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Dong Z, Hu B, Wang S, Wang M, Sun S, Liu X, Li D, Wu D. LncRNA MAGI2-AS3 promotes fracture healing through downregulation of miR-223-3p. J Orthop Surg Res 2024; 19:370. [PMID: 38907263 PMCID: PMC11193218 DOI: 10.1186/s13018-024-04850-5] [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: 04/29/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Long non-coding RNAs (LncRNAs) are recognized as a pivotal element in the processes of fracture healing and the osteogenic differentiation of stem cells. This study investigated the molecular mechanism and regulatory significance of lncRNA MAGI2-AS3 (MAGI2-AS3) in fracture healing. METHODS Serum levels of MAGI2-AS3 in patients with normal and delayed fracture healing were verified by RT-qPCR assays. The predictive efficacy of MAGI2-AS3 for delayed fracture healing was analyzed by ROC curve. Osteogenic markers were quantified by RT-qPCR assays. MC3T3-E1 cell viability was detected using CCK-8 assay, and flow cytometry was utilized to measure cell apoptosis. The dual-luciferase reporter gene assay was used to determine the targeted binding between MAGI2-AS3 and miR-223-3p. RESULTS Serum MAGI2-AS3 expression was decreased in patients with delayed fracture healing compared with patients with normal healing. Elevated MAGI2-AS3 resulted in an upregulation of the proliferative capacity of MC3T3-E1 cells and a decrease in mortality, along with increased levels of both osteogenic markers. However, after transfection silencing MAGI2-AS3, the trend was reversed. Additionally, miR-223-3p was the downstream target of MAGI2-AS3 and was controlled by MAGI2-AS3. miR-223-3p mimic reversed the promoting effects of MAGI2-AS3 overexpression on osteogenic marker levels and cell growth, and induced cell apoptosis. CONCLUSION The upregulation of MAGI2-AS3 may expedite the healing of fracture patients by targeting miR-223-3p, offering a novel biomarker for diagnosing patients with delayed healing.
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Affiliation(s)
- Zhiqiang Dong
- Department of Orthopedics, Xi'an International Medical Center Hospital, Xi'an, 710000, China
| | - Bingbing Hu
- Department of Orthopedics, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, China
| | - Shantao Wang
- Spinal Trauma Orthopedics, Yidu Central Hospital of Weifang, No.5168, Jiangjunshan Road, Qingzhou City, Weifang, 262500, China.
| | - Mingwei Wang
- Department of Pediatric, Yidu Central Hospital of Weifang, Weifang, 262500, China
| | - Shengliang Sun
- Hand, Foot and Ankle Surgery, Yidu Central Hospital of Weifang, Weifang, 262500, China
| | - Xinsheng Liu
- Spinal Trauma Orthopedics, Yidu Central Hospital of Weifang, No.5168, Jiangjunshan Road, Qingzhou City, Weifang, 262500, China
| | - Danzhi Li
- Spinal Trauma Orthopedics, Yidu Central Hospital of Weifang, No.5168, Jiangjunshan Road, Qingzhou City, Weifang, 262500, China
| | - Dengjiang Wu
- Department of Orthopedics, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.
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Yu C, Chen B, Su H, Yang Y. Long non-coding RNA MIAT serves as a biomarker of fragility fracture and promotes fracture healing. J Orthop Surg Res 2024; 19:343. [PMID: 38849896 PMCID: PMC11162066 DOI: 10.1186/s13018-024-04824-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Fragility fracture is common in the elderly. Osteoblast differentiation is essential for bone healing and regeneration. Expression pattern of long non-coding RNA MIAT during fracture healing was examined, and its role in osteoblast differentiation was investigated. METHODS 90 women with simple osteoporosis and 90 women with fragility fractures were included. Another 90 age-matched women were set as the control group. mRNA levels were tested using RT-qPCR. Cell viability was detected via CCK-8, and osteoblastic biomarkers, including ALP, OCN, Collagen I, and RUNX2 were tested via ELISA. The downstream miRNAs and genes targeted by MIAT were predicted by bioinformatics analysis, whose functions and pathways were annotated via GO and KEGG analysis. RESULTS Serum MIAT was upregulated in osteoporosis women with high accuracy of diagnostic efficacy. Serum MIAT was even elevated in the fragility fracture group, but decreased in a time manner after operation. MIAT knockdown promoted osteogenic proliferation and differentiation of MC3T3-E1, but the influences were reversed by miR-181a-5p inhibitor. A total of 137 overlapping target genes of miR-181a-5p were predicted based on the miRDB, TargetScan and microT datasets, which were mainly enriched for terms related to signaling pathways regulating pluripotency of stem cells, cellular senescence, and osteoclast differentiation. CONCLUSIONS LncRNA MIAT serves as a promising biomarker for osteoporosis, and promotes osteogenic differentiation via targeting miR-181a-5p.
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Affiliation(s)
- Chao Yu
- Department of Orthopedics, Liaocheng People's Hospital, No. 67, West Dongchang Road, Liaocheng, 252000, China
| | - Binbin Chen
- Department of Nephrology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Hui Su
- Department of Oncology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Yiqun Yang
- Department of Orthopedics, Liaocheng People's Hospital, No. 67, West Dongchang Road, Liaocheng, 252000, China.
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Doveri E, Majnooni M, Guivier-Curien C, Baron C, Lasaygues P. Computational model to address lens-based acoustic field aperture in the in vitro ultrasonic cell stimulation. ULTRASONICS 2024; 138:107226. [PMID: 38103352 DOI: 10.1016/j.ultras.2023.107226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
Low-Intensity Pulsed Ultrasound Stimulation (LIPUS) is a therapeutic modality used for bone tissue regeneration and healing. Its clinical efficacy is still debated, as the underlying physical phenomena remain poorly understood. The interaction between ultrasonic waves and cells, likely to trigger mechanotransduction inducing bone regeneration, is at the center of scientific concerns on the subject. In order to get new insights into these phenomena, the development of in vitro experiments is a key step but special attentions should be paid concerning to the actual acoustic area covered that has to be sufficiently large and homogeneous. To address this issue, an acoustic lens can be placed on the transducer to improve the homogeneity of the acoustic field over the entire cell culture area. A computational model is developed to test several shapes and heights of acoustic lenses and compare their effectiveness in order to find a compromise between the surface covered, the homogeneity of the intensity distribution and the acoustic pressure loss. All the lenses studied improve the enlargement of the field and its homogeneity but they all generate pressure acoustic loss. The best performing lens in terms of field homogeneity is the one that minimizes pressure acoustic loss but covers only 22% of the target surface. The best enlargement (68% of the surface covered) is obtained for a lens that produces a field that is 4 times less homogeneous and 3 times less efficient in terms of pressure acoustic loss. As no one lens is ideal, the choice of the lens should be the result of a compromise taking into account the prioritization of criteria.
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Affiliation(s)
- Elise Doveri
- Aix Marseille Univ, CNRS, Centrale Marseille, LMA UMR 7031, 4 impasse Nikola Tesla, 13453, Marseille, France.
| | - Meysam Majnooni
- Aix Marseille Univ, CNRS, Centrale Marseille, IRPHE UMR 7342, 49 rue Frédéric Joliot-Curie, 13384, Marseille, France.
| | - Carine Guivier-Curien
- Aix Marseille Univ, CNRS, Centrale Marseille, IRPHE UMR 7342, 49 rue Frédéric Joliot-Curie, 13384, Marseille, France.
| | - Cécile Baron
- Aix Marseille Univ, CNRS, Centrale Marseille, IRPHE UMR 7342, 49 rue Frédéric Joliot-Curie, 13384, Marseille, France.
| | - Philippe Lasaygues
- Aix Marseille Univ, CNRS, Centrale Marseille, LMA UMR 7031, 4 impasse Nikola Tesla, 13453, Marseille, France.
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4
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Ouchi D, Mori S, Arakawa M, Shindo T, Shimokawa H, Yasuda S, Kanai H. Optimizing irradiation conditions for low-intensity pulsed ultrasound to upregulate endothelial nitric oxide synthase. J Med Ultrason (2001) 2024; 51:39-48. [PMID: 38052761 DOI: 10.1007/s10396-023-01382-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/18/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Here we aimed to develop a minimally invasive treatment for ischemic heart disease and demonstrate that low-intensity pulsed ultrasound (LIPUS) therapy improves myocardial ischemia by promoting myocardial angiogenesis in a porcine model of chronic myocardial ischemia. Studies to date determined the optimal treatment conditions within the range of settings available with existing ultrasound equipment and did not investigate a wider range of conditions. METHODS We investigated a broad range of five parameters associated with ultrasound irradiation conditions that promote expression of endothelial nitric oxide synthase (eNOS), a key molecule that promotes angiogenesis in human coronary artery endothelial cells (HCAEC). RESULTS Suboptimal irradiation conditions included 1-MHz ultrasound frequency, 500-kPa sound pressure, 20-min total irradiation time, 32-48-[Formula: see text] pulse duration, and 320-[Formula: see text] pulse repetition time. Furthermore, a proposed index, [Formula: see text], calculated as the product of power and the total number of irradiation cycles applied to cells using LIPUS, uniformly revealed the experimental eNOS expression associated with the various values of five parameters under different irradiation conditions. CONCLUSION We determined the suboptimal ultrasound irradiation conditions for promoting eNOS expression in HCAEC.
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Affiliation(s)
- Daiki Ouchi
- Graduate School of Engineering, Tohoku University, 6-6-05 Aoba, Aramaki, Aoba-Ku, Sendai, Miyagi, 980-8579, Japan
| | - Shohei Mori
- Graduate School of Engineering, Tohoku University, 6-6-05 Aoba, Aramaki, Aoba-Ku, Sendai, Miyagi, 980-8579, Japan
| | - Mototaka Arakawa
- Graduate School of Engineering, Tohoku University, 6-6-05 Aoba, Aramaki, Aoba-Ku, Sendai, Miyagi, 980-8579, Japan.
- Graduate School of Biomedical Engineering, Tohoku University, 6-6-05 Aoba, Aramaki, Aoba-Ku, Sendai, Miyagi, 980-8579, Japan.
| | - Tomohiko Shindo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Graduate School, International University of Health and Welfare, Narita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kanai
- Graduate School of Engineering, Tohoku University, 6-6-05 Aoba, Aramaki, Aoba-Ku, Sendai, Miyagi, 980-8579, Japan.
- Graduate School of Biomedical Engineering, Tohoku University, 6-6-05 Aoba, Aramaki, Aoba-Ku, Sendai, Miyagi, 980-8579, Japan.
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Pereira LF, Fontes-Pereira AJ, de Albuquerque Pereira WC. Influence of Low-Intensity Pulsed Ultrasound Parameters on the Bone Mineral Density in Rat Model: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1687-1698. [PMID: 37121881 DOI: 10.1016/j.ultrasmedbio.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Bone recovery typically depends on the age of organisms or the prevalence of metabolic disorders such as osteoporosis, which is a metabolic condition characterized by decreased bone strength and bone mineral density (BMD). Therefore, low-intensity pulsed ultrasound (LIPUS), a non-invasive method for osteogenic stimulation, presents promising results. However, heterogeneity in animal study designs is a typical characteristic. Hence, we conducted a systematic review to evaluate the effectiveness of LIPUS in the recovery of experimental bone defects using rat models. We examined the areal and volumetric BMD to identify LIPUS doses to be applied and evaluated the accuracy reported by previous studies. METHODS The Virtual Health Library regional portal, PubMed, Embase, EBSCOhost, Scopus and CAPES were reviewed for animal studies that compared fracture treatments based on LIPUS with sham or no treatments using rat models and reported BMD as an outcome. The tool provided by the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) and the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADES) checklist were used to assess the bias and quality of such studies. RESULTS Of the six studies reviewed, the most frequently used LIPUS dose had an ultrasonic frequency of 1.0 MHz, repetition rate of 0.1 kHz and pulse duration of 2000 μs. An intensity (ISATA) of 30 mW/cm2 was the most preferred for bone recovery. However, the BMD could not solely irrefutably evaluate the effectiveness of LIPUS in bone recovery as the results were discordant with each other. The discrepancies in experimental methodologies, low-quality classifications and high risk of bias in the selected studies, however, did not validate the undertaking of a meta-analysis. CONCLUSION On the basis of the BMD results, no sufficient evidence was found to recommend the use of LIPUS for bone recovery in rat models. Thus, this systematic review indicates that the accuracy of such reports must be improved to improve their scientific quality to facilitate a transition of LIPUS applications from pre-clinical research to clinic use.
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Affiliation(s)
- Luiz Fernando Pereira
- Biomedical Engineering Program/COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Aldo José Fontes-Pereira
- Biomedical Engineering Program/COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Centro Universitário Serra dos Órgãos-Unifeso, Teresópolis, Rio de Janeiro, Brazil
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Zhou J, Zhu Y, Ai D, Zhou M, Li H, Fu Y, Song J. Low-intensity pulsed ultrasound regulates osteoblast-osteoclast crosstalk via EphrinB2/EphB4 signaling for orthodontic alveolar bone remodeling. Front Bioeng Biotechnol 2023; 11:1192720. [PMID: 37425367 PMCID: PMC10326439 DOI: 10.3389/fbioe.2023.1192720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023] Open
Abstract
Background: The limited regenerative potential of periodontal tissue remains a challenge in orthodontic treatment, especially with respect to alveolar bone remodeling. The dynamic balance between the bone formation of osteoblasts and the bone resorption of osteoclasts controls bone homeostasis. The osteogenic effect of low-intensity pulsed ultrasound (LIPUS) is widely accepted, so LIPUS is expected to be a promising method for alveolar bone regeneration. Osteogenesis is regulated by the acoustic mechanical effect of LIPUS, while the cellular perception, transduction mode and response regulation mechanism of LIPUS stimuli are still unclear. This study aimed to explore the effects of LIPUS on osteogenesis by osteoblast-osteoclast crosstalk and the underlying regulation mechanism. Methods: The effects of LIPUS on orthodontic tooth movement (OTM) and alveolar bone remodeling were investigated via rat model by histomorphological analysis. Mouse bone marrow mesenchymal stem cells (BMSCs) and bone marrow monocytes (BMMs) were purified and used as BMSC-derived osteoblasts and BMM-derived osteoclasts, respectively. The osteoblast-osteoclast co-culture system was used to evaluate the effect of LIPUS on cell differentiation and intercellular crosstalk by Alkaline phosphatase (ALP), Alizarin Red S (ARS), tartrate-resistant acid phosphatase (TRAP) staining, real-time quantitative PCR, western blotting and immunofluorescence. Results: LIPUS was found to improve OTM and alveolar bone remodeling in vivo, promote differentiation and EphB4 expression in BMSC-derived osteoblasts in vitro, particularly when cells were directly co-cultured with BMM-derived osteoclasts. LIPUS enhanced EphrinB2/EphB4 interaction between osteoblasts and osteoclasts in alveolar bone, activated the EphB4 receptor on osteoblasts membrane, transduced LIPUS-related mechanical signals to the intracellular cytoskeleton, and gave rise to the nuclear translocation of YAP in Hippo signaling pathway, thus regulating cell migration and osteogenic differentiation. Conclusions: This study shows that LIPUS modulates bone homeostasis by osteoblast-osteoclast crosstalk via EphrinB2/EphB4 signaling, which benefits the balance between OTM and alveolar bone remodeling.
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Affiliation(s)
- Jie Zhou
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yanlin Zhu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Dongqing Ai
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Mengjiao Zhou
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Han Li
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yiru Fu
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jinlin Song
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Xiao H, Yan A, Li M, Wang L, Xiang J. LIPUS accelerates bone regeneration via HDAC6-mediated ciliogenesis. Biochem Biophys Res Commun 2023; 641:34-41. [PMID: 36521283 DOI: 10.1016/j.bbrc.2022.12.010] [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: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
Delayed fracture union and nonunion are common complications of fracture encountered, while Low-intensity pulsed ultrasound (LIPUS) can stimulate bone regeneration. Still, the underlying mechanism of LIPUS on bone regeneration has been poorly understood, which resulted in varied outcomes in the clinic. Therefore, figuring out the mechanism of LIPUS on bone regeneration can lay the foundation for better use of LIPUS in clinical bone regenerative therapies. In this study, we created transgenic mice to reveal the relationship between the periosteal cells' fate and the number of ciliated cells under the LIPUS stimulation. In vitro, we isolated the periosteal cell and aim to figure out the relationship between LIPUS and HDAC6-mediated ciliogenesis and find out a potential target for LIPUS-based bone regeneration strategies. The results showed that LIPUS promoted femoral bone defect regeneration and enhanced osteogenic differentiation of Prrx1+ cells. However, these pro-effects were significantly weakened when the Prrx1+ cell's primary cilia were knocked down. Besides, LIPUS stimulated the formation of Prrx1+ cells' primary cilia in the bone defect microenvironment. In vitro, the results supported that LIPUS enhanced the osteogenic differentiation of Prrx1+ cells through HDAC6-mediated ciliogenesis. In conclusion, λ LIPUS could promote the osteogenic differentiation of Prrx1+ cells to stimulate bone regeneration and inhibit the expression of HDAC6 to increase the prevalence of primary cilia in Prrx1+ cells. LIPUS could enhance the osteogenic differentiation of Prrx1+ cells mainly through HDAC6-mediated ciliogenesis.
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Affiliation(s)
- Han Xiao
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, Changsha, Hunan, 410007, China; The Pediatric Academy of University of South China, Changsha, Hunan, 410007, China
| | - An Yan
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, Changsha, Hunan, 410007, China; The Pediatric Academy of University of South China, Changsha, Hunan, 410007, China
| | - Miao Li
- Department of Pediatric Orthopaedics, Hunan Children's Hospital, Changsha, Hunan, 410007, China; The Pediatric Academy of University of South China, Changsha, Hunan, 410007, China
| | - Linfeng Wang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jie Xiang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China; Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, 516600, China.
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Moussadikine I, Nguyễn MV, Nich C, Arrigoni PP, Quinette Y, Crenn V. MRI Bone Abnormality of the Knee following Ultrasound Therapy: Case Report and Short Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14202. [PMID: 36361081 PMCID: PMC9654887 DOI: 10.3390/ijerph192114202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Ultrasound (US) therapy in sports and medical pathologies is widely used by many physiotherapists and sports medicine clinicians; however, data regarding their potential side effects remain rare. We report a case of a 21-year-old woman with iliotibial band (ITB) syndrome treated with a physiotherapy session combined with US therapy. She had twenty 7 min US sessions on the knee, for 3 months (US at 1 Mhz with an intensity between 1 and 2 W/cm2). Due to persistence of the ITB syndrome's symptomatology after the 3 months of physiotherapy sessions, an MRI (magnetic resonance imaging) was carried out and revealed osteonecrosis-like bone abnormalities on the external femoral condyle, the external tibial plateau, and the proximal fibula. In view of these lesions, the ultrasonic therapy was stopped, and a repeat MRI demonstrated the progressive disappearance of these imaging abnormalities one year after the last US (ultrasound) treatment. In light of this case, we propose here a short review of reported osseous "osteonecrosis" abnormalities associated with US therapies.
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Affiliation(s)
- Ismaël Moussadikine
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Mỹ-Vân Nguyễn
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Christophe Nich
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
- INSERM, UMRS 1229, Regenerative Medicine and Skeleton (RMeS), Nantes Université, ONIRIS, 44042 Nantes, France
| | - Pierre-Paul Arrigoni
- Radiology Department, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Yonis Quinette
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Vincent Crenn
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
- CRCI2NA (Centre de Recherche en Cancérologie et Immunologie Nantes-Angers), INSERM UMR 1307, CNRS UMR 6075-Team 9 CHILD (Chromatin and Transcriptional Deregulation in Pediatric Bone Sarcoma), Nantes Université, 1 rue Gaston Veil, 44035 Nantes, France
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9
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Yi W, Chen Q, Liu C, Li K, Tao B, Tian G, Zhou L, Li X, Shen J, Liu B, Hu Z, Wang D, Bai D. LIPUS inhibits inflammation and catabolism through the NF-κB pathway in human degenerative nucleus pulposus cells. J Orthop Surg Res 2021; 16:619. [PMID: 34663388 PMCID: PMC8522043 DOI: 10.1186/s13018-021-02739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background Low-intensity pulsed ultrasound (LIPUS) is a safe and noninvasive rehabilitative physical therapy with anti-inflammatory effects. The current study investigated the effect of LIPUS on the inflammation of nucleus pulposus (NP) cells and its underlying mechanism. Methods Human NP cells were acquired from lumbar disc herniation tissue samples and cultured for experiments. Human NP cells were treated with LPS and then exposed to LIPUS (15 mW/cm2, 30 mW/cm2 and 60 mW/cm2) for 20 min daily for 3 days to determine the appropriate intensity to inhibit the expression of the inflammatory factors TNF-α and IL-1β. The gene and protein expression of aggrecan, collagen II, MMP-3 and MMP-9 was measured by real‐time PCR and western blotting, respectively. The activity of the nuclear factor‐kappa B (NF‐κB) pathway was examined by western blotting and immunofluorescence. After pretreatment with the NF-κB inhibitor PDTC, the expression of TNF-α, IL-1β, MMP-3 and MMP-9 was measured by real‐time PCR. Results LIPUS at intensities of 15 mW/cm2, 30 mW/cm2 and 60 mW/cm2 inhibited LPS-induced NP cell expression of the inflammatory factors TNF-α and IL-1β, especially at 30 mW/cm2. LIPUS significantly upregulated the gene and protein expression of aggrecan and collagen II and downregulated the gene and protein expression of MMP-3 and MMP-9 in LPS-induced NP cells. The NF‐κB signaling pathway was inhibited by LIPUS through inhibiting the protein expression of p-P65 and the translocation of P65 into the nucleus in LPS-induced NP cells. In addition, LIPUS had similar effects as the NF-κB inhibitor PDTC by inhibiting the NF-κB signaling pathway, inflammation and catabolism in LPS-induced human degenerative nucleus pulposus cells. Conclusion LIPUS inhibited inflammation and catabolism through the NF‐κB pathway in human degenerative nucleus pulposus cells.
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Affiliation(s)
- Weiwei Yi
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Qing Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Chuan Liu
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Kaiting Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Bailong Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Guihua Tian
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Lu Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Xiaohong Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Jieliang Shen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Bo Liu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Zhenming Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China
| | - Dawu Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China.
| | - Dingqun Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Shiyou Street, Yuzhong District, Chongqing, 400010, China.
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Kang JW, Cha SM, Kim SG, Choi IC, Suh DH, Park JW. Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy. J Orthop Surg Res 2021; 16:110. [PMID: 33541409 PMCID: PMC7863478 DOI: 10.1186/s13018-021-02266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Parallel osteotomy is essential for favorable osteotomy reduction and healing and technically challenging during diaphyseal ulnar shortening osteotomy (USO). This study aimed to evaluate the advantages of guided osteotomy for parallel osteotomy and reduction osteotomies, healing over freehand osteotomy. It also aimed to identify surgical factors affecting healing after diaphyseal USO. METHODS Between June 2005 and March 2016, 136 wrists that had undergone diaphyseal USO for ulnar impaction syndrome (UIS) were evaluated. The wrists were divided into two groups according to the osteotomy technique (group 1: freehand osteotomy, 74 wrists; group 2: guided osteotomy, 62 wrists). The osteotomy reduction gap and time to osteotomy healing (union and consolidation) were compared between the groups. A multiple regression test was performed to identify the surgical factors affecting healing. The cut-off length of the reduction gap to achieve osteotomy union on time and the cut-off period to decide the failure of complete consolidation were statistically calculated. RESULTS The baseline characteristics did not differ between the two groups. The osteotomy reduction gap and time to osteotomy union, and complete consolidation were shorter in group 2 than in group 1 (p = 0.002, < 0.001, 0.002). The osteotomy reduction gap was a critical surgical factor affecting both time to osteotomy union and complete consolidation (p < 0.001, < 0.001). The use of a dynamic compression plate affected only the time to complete consolidation (p < 0.001). The cut-off length of the osteotomy reduction gap to achieve osteotomy union on time was 0.85 mm. The cut-off period to decide the failure of complete consolidation was 23.5 months after osteotomy. CONCLUSIONS The minimal osteotomy reduction gap was the most important for timely osteotomy healing in the healthy ulna, and guided osteotomy was beneficial for reducing the osteotomy reduction gap.
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Affiliation(s)
- Jong Woo Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang-gyun Kim
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - In Cheul Choi
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Dong Hun Suh
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Jong Woong Park
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
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Jiang YX, Gong P, Zhang L. [A review of mechanisms by which low-intensity pulsed ultrasound affects bone regeneration]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2020; 38:571-575. [PMID: 33085244 DOI: 10.7518/hxkq.2020.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Low-intensity pulsed ultrasound (LIPUS) is a common physical therapy to accelerate the healing of bone fracture and treat delayed union of bone fracture. Vessels, nerves, and bone tissue are essential constituents of bone system. Recently, increasing evidence has been revealed that LIPUS can not only promote bone regeneration by directly regulating osteoblasts, osteoblasts, mesenchymal stem cells, but also have a positive impact on the repair of bone healing through vessels and nerves. Thus, we reviewed and summarized the latest published literature about the molecular mechanism for the effects of LIPUS on bone regeneration, which might offer a promising therapy for bone-related diseases.
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Affiliation(s)
- Yi-Xuan Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ping Gong
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Liang Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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12
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Horne DA, Jones PD, Adams MS, Lotz JC, Diederich CJ. LIPUS far-field exposimetry system for uniform stimulation of tissues in-vitro: development and validation with bovine intervertebral disc cells. Biomed Phys Eng Express 2020; 6:035033. [PMID: 33438678 DOI: 10.1088/2057-1976/ab8b26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Therapeutic Low-intensity Pulsed Ultrasound (LIPUS) has been applied clinically for bone fracture healing and has been shown to stimulate extracellular matrix (ECM) metabolism in numerous soft tissues including intervertebral disc (IVD). In-vitro LIPUS testing systems have been developed and typically include polystyrene cell culture plates (CCP) placed directly on top of the ultrasound transducer in the acoustic near-field (NF). This configuration introduces several undesirable acoustic artifacts, making the establishment of dose-response relationships difficult, and is not relevant for targeting deep tissues such as the IVD, which may require far-field (FF) exposure from low frequency sources. The objective of this study was to design and validate an in-vitro LIPUS system for stimulating ECM synthesis in IVD-cells while mimicking attributes of a deep delivery system by delivering uniform, FF acoustic energy while minimizing reflections and standing waves within target wells, and unwanted temperature elevation within target samples. Acoustic field simulations and hydrophone measurements demonstrated that by directing LIPUS energy at 0.5, 1.0, or 1.5 MHz operating frequency, with an acoustic standoff in the FF (125-350 mm), at 6-well CCP targets including an alginate ring spacer, uniform intensity distributions can be delivered. A custom FF LIPUS system was fabricated and demonstrated reduced acoustic intensity field heterogeneity within CCP-wells by up to 93% compared to common NF configurations. When bovine IVD cells were exposed to LIPUS (1.5 MHz, 200 μs pulse, 1 kHz pulse frequency, and ISPTA = 120 mW cm-2) using the FF system, sample heating was minimal (+0.81 °C) and collagen content was increased by 2.6-fold compared to the control and was equivalent to BMP-7 growth factor treatment. The results of this study demonstrate that FF LIPUS exposure increases collagen content in IVD cells and suggest that LIPUS is a potential noninvasive therapeutic for stimulating repair of tissues deep within the body such as the IVD.
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Affiliation(s)
- Devante A Horne
- Department of Orthopaedic Surgery, University of California, San Francisco, United States of America. The UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley, and University of California, San Francisco, United States of America. Thermal Therapy Research Group, Radiation Oncology Department, University of California, San Francisco, United States of America
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13
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Baron C, Nguyen VH, Naili S, Guivier-Curien C. Interaction of ultrasound waves with bone remodelling: a multiscale computational study. Biomech Model Mechanobiol 2020; 19:1755-1764. [DOI: 10.1007/s10237-020-01306-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
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Batista JM, Nakagaki WR, Soares EA, Camilli JA. Effects of low-intensity pulsed ultrasound exposure on rats tibia periosteum. AN ACAD BRAS CIENC 2020; 92:e20180903. [PMID: 32074178 DOI: 10.1590/0001-3765202020180903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/10/2018] [Indexed: 12/15/2022] Open
Abstract
The periosteum is a rich source of osteoprogenitor cells and periosteal grafts can be used as an alternative method to replace bone grafts. The low-intensity pulsed ultrasound (LIPUS) has often been used as a noninvasive method to stimulate osteogenesis and reduce the fracture healing time. The aim of this study was to evaluate the effects of the ultrasound exposure on the rat tibia periosteum. Group I (7 animals) received LIPUS therapy on the left tibia for 7 days and group II (7 animals) on the left tibia for 14 days. After euthanasia, the tibias were processed. Number of periosteal cells and vessels and thickness of the periosteum were analyzed. The number of periosteal cells was higher in stimulated periosteum compared to controls at 7 and 14 days, but the number of vessels and the thickness only were higher in the group stimulated at 14 days. Furthermore, the ultrasound treatment for 14 days was more effective than 7 days. The ultrasound stimulation of the periosteum prior to grafting procedure can be advantageous, since it increases periosteal activity, and LIPUS may be an alternative method for stimulating the periosteum when the use of periosteal grafts in bone repair is needed.
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Affiliation(s)
- Jaqueline Martins Batista
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas/UNICAMP, Programa de Pós-Graduação em Biologia Celular e Estrutural, Avenida Bertrand Russel, s/n, 13083-865 Campinas, SP, Brazil
| | - Wilson Romero Nakagaki
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas/UNICAMP, Programa de Pós-Graduação em Biologia Celular e Estrutural, Avenida Bertrand Russel, s/n, 13083-865 Campinas, SP, Brazil.,Programa de Mestrado em Ciências da Saúde, Universidade do Oeste Paulista/UNOESTE, Pró-Reitoria de Pesquisa e Pós-Graduação/Campus II, Rodovia Raposo Tavares, Km 572, Bairro do Limoeiro, 19067-175 Presidente Prudente, SP, Brazil
| | - Evelise Aline Soares
- Departamento de Anatomia, Universidade Federal de Alfenas/UNIFAL, Rua Gabriel Monteiro da Silva 700, 37130-001 Alfenas, MG, Brazil
| | - José Angelo Camilli
- Departamento de Biologia Estrutural e Funcional, Instituto de Biologia, Universidade Estadual de Campinas/UNICAMP, Programa de Pós-Graduação em Biologia Celular e Estrutural, Avenida Bertrand Russel, s/n, 13083-865 Campinas, SP, Brazil
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15
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Jiang X, Savchenko O, Li Y, Qi S, Yang T, Zhang W, Chen J. A Review of Low-Intensity Pulsed Ultrasound for Therapeutic Applications. IEEE Trans Biomed Eng 2019; 66:2704-2718. [DOI: 10.1109/tbme.2018.2889669] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Athletic trainers, physical therapists, and team physicians have differing roles when providing care, yet often need to collaborate. Athletic trainers and physical therapists use a variety of therapeutic modalities and manual therapy techniques in conjunction with rehabilitation exercises to improve outcomes. Clinicians must be knowledgeable of the scientific rationale for each modality to choose the most effective treatment for the specific condition and stage of recovery. The team physician should be familiar with the use of common procedures in an athletic training room. Here, we review the most current evidence and the basic methods encountered in athletic training room settings.
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Duan X, Yu ACH, Wan JMF. Cellular Bioeffect Investigations on Low-Intensity Pulsed Ultrasound and Sonoporation: Platform Design and Flow Cytometry Protocol. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:1422-1434. [PMID: 31217101 DOI: 10.1109/tuffc.2019.2923443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
At low-intensity levels, ultrasound can potentially generate therapeutic effects on living cells, and it can trigger sonoporation when microbubbles (MBs) are present to facilitate drug delivery. Yet, our foundational knowledge of low-intensity pulsed ultrasound (LIPUS) and sonoporation remains to be critically weak because the pertinent cellular bioeffects have not been rigorously studied. In this article, we present a population-based experimental protocol that can effectively foster investigations on the mechanistic bioeffects of LIPUS and sonoporation over a cell population. Walkthroughs of different methodological details are presented, including the fabrication of the ultrasound exposure platform and its calibration, as well as the design of a bioassay procedure that uses fluorescent tracers and flow cytometry to isolate sonicated cells with similar characteristics. An application example is also presented to illustrate how our protocol can be used to investigate the downstream cellular bioeffects of leukemia cells. We show that, with 1-MHz LIPUS exposure (with 29.1 J/cm2 delivered acoustic energy density), variations in viability and morphology would be found among different types of sonicated leukemia cells (HL-60, Molt-4) in the absence and presence of MBs. Taken altogether, this article provides a reference on how cellular bioeffect experiments on LIPUS and sonoporation can be planned meticulously to acquire strong observations that are critical to establish the biological foundations for therapeutic applications.
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Abstract
OBJECTIVE To examine the effect of low-intensity pulsed ultrasound (LIPUS) on early-stage spondylolysis in young athletes. DESIGN Case-control study. SETTING A single outpatient orthopedic and sports clinic. PATIENTS A total of 82 young athletes (80 boys and 2 girls; mean age, 14.8 years; range, 10-18 years) with early-stage lumbar spondylolysis were enrolled in this study. All patients were examined by plain radiography and magnetic resonance imaging. INTERVENTIONS Patients received either standard conservative treatment combined with LIPUS (n = 35) or without LIPUS (n = 47), according to the sequence of admission. The standard conservative treatment included thoracolumbosacral brace, sports modification, and therapeutic exercise. MAIN OUTCOME MEASURES The time required to return to previous sports activities was analyzed by using Kaplan-Meier methods with the log-rank test. RESULTS The baseline parameters of both groups were not significantly different. The median time to return to previous sports activities was 61 days [95% confidence interval (CI): 58-69 days] in the group treated with LIPUS, which was significantly shorter than that of the group treated without LIPUS (167 days, 95% CI: 135-263 days; P < 0.01). CONCLUSIONS These results suggest that LIPUS combined with conservative treatment for early-stage lumbar spondylolysis in young athletes could be a useful therapy for quick return to playing sports.
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Grivas KN, Vavva MG, Polyzos D, Carlier A, Geris L, Van Oosterwyck H, Fotiadis DI. Effect of ultrasound on bone fracture healing: A computational mechanobioregulatory model. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 145:1048. [PMID: 30823826 DOI: 10.1121/1.5089221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/12/2019] [Indexed: 06/09/2023]
Abstract
Bone healing process is a complicated phenomenon regulated by biochemical and mechanical signals. Experimental studies have shown that ultrasound (US) accelerates bone ossification and has a multiple influence on cell differentiation and angiogenesis. In a recent work of the authors, a bioregulatory model for providing bone-healing predictions was addressed, taking into account for the first time the salutary effect of US on the involved angiogenesis. In the present work, a mechanobioregulatory model of bone solidification under the US presence incorporating also the mechanical environment on the regeneration process, which is known to affect cellular processes, is presented. An iterative procedure is adopted, where the finite element method is employed to compute the mechanical stimuli at the linear elastic phases of the poroelastic callus region and a coupled system of partial differential equations to simulate the enhancement by the US cell angiogenesis process and thus the oxygen concentration in the fractured area. Numerical simulations with and without the presence of US that illustrate the influence of progenitor cells' origin in the healing pattern and the healing rate and simultaneously demonstrate the salutary effect of US on bone repair are presented and discussed.
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Affiliation(s)
- Konstantinos N Grivas
- Department of Mechanical Engineering and Aeronautics, University of Patras, GR 26500, Patras, Greece
| | - Maria G Vavva
- Department of Mechanical Engineering and Aeronautics, University of Patras, GR 26500, Patras, Greece
| | - Demosthenes Polyzos
- Department of Mechanical Engineering and Aeronautics, University of Patras, GR 26500, Patras, Greece
| | - Aurélie Carlier
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C-PB 2419, B-3001, Leuven, Belgium
| | - Liesbet Geris
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C-PB 2419, B-3001, Leuven, Belgium
| | - Hans Van Oosterwyck
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300C-PB 2419, B-3001, Leuven, Belgium
| | - Dimitrios I Fotiadis
- Department of Materials Science and Engineering, University of Ioannina, GR 45110, Ioannina, Greece
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Banerjee H, Roy B, Chaudhury K, Srinivasan B, Chakraborty S, Ren H. Frequency-induced morphology alterations in microconfined biological cells. Med Biol Eng Comput 2018; 57:819-835. [PMID: 30415434 DOI: 10.1007/s11517-018-1908-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 09/29/2018] [Indexed: 01/09/2023]
Abstract
Low-intensity therapeutic ultrasound has demonstrated an impetus in bone signaling and tissue healing for decades now. Though this technology is clinically well proven, still there are breaches in studies to understand the fundamental principle of how osteoblast tissue regenerates physiologically at the cellular level with ultrasound interaction as a form of acoustic wave stimuli. Through this article, we illustrate an analysis for cytomechanical changes of cell membrane periphery as a basic first physical principle for facilitating late downstream biochemical pathways. With the help of in situ single-cell direct analysis in a microfluidic confinement, we demonstrate that alteration of low-intensity pulse ultrasound (LIPUS) frequency would physically perturb cell membrane and establish inherent cell oscillation. We experimentally demonstrate here that, at LIPUS resonance near 1.7 MHz (during 1-3 MHz alteration), cell membrane area would expand to 6.85 ± 0.7% during ultrasound exposure while it contracts 44.68 ± 0.8% in post actuation. Conversely, cell cross-sectional area change (%) from its previous morphology during and after switching off LIPUS was reversibly different before and after resonance. For instance, at 1.5 MHz, LIPUS exposure produced 1.44 ± 0.5% expansion while in contrast 2 MHz instigates 1.6 ± 0.3% contraction. We conclude that alteration of LIPUS frequency from 1-3 MHz keeping other ultrasound parameters like exposure time, pulse repetition frequency (PRF), etc., constant, if applied to a microconfined biological single living cell, would perturb physical structure reversibly based on the system resonance during and post exposure ultrasound pulsing. We envision, in the near future, our results would constitute the foundation of mechanistic effects of low-intensity therapeutic ultrasound and its allied potential in medical applications. Graphical Abstract Frequency Dependent Characterization of Area Strain in Cell Membrane by Microfluidic Based Single Cell Analysis.
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Affiliation(s)
- Hritwick Banerjee
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Village Palaj Simkheda, Gandhinagar, Gujarat, 382355, India. .,Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, 721302, India. .,Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore. .,Singapore Institute for Neurotechnology (SINAPSE), Centre for Life Sciences, National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore.
| | - Bibhas Roy
- Department of Biotechnology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, 721302, India.,Mechanobiology Institute, National University of Singapore, T-Lab, #10-01 5A Engineering Drive 1, Singapore, 117411, Singapore
| | - Kaustav Chaudhury
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, 721302, India.,National Institute of Technology Rourkela, Odisha, 769008, India
| | - Babji Srinivasan
- Department of Electrical Engineering, Indian Institute of Technology Gandhinagar, Village Palaj Simkheda, Gandhinagar, Gujarat, 382355, India.,Department of Chemical Engineering, Indian Institute of Technology Gandhinagar, Village Palaj Simkheda, Gandhinagar, Gujarat, 382355, India
| | - Suman Chakraborty
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, 721302, India.,School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, 721302, India
| | - Hongliang Ren
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore, 117575, Singapore. .,Singapore Institute for Neurotechnology (SINAPSE), Centre for Life Sciences, National University of Singapore, 28 Medical Drive, #05-COR, Singapore, 117456, Singapore. .,National University of Singapore (Suzhou) Research Institute (NUSRI), Wuzhong Dist., Suzhou, Jiangsu Province, China.
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21
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Effect of ultrasound on bone fracture healing: A computational bioregulatory model. Comput Biol Med 2018; 100:74-85. [DOI: 10.1016/j.compbiomed.2018.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/23/2018] [Accepted: 06/23/2018] [Indexed: 12/22/2022]
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22
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Lou S, Lv H, Li Z, Tang P, Wang Y. Effect of low-intensity pulsed ultrasound on distraction osteogenesis: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2018; 13:205. [PMID: 30119631 PMCID: PMC6098620 DOI: 10.1186/s13018-018-0907-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Low-intensity pulsed ultrasound (LIPUS) is a common adjunct used to promote bone healing for fresh fractures and non-unions, but its efficacy for bone distraction osteogenesis remains uncertain. This study aims to determine whether LIPUS can effectively and safely reduce the associated treatment time for patients undergoing distraction osteogenesis. METHODS MEDLINE, EMBASE, and the Cochrane Library were searched until May 1, 2018, without language restriction. Studies should be randomized controlled trials (RCTs) or quasi-RCTs of LIPUS compared with sham devices or no devices in patients who undergo distraction osteogenesis. The primary outcome was the treatment time. The secondary outcome was the risk of complications. Treatment effects were assessed using mean differences, standardized mean differences, or risk ratios using a random-effects model. The Cochrane risk-of-bias tool was used to assess the risk of bias. The I2 statistic was used to assess the heterogeneity. The GRADE system was used to evaluate the evidence quality. RESULTS A total of 7 trials with 172 patients were included. The pooled results suggested that during the process of distraction osteogenesis, LIPUS therapy did not show a statistically significant reduction in the treatment time (mean difference, - 8.75 days/cm; 95% CI, - 20.68 to 3.18 days/cm; P = 0.15; I2 = 72%) or in the risk of complications (risk ratio, 0.90 in favor of LIPUS; 95% CI, 0.65 to 1.24; I2 = 0%). Also, LIPUS therapy did not show a significant effect on the radiological gap fill area (standardized mean difference, 0.48 in favor of control; 95%CI, - 1.49 to 0.52; I2 = 0%), the histological gap fill length (standardized mean difference, 0.76 in favor of control; 95%CI, - 1.78 to 0.27; I2 = 0%), or the bone density increase (standardized mean difference, 0.43 in favor of LIPUS; 95%CI, - 0.02 to 0.88; I2 = 0%). CONCLUSIONS Among patients undergoing distraction osteogenesis, neither the treatment time nor the risk of complications could be reduced by LIPUS therapy. The currently available evidence is insufficient to support the routine use of this intervention in clinical practice. TRIAL REGISTRATION CRD 42017073596.
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Affiliation(s)
- Shenghan Lou
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Road, Harbin, 150001, Heilongjiang, People's Republic of China.,Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Houchen Lv
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Zhirui Li
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Peifu Tang
- Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Yansong Wang
- Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Road, Harbin, 150001, Heilongjiang, People's Republic of China.
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Katsianou MA, Skondra FG, Gargalionis AN, Piperi C, Basdra EK. The role of transient receptor potential polycystin channels in bone diseases. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:246. [PMID: 30069448 DOI: 10.21037/atm.2018.04.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transient receptor potential (TRP) channels are cation channels which act as molecular sensors that enable cells to detect and respond to a plethora of mechanical and environmental cues. TRPs are involved in various physiological processes, such as mechanosensation, non-inception and thermosensation, while mutations in genes encoding them can lead to pathological conditions, called "channelopathies". The subfamily of transient receptor potential polycystins (TRPPs), Polycystin 1 (PC1, TRPP1) and Polycystin 2 (PC2, TRPP2), act as mechanoreceptors, sensing external mechanical forces, including strain, stretch and fluid shear stress, triggering a cascade of signaling pathways involved in osteoblastogenesis and ultimately bone formation. Both in vitro studies and research on animal models have already identified their implications in bone homeostasis. However, uncertainty veiling the role of polycystins (PCs) in bone disease urges studies to elucidate further their role in this field. Mutations in TRPPs have been related to autosomal polycystic kidney disease (ADKPD) and research groups try to identify their role beyond their well-established contribution in kidney disease. Such an elucidation would be beneficial for identifying signaling pathways where polycystins are involved in bone diseases related to exertion of mechanical forces such as osteoporosis, osteopenia and craniosynostosis. A better understanding of the implications of TRPPs in bone diseases would possibly lay the cornerstone for effective therapeutic schemes.
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Affiliation(s)
- Maria A Katsianou
- Cellular and Molecular Biomechanics Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini G Skondra
- Cellular and Molecular Biomechanics Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios N Gargalionis
- Cellular and Molecular Biomechanics Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Piperi
- Cellular and Molecular Biomechanics Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthimia K Basdra
- Cellular and Molecular Biomechanics Unit, Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Denaro V, Longo UG, Salvatore G, Candela V, Maffulli N. Subcutaneous emphysema of the leg after hardware removal and bone allografting for infected non-union of the distal femur. BMC Musculoskelet Disord 2017; 18:351. [PMID: 28810893 PMCID: PMC5558669 DOI: 10.1186/s12891-017-1706-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/02/2017] [Indexed: 11/12/2022] Open
Abstract
Background Infected non-unions of the supracondylar region of the femur are uncommon. Even though hardware removal is a common procedure, it may lead to complications, including neurovascular injury, refracture, worsening pain or recurrence of deformity. Case presentation We report on a male who developed subcutaneous emphysema of the leg after hardware removal and bone allografting for an infected non-union of the distal femur. He was managed by debridement of the surgical wound, antibiotic therapy, multiple fasciotomies, and application of a VAC (vacuum-assisted closure) system. Conclusions Although subcutaneous emphysema of the leg after hardware removal and bone allografting for infected non-union of the distal femur is extremely rare, the potential life treating complications and their potential impact on the functional status of the patient have to be taken into consideration when counseling patients about this procedure. Even when it is not possible to identify a bacterial pathogen responsible for the subcutaneous emphysema of the leg, prompt intervention may save the limb of the patient.
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Affiliation(s)
- Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy.
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Vincenzo Candela
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Trigoria, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK.,University of Salerno School of Medicine, Salerno, Italy
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Frequency sensitive mechanism in low-intensity ultrasound enhanced bioeffects. PLoS One 2017; 12:e0181717. [PMID: 28763448 PMCID: PMC5538718 DOI: 10.1371/journal.pone.0181717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/06/2017] [Indexed: 11/19/2022] Open
Abstract
This study presents two novel theoretical models to elucidate frequency sensitive nuclear mechanisms in low-intensity ultrasound enhanced bioeffects. In contrast to the typical 1.5 MHz pulsed ultrasound regime, our group previously experimentally confirmed that ultrasound stimulation of anchored chondrocytes at resonant frequency maximized gene expression of load inducible genes which are regulatory markers for cellular response to external stimuli. However, ERK phosphorylation displayed no frequency dependency, suggesting that the biochemical mechanisms involved in enhanced gene expression is downstream of ERK phosphorylation. To elucidate such underlying mechanisms, this study presents a theoretical model of an anchored cell, representing an in vitro chondrocyte, in an ultrasound field. The model results showed that the mechanical energy storage is maximized at the chondrocyte's resonant frequency and the energy density in the nucleus is almost twice as high as in the cytoplasm. Next, a mechanochemical model was developed to link the mechanical stimulation of ultrasound and the increased mechanical energy density in the nucleus to the downstream targets of the ERK pathway. This study showed for the first time that ultrasound stimulation induces frequency dependent gene expression as a result of altered rates of transcription factors binding to chromatin.
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Cao H, Feng L, Wu Z, Hou W, Li S, Hao Y, Wu L. Effect of low-intensity pulsed ultrasound on the biological behavior of osteoblasts on porous titanium alloy scaffolds: An in vitro and in vivo study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 80:7-17. [PMID: 28866219 DOI: 10.1016/j.msec.2017.05.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/03/2017] [Accepted: 05/13/2017] [Indexed: 01/24/2023]
Abstract
Low-intensity pulsed ultrasound (LIPUS) has been used in patients with fresh fractures, delayed union and non-union to enhance bone healing and improve functional outcome. However, there were few studies concerning the effects of LIPUS on the biological behavior of osteoblasts on porous scaffolds. This study aimed to evaluate the effects of LIPUS on the biological behavior of osteoblasts on porous titanium-6aluminum-4vanadium (Ti6Al4V) alloy scaffolds in vitro and in vivo. Scaffolds were randomly divided into an ultrasound group and a control group. Mouse pre-osteoblast cells were cultured with porous Ti6Al4V scaffolds in vitro. The effects of LIPUS on the biological behavior of osteoblasts were evaluated by observing the adhesion, proliferation, differentiation and ingrowth depth on porous Ti6Al4V scaffolds. In addition, scaffolds were implanted into rabbit mandibular defects in vivo. The effects of LIPUS on bone regeneration were evaluated via micro-CT, fluorescent staining and toluidine blue staining. The results revealed that osteoblast adhered well to the scaffolds, and there was no significant difference in the methyl thiazolyl tetrazolium value between the ultrasound group and the control group (p>0.05). Compared with the control group, ultrasound promoted the alkaline phosphatase activity, osteocalcin levels and ingrowth depth of the cells on the scaffolds (p<0.05). In addition, micro-CT and histomorphological analysis showed that the volume and amount of new bone formation were increased and that bone maturity was improved in the ultrasound group compared to the control group. These results indicate that LIPUS promotes osteoblast differentiation as well as enhances bone ingrowth in porous Ti6Al4V scaffolds, and promotes bone formation and maturity in porous Ti6Al4V scaffolds.
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Affiliation(s)
- Hongjuan Cao
- Department of Prosthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Lifang Feng
- Department of Prosthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Zhenxian Wu
- Department of Prosthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Wentao Hou
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, Liaoning, People's Republic of China
| | - Shujun Li
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, Liaoning, People's Republic of China
| | - Yulin Hao
- Shenyang National Laboratory for Materials Science, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, Liaoning, People's Republic of China
| | - Lin Wu
- Department of Prosthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning, People's Republic of China.
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Miller AD, Subramanian A, Viljoen HJ. A nonlinear model of cell interaction with an acoustic field. J Biomech 2017; 56:83-88. [PMID: 28372796 DOI: 10.1016/j.jbiomech.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/24/2017] [Accepted: 03/05/2017] [Indexed: 10/20/2022]
Abstract
A theoretical and experimental nonlinear analysis of cellular response/displacement to ultrasound excitations is presented. Linear cell models can predict the resonant frequency (fR∼5MHz), but only a nonlinear analysis can reveal the amount of mechanical energy that couples into the cell and the bifurcation behavior of the cell when it is excited near resonance. The cell dynamics is described by the nonlinear viscoelastic constitutive behavior of the cytoplasm, nucleus and their respective membranes, in the presence of a fluid with an oscillating pressure field. The method of multiple scales is used to derive the amplitude of oscillation of the cytoplasm and nucleus as a function of frequency. A major finding is the existence of multiple solutions for a range of sub-resonant frequencies. At positive detuning (f>fR), the mechanical energy that couples into the cell is small, it is higher at resonance but significantly higher at sub-resonant frequencies in the multiplicity range. Experimentally it was shown when 3.5MHz is approached sub- and supra-resonance and 6.5MHz is approached sub-resonance, gene expression was statistically higher than that when stimulated directly. Thus, there exists an optimal range of frequencies for ultrasound treatment - in the region of multiplicity where deformation and thus mechanical energy coupling is maximized. The ultrasound protocol must be designed to operate at the solution associated with the higher mechanical energy - thus the start-up conditions should be in the domain of attraction of the high energy solution.
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Affiliation(s)
- A D Miller
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - A Subramanian
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - H J Viljoen
- Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USA.
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Schandelmaier S, Kaushal A, Lytvyn L, Heels-Ansdell D, Siemieniuk RAC, Agoritsas T, Guyatt GH, Vandvik PO, Couban R, Mollon B, Busse JW. Low intensity pulsed ultrasound for bone healing: systematic review of randomized controlled trials. BMJ 2017; 356:j656. [PMID: 28348110 PMCID: PMC5484179 DOI: 10.1136/bmj.j656] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/16/2022]
Abstract
Objective To determine the efficacy of low intensity pulsed ultrasound (LIPUS) for healing of fracture or osteotomy.Design Systematic review and meta-analysis.Data sources Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and trial registries up to November 2016.Study selection Randomized controlled trials of LIPUS compared with sham device or no device in patients with any kind of fracture or osteotomy.Review methods Two independent reviewers identified studies, extracted data, and assessed risk of bias. A parallel guideline committee (BMJ Rapid Recommendation) provided input on the design and interpretation of the systematic review, including selection of outcomes important to patients. The GRADE system was used to assess the quality of evidence.Results 26 randomized controlled trials with a median sample size of 30 (range 8-501) were included. The most trustworthy evidence came from four trials at low risk of bias that included patients with tibia or clavicle fractures. Compared with control, LIPUS did not reduce time to return to work (percentage difference: 2.7% later with LIPUS, 95% confidence interval 7.7% earlier to 14.3% later; moderate certainty) or the number of subsequent operations (risk ratio 0.80, 95% confidence interval 0.55 to 1.16; moderate certainty). For pain, days to weight bearing, and radiographic healing, effects varied substantially among studies. For all three outcomes, trials at low risk of bias failed to show a benefit with LIPUS, while trials at high risk of bias suggested a benefit (interaction P<0.001). When only trials at low risk of bias trials were considered, LIPUS did not reduce days to weight bearing (4.8% later, 4.0% earlier to 14.4% later; high certainty), pain at four to six weeks (mean difference on 0-100 visual analogue scale: 0.93 lower, 2.51 lower to 0.64 higher; high certainty), and days to radiographic healing (1.7% earlier, 11.2% earlier to 8.8% later; moderate certainty).Conclusions Based on moderate to high quality evidence from studies in patients with fresh fracture, LIPUS does not improve outcomes important to patients and probably has no effect on radiographic bone healing. The applicability to other types of fracture or osteotomy is open to debate.Systematic review registration PROSPERO CRD42016050965.
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Affiliation(s)
- Stefan Schandelmaier
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, CH-4031 Basel, Switzerland
| | - Alka Kaushal
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Lyubov Lytvyn
- Oslo University Hospital, Forskningsveien 2b, Postboks 1089, Blindern 0317 Oslo, Norway
| | - Diane Heels-Ansdell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
| | - Reed A C Siemieniuk
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Thomas Agoritsas
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Division General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva, Switzerland
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
| | - Per O Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
- Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Rachel Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Brent Mollon
- Orillia Soldiers' Memorial Hospital, 41 Frederick Street, Orillia, ON L3V 5W6, Canada
| | - Jason W Busse
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON L8S 4K1, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON L8S 4K1, Canada
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Zheng N, Tang N, Qin L. Atypical femoral fractures and current management. J Orthop Translat 2016; 7:7-22. [PMID: 30035084 PMCID: PMC5987564 DOI: 10.1016/j.jot.2016.06.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 01/22/2023] Open
Abstract
With the rapid increase in patients receiving bisphosphonates (BPs) for treating osteoporosis, one of the clinical complications associated with its long-term use is atypical femoral fractures (AFFs). Although the absolute risk for AFFs is low and it was a consensus that AFFs were acceptable compared with the amount of osteoporotic fractures BPs have prevented, epidemiological studies have proved that BPs had a strong association with AFFs and possibly more people were going to suffer from this adverse effect with wide prescriptions of this drug. In addition, AFFs seemed to have impaired ability to heal. Thus, to understand the mechanism(s) behind AFFs is important and desirable for considering preventive measures. This article reviewed the clinical features of AFFs as well as potential underlining pathological characteristics, such as the decreased turnover rate caused by BPs that led to multiple-level alternations, e.g., changes not only at cellular and tissue levels, but also related to changes in bone micro- and macrostructure and organic/inorganic contents, leading to potentially compromised mechanical properties of cortical bone when exposed to prolonged BP therapy. Severely suppressed bone turnover may also be the underlying mechanism for impaired fracture healing in patients with AFFs. The rising concerns about the risk for AFFs in nonosteoporotic patients receiving high-dose BPs to treat cancers were also discussed. Detailed investigation will help develop potential targeted pharmacological treatments such as parathyroid hormone. In addition, potential innovative internal fixation implants were discussed with regard to dynamic and biological fixation for enhancing AFF repair.
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Affiliation(s)
- Nianye Zheng
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ning Tang
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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30
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Shindo T, Ito K, Ogata T, Hatanaka K, Kurosawa R, Eguchi K, Kagaya Y, Hanawa K, Aizawa K, Shiroto T, Kasukabe S, Miyata S, Taki H, Hasegawa H, Kanai H, Shimokawa H. Low-Intensity Pulsed Ultrasound Enhances Angiogenesis and Ameliorates Left Ventricular Dysfunction in a Mouse Model of Acute Myocardial Infarction. Arterioscler Thromb Vasc Biol 2016; 36:1220-9. [DOI: 10.1161/atvbaha.115.306477] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/03/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Tomohiko Shindo
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Kenta Ito
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Tsuyoshi Ogata
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Kazuaki Hatanaka
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Ryo Kurosawa
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Kumiko Eguchi
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Yuta Kagaya
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Kenichiro Hanawa
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Kentaro Aizawa
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Takashi Shiroto
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Sachie Kasukabe
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Satoshi Miyata
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Hirofumi Taki
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Hideyuki Hasegawa
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Hiroshi Kanai
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Graduate School of Medicine (T. Shindo, K.T., T.O., K. Hatanaka, R.K., K.E., Y.K., K. Hanawa, K.A., T. Shiroto, S.K., S.M., H.S.) and Department of Electronic Engineering, Graduate School of Engineering and Division of Biomedical Measurements and Diagnostics, Graduate School of Biomedical Engineering (H.T., H.H., H.K.), Tohoku University, Sendai, Japan
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Xin Z, Lin G, Lei H, Lue TF, Guo Y. Clinical applications of low-intensity pulsed ultrasound and its potential role in urology. Transl Androl Urol 2016; 5:255-66. [PMID: 27141455 PMCID: PMC4837316 DOI: 10.21037/tau.2016.02.04] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Low-intensity pulsed ultrasound (LIPUS) is a form of ultrasound that delivered at a much lower intensity (<3 W/cm2) than traditional ultrasound energy and output in the mode of pulse wave, and it is typically used for therapeutic purpose in rehabilitation medicine. LIPUS has minimal thermal effects due to its low intensity and pulsed output mode, and its non-thermal effects which is normally claimed to induce therapeutic changes in tissues attract most researchers’ attentions. LIPUS have been demonstrated to have a rage of biological effects on tissues, including promoting bone-fracture healing, accelerating soft-tissue regeneration, inhibiting inflammatory responses and so on. Recent studies showed that biological effects of LIPUS in healing morbid body tissues may be mainly associated with the upregulation of cell proliferation through activation of integrin receptors and Rho/ROCK/Src/ERK signaling pathway, and with promoting multilineage differentiation of mesenchyme stem/progenitor cell lines through ROCK-Cot/Tpl2-MEK-ERK signaling pathway. Hopefully, LIPUS may become an effective clinical procedure for the treatment of urological diseases, such as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), erectile dysfunction (ED), and stress urinary incontinence (SUI) in the field of urology. It still needs an intense effort for basic-science and clinical investigators to explore the biomedical applications of ultrasound.
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Affiliation(s)
- Zhongcheng Xin
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
| | - Guiting Lin
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
| | - Hongen Lei
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
| | - Tom F Lue
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
| | - Yinglu Guo
- 1 Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China ; 2 Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA 94143-0738, USA
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Low Intensity Pulsed Ultrasound Promotes the Extracellular Matrix Synthesis of Degenerative Human Nucleus Pulposus Cells Through FAK/PI3K/Akt Pathway. Spine (Phila Pa 1976) 2016; 41:E248-54. [PMID: 26571160 DOI: 10.1097/brs.0000000000001220] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro experimental study. OBJECTIVE To investigate the effect of low-intensity pulsed ultrasound (LIPUS) on the extracellular matrix (ECM) synthesis of degenerative human nucleus pulposus cells and explore the molecular mechanism. SUMMARY OF BACKGROUND DATA LIPUS has been used successfully for bone fracture healing and been proved to be effective in stimulating ECM metabolism in animal intervertebral disc cells. However, whether LIPUS also exerts an anabolic effect on degenerative human nucleus pulposus cells and the possible molecular mechanism is still unclear. METHODS The degenerative human nucleus pulposus cells were cultured in calcium alginate beads. In the LIPUS group, cells were exposed to an average temporal intensity of 30 mW/cm2 and a frequency of 1.5 MHz of LIPUS 20 minutes daily for 1 week. The control group was cultured in the same way but without LIPUS stimulation. The LY294002 group was stimulated by LIPUS and treated with LY294002 simultaneously. The expression of aggrecan, collagen-II, Sox9, tissue inhibitor of metalloproteinase-,1 and matrix metalloproteinase-3 were evaluated by Enzyme-Linked Immunosorbent Assay, Western blot or RT-PCR. Expression of signaling proteins involved in FAK/PI3K/Akt pathway was studied by Western blot analysis. RESULTS LIPUS significantly upregulated expression of aggrecan, collagen-II, Sox9, and tissue inhibitor of metalloproteinase-1 compared with control group, but inhibited secretion of matrix metalloproteinase-3. The study further demonstrated that the upregulation of aggrecan, collagen-II, and Sox9 was related to the activation of focal adhesion kinase (FAK)//PI3K/Akt pathway caused by LIPUS. Moreover, inhibition of PI3K/Akt significantly suppressed the special biological effect activated by LIPUS. CONCLUSION LIPUS promotes the ECM synthesis of degenerative human nucleus pulposus cells through activation of FAK/PI3K/Akt pathway. LEVEL OF EVIDENCE N/A.
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Padilla F, Puts R, Vico L, Guignandon A, Raum K. Stimulation of Bone Repair with Ultrasound. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:385-427. [PMID: 26486349 DOI: 10.1007/978-3-319-22536-4_21] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This chapter reviews the different options available for the use of ultrasound in the enhancement of fracture healing or in the reactivation of a failed healing process: LIPUS, shock waves and ultrasound-mediated delivery of bioactive molecules, such as growth factors or plasmids. The main emphasis is on LIPUS, or Low Intensity Pulsed Ultrasound, the most widespread and studied technique. LIPUS has pronounced bioeffects on tissue regeneration, while employing intensities within a diagnostic range. The biological response to LIPUS is complex as the response of numerous cell types to this stimulus involves several pathways. Known to-date mechanotransduction pathways involved in cell responses include MAPK and other kinases signaling pathways, gap-junctional intercellular communication, up-regulation and clustering of integrins, involvement of the COX-2/PGE2 and iNOS/NO pathways, and activation of the ATI mechanoreceptor. Mechanisms at the origin of LIPUS biological effects remain intriguing, and analysis is hampered by the diversity of experimental systems used in-vitro. Data point to clear evidence that bioeffects can be modulated by direct and indirect mechanical effects, like acoustic radiation force, acoustic streaming, propagation of surface waves, heat, fluid-flow induced circulation and redistribution of nutrients, oxygen and signaling molecules. One of the future engineering challenge is therefore the design of dedicated experimental set-ups allowing control of these different mechanical phenomena, and to relate them to biological responses. Then, the derivation of an 'acoustic dose' and the cross-calibration of the different experimental systems will be possible. Despite this imperfect knowledge of LIPUS biophysics, the clinical evidence, although most often of low quality, speaks in favor of the clinical use of LIPUS, when the economics of nonunion and the absence of toxicity of this ultrasound technology are taken into account.
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Affiliation(s)
| | - Regina Puts
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Föhrerstr. 15, 13353, Berlin, Germany
| | - Laurence Vico
- Inserm U1059 Lab Biologie intégrée du Tissu Osseux, Université de Saint-Etienne, St-Etienne, 42023, France
| | - Alain Guignandon
- Inserm U1059 Lab Biologie intégrée du Tissu Osseux, Université de Saint-Etienne, St-Etienne, 42023, France
| | - Kay Raum
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Föhrerstr. 15, 13353, Berlin, Germany
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Macione J, Long D, Nesbitt S, Wentzell S, Yokota H, Pandit V, Kotha S. Stimulation of osteoblast differentiation with guided ultrasound waves. J Ther Ultrasound 2015; 3:12. [PMID: 26246899 PMCID: PMC4526286 DOI: 10.1186/s40349-015-0034-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/27/2015] [Indexed: 11/18/2022] Open
Abstract
Background Ultrasound induces mechanical vibration and heat, causing differentiation and proliferation in osteoblasts. All known in vitro evaluations of ultrasound are, however, performed with longitudinal ultrasound waves. We addressed a question: Do other forms of ultrasound waves, such as guided waves (longitudinal and guided flexural) transduced at a remote location, enhance differentiation of osteoblast cells? Methods In this study, we employed guided Lamb waves that were induced in a borosilicate glass slide (cortical bone mimic). An average energy of 10–30 mW/cm2 for 20 min per day was applied to MC3T3 osteoblast-like cells, which were placed 30–75 mm distant from the transducer. Results The result revealed that guided waves significantly stimulated the differentiation and mineralization of MC3T3 cells. In particular, guided waves elevated mRNA expression levels of bone formation-related genes such as alkaline phosphatase, osteopontin, osteocalcin, osteoprotegerin, and bone sialoprotein on days 8 and 16. In addition, the amount of mineralization found via Alizarin red staining was increased by 157 % (p = 0.034). The amount of mineralization was found to be independent of distance from the transducer (p = 0.967). Conclusion We demonstrate herein that ultrasound in a form of guided Lamb waves is capable of inducing osteoblast differentiation in vitro, and it may enable the stimulation of osteoblasts in vivo over a distance from the site of ultrasound application.
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Affiliation(s)
- James Macione
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Daniel Long
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Sterling Nesbitt
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Scott Wentzell
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Hiroki Yokota
- Department of Biomedical Engineering, Indiana University Purdue University Indianapolis, Indianapolis, IN 46202 USA
| | - Vaibhav Pandit
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180 USA
| | - Shiva Kotha
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180 USA
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Abstract
Skeletal loading is an important physiological regulator of bone mass. Theoretically, mechanical forces or administration of drugs that activate bone mechanosensors would be a novel treatment for osteoporotic disorders, particularly age-related osteoporosis and other bone loss caused by skeletal unloading. Uncertainty regarding the identity of the molecular targets that sense and transduce mechanical forces in bone, however, has limited the therapeutic exploitation of mechanosesning pathways to control bone mass. Recently, two evolutionally conserved mechanosensing pathways have been shown to function as "physical environment" sensors in cells of the osteoblasts lineage. Indeed, polycystin-1 (Pkd1, or PC1) and polycystin-2 (Pkd2, or PC2' or TRPP2), which form a flow sensing receptor channel complex, and TAZ (transcriptional coactivator with PDZ-binding motif, or WWTR1), which responds to the extracellular matrix microenvironment act in concert to reciprocally regulate osteoblastogenesis and adipogenesis through co-activating Runx2 and a co-repressing PPARγ activities. Interactions of polycystins and TAZ with other putative mechanosensing mechanism, such as primary cilia, integrins and hemichannels, may create multifaceted mechanosensing networks in bone. Moreover, modulation of polycystins and TAZ interactions identify novel molecular targets to develop small molecules that mimic the effects of mechanical loading on bone.
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Affiliation(s)
- Zhousheng Xiao
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38165, USA
| | - Leigh Darryl Quarles
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38165, USA
- Coleman College of Medicine Building, Suite B216, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN 38163, USA
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Hu Y, Wan JMF, Yu ACH. Cytomechanical perturbations during low-intensity ultrasound pulsing. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1587-98. [PMID: 24642219 DOI: 10.1016/j.ultrasmedbio.2014.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 12/23/2013] [Accepted: 01/07/2014] [Indexed: 05/24/2023]
Abstract
To establish the therapeutic potential of low-intensity ultrasound, it is important to characterize its biophysical interactions with living cells. Here, through a series of single-cell direct observations, we show that low-intensity ultrasound pulsing would give rise to a dynamic course of cytomechanical perturbations at both the membrane and nucleus levels. Our investigation was conducted using a composite platform that coupled a 1-MHz ultrasound exposure hardware to a confocal microscopy system. Short ultrasound pulses (5 cycles, 2-kHz pulse repetition frequency) with a spatial-peak time-averaged intensity of 0.24 W/cm(2) (0.85-MPa peak positive acoustic pressure) were delivered over a 10-min period to adherent Neuro-2a neuroblastoma cells, and live imaging of cellular dynamics was performed before, during and after the exposure period. Bright-field imaging results revealed progressive shrinkage of cellular cross-sectional area (25%-45%, N = 7) during low-intensity ultrasound pulsing; the initial rate of size decrease was estimated to be 8%-14% per minute. This shrinkage was found to be transient, as the sonicated cells had recovered (at a rate of size increase of 0.4%-0.9% per minute) to their pre-exposure size within 30 min after the end of exposure. Three-dimensional confocal imaging results further revealed that (i) ultrasound-induced membrane contraction was volumetric in nature (21%-45% reduction), and (ii) a concomitant decrease in nucleus volume was evident (12%-25% reduction). Together, these findings indicate that low-intensity ultrasound pulsing, if applied on the order of minutes, would reversibly perturb the physical and subcellular structures of living cells.
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Affiliation(s)
- Yaxin Hu
- Medical Engineering Program, University of Hong Kong, Pokfulam, Hong Kong
| | - Jennifer M F Wan
- Medical Engineering Program, University of Hong Kong, Pokfulam, Hong Kong
| | - Alfred C H Yu
- Medical Engineering Program, University of Hong Kong, Pokfulam, Hong Kong.
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Padilla F, Puts R, Vico L, Raum K. Stimulation of bone repair with ultrasound: a review of the possible mechanic effects. ULTRASONICS 2014; 54:1125-45. [PMID: 24507669 DOI: 10.1016/j.ultras.2014.01.004] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 12/20/2013] [Accepted: 01/07/2014] [Indexed: 05/15/2023]
Abstract
In vivo and in vitro studies have demonstrated the positive role that ultrasound can play in the enhancement of fracture healing or in the reactivation of a failed healing process. We review the several options available for the use of ultrasound in this context, either to induce a direct physical effect (LIPUS, shock waves), to deliver bioactive molecules such as growth factors, or to transfect cells with osteogenic plasmids; with a main focus on LIPUS (or Low Intensity Pulsed Ultrasound) as it is the most widespread and studied technique. The biological response to LIPUS is complex as numerous cell types respond to this stimulus involving several pathways. Known to-date mechanotransduction pathways involved in cell responses include MAPK and other kinases signaling pathways, gap-junctional intercellular communication, up-regulation and clustering of integrins, involvement of the COX-2/PGE2, iNOS/NO pathways and activation of ATI mechanoreceptor. The mechanisms by which ultrasound can trigger these effects remain intriguing. Possible mechanisms include direct and indirect mechanical effects like acoustic radiation force, acoustic streaming, and propagation of surface waves, fluid-flow induced circulation and redistribution of nutrients, oxygen and signaling molecules. Effects caused by the transformation of acoustic wave energy into heat can usually be neglected, but heating of the transducer may have a potential impact on the stimulation in some in-vitro systems, depending on the coupling conditions. Cavitation cannot occur at the pressure levels delivered by LIPUS. In-vitro studies, although not appropriate to identify the overall biological effects, are of great interest to study specific mechanisms of action. The diversity of current experimental set-ups however renders this analysis very complex, as phenomena such as transducer heating, inhomogeneities of the sound intensity in the near field, resonances in the transmission and reflection through the culture dish walls and the formation of standing waves will greatly affect the local type and amplitude of the stimulus exerted on the cells. A future engineering challenge is therefore the design of dedicated experimental set-ups, in which the different mechanical phenomena induced by ultrasound can be controlled. This is a prerequisite to evaluate the biological effects of the different phenomena with respect to particular parameters, like intensity, frequency, or duty cycle. By relating the variations of these parameters to the induced physical effects and to the biological responses, it will become possible to derive an 'acoustic dose' and propose a quantification and cross-calibration of the different experimental systems. Improvements in bone healing management will probably also come from a combination of ultrasound with a 'biologic' components, e.g. growth factors, scaffolds, gene therapies, or drug delivery vehicles, the effects of which being potentiated by the ultrasound.
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Affiliation(s)
- Frédéric Padilla
- Inserm, U1032, LabTau, Lyon F-69003, France; Université de Lyon, Lyon F-69003, France.
| | - Regina Puts
- Julius Wolff Institut & Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
| | - Laurence Vico
- Inserm U1059 Lab Biologie intégrée du Tissu Osseux, Université de Lyon, St-Etienne F-42023, France
| | - Kay Raum
- Julius Wolff Institut & Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
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Leskinen JJ, Olkku A, Mahonen A, Hynynen K. Nonuniform Temperature Rise in In Vitro Osteoblast Ultrasound Exposures With Associated Bioeffect. IEEE Trans Biomed Eng 2014; 61:920-7. [DOI: 10.1109/tbme.2013.2292546] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Genes responsive to low-intensity pulsed ultrasound in MC3T3-E1 preosteoblast cells. Int J Mol Sci 2013; 14:22721-40. [PMID: 24252911 PMCID: PMC3856087 DOI: 10.3390/ijms141122721] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/04/2013] [Accepted: 08/06/2013] [Indexed: 12/12/2022] Open
Abstract
Although low-intensity pulsed ultrasound (LIPUS) has been shown to enhance bone fracture healing, the underlying mechanism of LIPUS remains to be fully elucidated. Here, to better understand the molecular mechanism underlying cellular responses to LIPUS, we investigated gene expression profiles in mouse MC3T3-E1 preosteoblast cells exposed to LIPUS using high-density oligonucleotide microarrays and computational gene expression analysis tools. Although treatment of the cells with a single 20-min LIPUS (1.5 MHz, 30 mW/cm(2)) did not affect the cell growth or alkaline phosphatase activity, the treatment significantly increased the mRNA level of Bglap. Microarray analysis demonstrated that 38 genes were upregulated and 37 genes were downregulated by 1.5-fold or more in the cells at 24-h post-treatment. Ingenuity pathway analysis demonstrated that the gene network U (up) contained many upregulated genes that were mainly associated with bone morphology in the category of biological functions of skeletal and muscular system development and function. Moreover, the biological function of the gene network D (down), which contained downregulated genes, was associated with gene expression, the cell cycle and connective tissue development and function. These results should help to further clarify the molecular basis of the mechanisms of the LIPUS response in osteoblast cells.
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Low-intensity pulsed ultrasound accelerates tooth movement via activation of the BMP-2 signaling pathway. PLoS One 2013; 8:e68926. [PMID: 23894376 PMCID: PMC3720872 DOI: 10.1371/journal.pone.0068926] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 06/03/2013] [Indexed: 12/16/2022] Open
Abstract
The present study was designed to determine the underlying mechanism of low-intensity pulsed ultrasound (LIPUS) induced alveolar bone remodeling and the role of BMP-2 expression in a rat orthodontic tooth movement model. Orthodontic appliances were placed between the homonymy upper first molars and the upper central incisors in rats under general anesthesia, followed by daily 20-min LIPUS or sham LIPUS treatment beginning at day 0. Tooth movement distances and molecular changes were evaluated at each observation point. In vitro and in vivo studies were conducted to detect HGF (Hepatocyte growth factor)/Runx2/BMP-2 signaling pathways and receptor activator of NFκB ligand (RANKL) expression by quantitative real time PCR (qRT-PCR), Western blot and immunohistochemistry. At day 3, LIPUS had no effect on the rat orthodontic tooth movement distance and BMP-2-induced alveolar bone remodeling. However, beginning at day 5 and for the following time points, LIPUS significantly increased orthodontic tooth movement distance and BMP-2 signaling pathway and RANKL expression compared with the control group. The qRT-PCR and Western blot data in vitro and in vivo to study BMP-2 expression were consistent with the immunohistochemistry observations. The present study demonstrates that LIPUS promotes alveolar bone remodeling by stimulating the HGF/Runx2/BMP-2 signaling pathway and RANKL expression in a rat orthodontic tooth movement model, and LIPUS increased BMP-2 expression via Runx2 regulation.
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Louw TM, Budhiraja G, Viljoen HJ, Subramanian A. Mechanotransduction of ultrasound is frequency dependent below the cavitation threshold. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1303-19. [PMID: 23562015 PMCID: PMC4183372 DOI: 10.1016/j.ultrasmedbio.2013.01.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/18/2013] [Accepted: 01/27/2013] [Indexed: 05/11/2023]
Abstract
This study provides evidence that low-intensity ultrasound directly affects nuclear processes, and the magnitude of the effect varies with frequency. In particular, we show that the transcriptional induction of first load-inducible genes, which is independent of new protein synthesis, is frequency dependent. Bovine chondrocytes were exposed to low-intensity (below the cavitational threshold) ultrasound at 2, 5 and 8 MHz. Ultrasound elevated the expression of early response genes c-Fos, c-Jun and c-Myc, maximized at 5 MHz. The phosphorylated ERK inhibitor PD98059 abrogated any increase in c-series gene expression, suggesting that signaling occurs via the MAPPK/ERK pathway. However, phosphorylated ERK levels did not change with ultrasound frequency, indicating that processes downstream of ERK phosphorylation (such as nuclear transport and chromatin reorganization) respond to ultrasound with frequency dependence. A quantitative, biphasic mathematical model based on Biot theory predicted that cytoplasmic and nuclear stress is maximized at 5.2 ± 0.8 MHz for a chondrocyte, confirming experimental measurements.
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Affiliation(s)
- Tobias M Louw
- Department of Chemical & Biomolecular Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
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Antonova E, Le TK, Burge R, Mershon J. Tibia shaft fractures: costly burden of nonunions. BMC Musculoskelet Disord 2013; 14:42. [PMID: 23351958 PMCID: PMC3573940 DOI: 10.1186/1471-2474-14-42] [Citation(s) in RCA: 226] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 01/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tibia shaft fractures (TSF) are common for men and women and cause substantial morbidity, healthcare use, and costs. The impact of nonunions on healthcare use and costs is poorly described. Our goal was to investigate patient characteristics and healthcare use and costs associated with TSF in patients with and without nonunion. METHODS We retrospectively analyzed medical claims in large U.S. managed care claims databases (Thomson Reuters MarketScan®, 16 million lives). We studied patients ≥ 18 years old with a TSF diagnosis (ICD-9 codes: 823.20, 823.22, 823.30, 823.32) in 2006 with continuous pharmaceutical and medical benefit enrollment 1 year prior and 2 years post-fracture. Nonunion was defined by ICD-9 code 733.82 (after the TSF date). RESULTS Among the 853 patients with TSF, 99 (12%) had nonunion. Patients with nonunion had more comorbidities (30 vs. 21, pre-fracture) and were more likely to have their TSF open (87% vs. 70%) than those without nonunion. Patients with nonunion were more likely to have additional fractures during the 2-year follow-up (of lower limb [88.9% vs. 69.5%, P < 0.001], spine or trunk [16.2% vs. 7.2%, P = 0.002], and skull [5.1% vs. 1.3%, P = 0.008]) than those without nonunion. Nonunion patients were more likely to use various types of surgical care, inpatient care (tibia and non-tibia related: 65% vs. 40%, P < 0.001) and outpatient physical therapy (tibia-related: 60% vs. 42%, P < 0.001) than those without nonunion. All categories of care (except emergency room costs) were more expensive in nonunion patients than in those without nonunion: median total care cost $25,556 vs. $11,686, P < 0.001. Nonunion patients were much more likely to be prescribed pain medications (99% vs. 92%, P = 0.009), especially strong opioids (90% vs. 76.4%, P = 0.002) and had longer length of opioid therapy (5.4 months vs. 2.8 months, P < 0.001) than patients without nonunion. Tibia fracture patterns in men differed from those in women. CONCLUSIONS Nonunions in TSF's are associated with substantial healthcare resource use, common use of strong opioids, and high per-patient costs. Open fractures are associated with higher likelihood of nonunion than closed ones. Effective screening of nonunion risk may decrease this morbidity and subsequent healthcare resource use and costs.
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Lam WL, Guo X, Leung KS, Kwong KSC. The role of the sensory nerve response in ultrasound accelerated fracture repair. ACTA ACUST UNITED AC 2012; 94:1433-8. [PMID: 23015574 DOI: 10.1302/0301-620x.94b10.29139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study was designed to test the hypothesis that the sensory innervation of bone might play an important role in sensing and responding to low-intensity pulsed ultrasound and explain its effect in promoting fracture healing. In 112 rats a standardised mid-shaft tibial fracture was created, supported with an intramedullary needle and divided into four groups of 28. These either had a sciatic neurectomy or a patellar tendon resection as control, and received the ultrasound or not as a sham treatment. Fracture union, callus mineralisation and remodelling were assessed using plain radiography, peripheral quantitative computed tomography and histomorphology. Daily ultrasound treatment significantly increased the rate of union and the volumetric bone mineral density in the fracture callus in the neurally intact rats (p = 0.025), but this stimulating effect was absent in the rats with sciatic neurectomy. Histomorphology demonstrated faster maturation of the callus in the group treated with ultrasound when compared with the control group. The results supported the hypothesis that intact innervation plays an important role in allowing low-intensity pulsed ultrasound to promote fracture healing.
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Affiliation(s)
- W-L Lam
- The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Ham, Hong Kong
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de Brito Vieira WH, Aguiar KA, da Silva KM, Canela PM, da Silva FS, Abreu BJ. Overview of ultrasound usage trends in orthopedic and sports physiotherapy. Crit Ultrasound J 2012; 4:11. [PMID: 22871050 PMCID: PMC3439362 DOI: 10.1186/2036-7902-4-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 05/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to examine current beliefs about the use, the clinical importance, the theoretical fundamentals and the utilization criteria of therapeutic ultrasound (TUS) among physical therapists on the clinical practice in orthopedic and sports physiotherapy in Brazil. METHODS A brief survey was developed based on previous studies and was sent to 55 physical therapists with advanced competency in orthopedics and sports physiotherapy. The questions addressed general topics about the professional profile and ultrasound usage and dosage. RESULTS Our data show the wide availability and frequent use of TUS in this sample of physical therapists. TUS is used in distinct musculoskeletal injuries and/or disorders in both acute and chronic conditions. Muscles, tendons and ligaments represented the major structures where TUS is used. Questions on the basic theory of TUS demonstrated a lack of knowledge of the ultrasound physiological effects as well as its interaction with biological tissues and TUS absolute contraindication. CONCLUSION A Brazilian profile about the US usage and dosage in orthopedic and sports physiotherapy is presented and highlights the need for a continuous upgrading process and further research into its effects.
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Affiliation(s)
- Wouber Herickson de Brito Vieira
- Departamento de Morfologia, Universidade Federal do Rio Grande do Norte, Av, Lagoa Nova S/N, Natal, Rio Grande do Norte, 1524-59072-970, Brazil.
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Leskinen JJ, Hynynen K. Study of factors affecting the magnitude and nature of ultrasound exposure with in vitro set-ups. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:777-94. [PMID: 22425382 DOI: 10.1016/j.ultrasmedbio.2012.01.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/17/2012] [Accepted: 01/21/2012] [Indexed: 05/07/2023]
Abstract
Therapeutic ultrasound is a clinically applied method to improve fracture healing and holds great potential as a manipulator of biologic material relevant to tissue engineering approaches. Unfortunately, the cell stimulating property of ultrasound is not known, which inhibits the optimal use of this technique. Additionally, many in vitro studies in this field use ultrasound configurations that are vulnerable to errors during calibration and use. These errors arise from the structural simplicity and incomplete characterization of these configurations. In this study, pulse-echo ultrasound, laser Doppler vibrometry and Schlieren imaging were applied to noninvasively characterize common in vitro experimental configurations. Fine wire thermocouple measurements were conducted to characterize any possible temperature rise during the ultrasound exposures. The results quantified the frequency dependent sound transmission through culture wells and the standing wave effect within the cell volume. These effects can cause uncertainty of up to 700% in the actual ultrasound exposure experienced by the cell. A temperature rise of 2.7°C was measured from an ultrasound configuration commonly used in vitro ultrasound studies. Furthermore, wave mode conversion in culture wells was observed, emphasizing the complexity of these sonications. Similar type Lamb waves have been observed in bone in vivo. Thus, Lamb waves may be a mechanism for stimulating the cells.
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Affiliation(s)
- Jarkko J Leskinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
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Biological strategies to enhance healing of the avascular area of the meniscus. Stem Cells Int 2011; 2012:528359. [PMID: 22220179 PMCID: PMC3246301 DOI: 10.1155/2012/528359] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 11/01/2011] [Indexed: 12/15/2022] Open
Abstract
Meniscal injuries in the vascularized peripheral part of the meniscus have a better healing potential than tears in the central avascular zone because meniscal healing principally depends on its vascular supply. Several biological strategies have been proposed to enhance healing of the avascular area of the meniscus: abrasion therapy, fibrin clot, organ culture, cell therapy, and applications of growth factors. However, data are too heterogeneous to achieve definitive conclusions on the use of these techniques for routine management of meniscal lesions. Although most preclinical and clinical studies are very promising, they are still at an experimental stage. More prospective randomised controlled trials are needed to compare the different techniques for clinical results, applicability, and cost-effectiveness.
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Scaffolds in tendon tissue engineering. Stem Cells Int 2011; 2012:517165. [PMID: 22190961 PMCID: PMC3236365 DOI: 10.1155/2012/517165] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 10/18/2011] [Indexed: 02/06/2023] Open
Abstract
Tissue engineering techniques using novel scaffold materials offer potential alternatives for managing tendon disorders. Tissue engineering strategies to improve tendon repair healing include the use of scaffolds, growth factors, cell seeding, or a combination of these approaches. Scaffolds have been the most common strategy investigated to date. Available scaffolds for tendon repair include both biological scaffolds, obtained from mammalian tissues, and synthetic scaffolds, manufactured from chemical compounds. Preliminary studies support the idea that scaffolds can provide an alternative for tendon augmentation with an enormous therapeutic potential. However, available data are lacking to allow definitive conclusion on the use of scaffolds for tendon augmentation. We review the current basic science and clinical understanding in the field of scaffolds and tissue engineering for tendon repair.
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Longo UG, Loppini M, Berton A, Spiezia F, Maffulli N, Denaro V. Tissue engineered strategies for skeletal muscle injury. Stem Cells Int 2011; 2012:175038. [PMID: 25098362 PMCID: PMC3216349 DOI: 10.1155/2012/175038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/15/2011] [Indexed: 12/13/2022] Open
Abstract
Skeletal muscle injuries are common in athletes, occurring with direct and indirect mechanisms and marked residual effects, such as severe long-term pain and physical disability. Current therapy consists of conservative management including RICE protocol (rest, ice, compression and elevation), nonsteroidal anti-inflammatory drugs, and intramuscular corticosteroids. However, current management of muscle injuries often does not provide optimal restoration to preinjury status. New biological therapies, such as injection of platelet-rich plasma and stem-cell-based therapy, are appealing. Although some studies support PRP application in muscle-injury management, reasons for concern persist, and further research is required for a standardized and safe use of PRP in clinical practice. The role of stem cells needs to be confirmed, as studies are still limited and inconsistent. Further research is needed to identify mechanisms involved in muscle regeneration and in survival, proliferation, and differentiation of stem cells.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Mattia Loppini
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Filippo Spiezia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR) Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Longo UG, Petrillo S, Franceschetti E, Maffulli N, Denaro V. Growth factors and anticatabolic substances for prevention and management of intervertebral disc degeneration. Stem Cells Int 2011; 2012:897183. [PMID: 25098367 PMCID: PMC3216373 DOI: 10.1155/2012/897183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/12/2011] [Indexed: 12/17/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is frequent, appearing from the second decade of life and progressing with age. Conservative management often fails, and patients with IVD degeneration may need surgical intervention. Several treatment strategies have been proposed, although only surgical discectomy and arthrodesis have been proved to be predictably effective. Biological strategies aim to prevent and manage IVD degeneration, improving the function and anabolic and reparative capabilities of the nucleus pulposus and annulus fibrosus cells and inhibiting matrix degradation. At present, clinical applications are still in their infancy. Further studies are required to clarify the role of growth factors and anticatabolic substances for prevention and management of intervertebral disc degeneration.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, Via Álvaro del Portillo 200, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR), Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, Via Álvaro del Portillo 200, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR), Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, Via Álvaro del Portillo 200, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR), Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico, University of Rome, Via Álvaro del Portillo 200, 00128 Rome, Italy
- Centro Integrato di Ricerca (CIR), Università Campus Bio-Medico di Roma, Via Álvaro del Portillo 21, 00128 Rome, Italy
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Advances in meniscal tissue engineering. Stem Cells Int 2011; 2012:420346. [PMID: 25098366 PMCID: PMC3205710 DOI: 10.1155/2012/420346] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 08/26/2011] [Indexed: 01/08/2023] Open
Abstract
Meniscal tears are the most common knee injuries and have a poor ability of healing. In the last few decades, several techniques have been increasingly used to optimize meniscal healing. Current research efforts of tissue engineering try to combine cell-based therapy, growth factors, gene therapy, and reabsorbable scaffolds to promote healing of meniscal defects. Preliminary studies did not allow to draw definitive conclusions on the use of these techniques for routine management of meniscal lesions. We performed a review of the available literature on current techniques of tissue engineering for the management of meniscal tears.
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