functional Index, Bath Ankylosing Spondylitis Functional Index, and Ankylosing Spondylitis Quality of Life Scale.
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