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Eugenia Ortiz M, Sinhorim L, Hoffmann de Oliveira B, Hardt da Silva R, Melo de Souza G, de Souza G, Paula Piovezan A, Balduino Bittencourt E, Bianco G, Shiguemi Inoue Salgado A, Klingler W, Schleip R, Fernandes Martins D. Analgesia by fascia manipulation is mediated by peripheral and spinal adenosine A 1 receptor in a mouse model of peripheral inflammation. Neuroscience 2024; 555:125-133. [PMID: 39038598 DOI: 10.1016/j.neuroscience.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/08/2024] [Accepted: 07/18/2024] [Indexed: 07/24/2024]
Abstract
The role of adenosine receptors in fascial manipulation-induced analgesia has not yet been investigated. The purpose of this study was to evaluate the involvement of the adenosine A1 receptor (A1R) in the antihyperalgesic effect of plantar fascia manipulation (PFM), specifically in mice with peripheral inflammation. Mice injected with Complete Freund's Adjuvant (CFA) underwent behavioral, i.e. mechanical hyperalgesia and edema. The mice underwent PFM for either 3, 9 or 15 min. Response frequency to mechanical stimuli was then assessed at 24 and 96 h after plantar CFA injection. The adenosinergic receptors were assessed by systemic (intraperitoneal, i.p.), central (intrathecal, i.t.), and peripheral (intraplantar, i.pl.) administration of caffeine. The participation of the A1R was investigated using the 1,3-dipropyl-8-cyclopentylxanthine (DPCPX), a selective A1R subtype antagonist. PFM inhibited mechanical hyperalgesia induced by CFA injection and did not reduce paw edema. Furthermore, the antihyperalgesic effect of PFM was prevented by pretreatment of the animals with caffeine given by i.p., i.pl., and i.t. routes. In addition, i.pl. and i.t. administrations of DPCPX blocked the antihyperalgesia caused by PFM. These observations indicate that adenosine receptors mediate the antihyperalgesic effect of PFM. Caffeine's inhibition of PFM-induced antihyperalgesia suggests that a more precise understanding of how fascia-manipulation and caffeine interact is warranted.
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Affiliation(s)
- Maria Eugenia Ortiz
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil
| | - Larissa Sinhorim
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil
| | - Bruna Hoffmann de Oliveira
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil
| | - Rafaela Hardt da Silva
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil
| | - Gabriel Melo de Souza
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil
| | - Gabriela de Souza
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil
| | - Anna Paula Piovezan
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil
| | - Edsel Balduino Bittencourt
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil; Coastal Health Institute, Jacksonville, USA
| | - Gianluca Bianco
- Research Laboratory of Posturology and Neuromodulation (RELPON), Department of Human Neuroscience, Sapienza University, Rome, Italy; Istituto di Formazione in Agopuntura e Neuromodulazione (IFAN), Roma, Italy
| | | | - Werner Klingler
- SRH Hospitals, Sigmaringen, Germany; Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Department for Medical Professions, Diploma University of Applied Sciences, Bad Sooden-Allendorf, Germany
| | - Robert Schleip
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Department for Medical Professions, Diploma University of Applied Sciences, Bad Sooden-Allendorf, Germany; Fascia Research Group, Experimental Anesthesiology, Ulm University, Ulm, Germany
| | - Daniel Fernandes Martins
- Experimental Neuroscience Laboratory (LaNEx), Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil.
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Sabeh F, Li XY, Olson AW, Botvinick E, Kurup A, Gimenez LE, Cho JS, Weiss SJ. Mmp14-dependent remodeling of the pericellular-dermal collagen interface governs fibroblast survival. J Cell Biol 2024; 223:e202312091. [PMID: 38990714 PMCID: PMC11244150 DOI: 10.1083/jcb.202312091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/10/2024] [Accepted: 05/30/2024] [Indexed: 07/13/2024] Open
Abstract
Dermal fibroblasts deposit type I collagen, the dominant extracellular matrix molecule found in skin, during early postnatal development. Coincident with this biosynthetic program, fibroblasts proteolytically remodel pericellular collagen fibrils by mobilizing the membrane-anchored matrix metalloproteinase, Mmp14. Unexpectedly, dermal fibroblasts in Mmp14-/- mice commit to a large-scale apoptotic program that leaves skin tissues replete with dying cells. A requirement for Mmp14 in dermal fibroblast survival is recapitulated in vitro when cells are embedded within, but not cultured atop, three-dimensional hydrogels of crosslinked type I collagen. In the absence of Mmp14-dependent pericellular proteolysis, dermal fibroblasts fail to trigger β1 integrin activation and instead actuate a TGF-β1/phospho-JNK stress response that leads to apoptotic cell death in vitro as well as in vivo. Taken together, these studies identify Mmp14 as a requisite cell survival factor that maintains dermal fibroblast viability in postnatal dermal tissues.
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Affiliation(s)
- Farideh Sabeh
- Division of Genetic Medicine, Department of Internal Medicine, Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
| | - Xiao-Yan Li
- Division of Genetic Medicine, Department of Internal Medicine, Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
| | - Adam W. Olson
- Division of Genetic Medicine, Department of Internal Medicine, Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
| | - Elliot Botvinick
- The Henry Samueli School of Engineering, University of California, Irvine, CA, USA
| | - Abhishek Kurup
- The Henry Samueli School of Engineering, University of California, Irvine, CA, USA
| | - Luis E. Gimenez
- Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
| | - Jung-Sun Cho
- Division of Genetic Medicine, Department of Internal Medicine, Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
| | - Stephen J. Weiss
- Division of Genetic Medicine, Department of Internal Medicine, Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
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Blockhuys S, Wittung-Stafshede P. Yoga as a Complementary Therapy for Cancer Patients: From Clinical Observations to Biochemical Mechanisms. Complement Med Res 2024:1-13. [PMID: 38991506 DOI: 10.1159/000540213] [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: 02/14/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Integrative oncology combines conventional and complementary, or integrative, therapies for a holistic treatment of cancer patients. Yoga is increasingly used as a complementary therapy for cancer patients, but there is no direct evidence for its effect on cancer pathophysiology like tumor response, or patient outcome like overall survival. SUMMARY In this narrative review, we present in detail published studies from randomized clinical trials on complementary yoga therapy for cancer patients, including details about the biochemical mechanisms involved. Medicinal hatha yoga with breathing, postures, meditation, and relaxation enhances the quality of life of cancer patients by providing both psychological and physiological health benefits, highlighting the interconnectedness of mind and body. Yoga therapy reduces stress levels improving heart rate variability, leading to changes in hormonal regulation (e.g., cortisol), reduced oxidative stress, and improved immune function with reduced inflammation. Still, the biochemical effects of yoga on the cancer disease itself are unrevealed. KEY MESSAGES More clinical and basic research is needed for further establishment of yoga as complementary therapy in oncology.
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Affiliation(s)
- Stéphanie Blockhuys
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Li YY, Ji SF, Fu XB, Jiang YF, Sun XY. Biomaterial-based mechanical regulation facilitates scarless wound healing with functional skin appendage regeneration. Mil Med Res 2024; 11:13. [PMID: 38369464 PMCID: PMC10874556 DOI: 10.1186/s40779-024-00519-6] [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: 07/03/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
Scar formation resulting from burns or severe trauma can significantly compromise the structural integrity of skin and lead to permanent loss of skin appendages, ultimately impairing its normal physiological function. Accumulating evidence underscores the potential of targeted modulation of mechanical cues to enhance skin regeneration, promoting scarless repair by influencing the extracellular microenvironment and driving the phenotypic transitions. The field of skin repair and skin appendage regeneration has witnessed remarkable advancements in the utilization of biomaterials with distinct physical properties. However, a comprehensive understanding of the underlying mechanisms remains somewhat elusive, limiting the broader application of these innovations. In this review, we present two promising biomaterial-based mechanical approaches aimed at bolstering the regenerative capacity of compromised skin. The first approach involves leveraging biomaterials with specific biophysical properties to create an optimal scarless environment that supports cellular activities essential for regeneration. The second approach centers on harnessing mechanical forces exerted by biomaterials to enhance cellular plasticity, facilitating efficient cellular reprogramming and, consequently, promoting the regeneration of skin appendages. In summary, the manipulation of mechanical cues using biomaterial-based strategies holds significant promise as a supplementary approach for achieving scarless wound healing, coupled with the restoration of multiple skin appendage functions.
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Affiliation(s)
- Ying-Ying Li
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, Chinese PLA General Hospital and PLA Medical College; PLA Key Laboratory of Tissue Repair and Regenerative Medicine and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration; Research Unit of Trauma Care, Tissue Repair and Regeneration, Chinese Academy of Medical Sciences, 2019RU051, Beijing, 100048, China
| | - Shuai-Fei Ji
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, Chinese PLA General Hospital and PLA Medical College; PLA Key Laboratory of Tissue Repair and Regenerative Medicine and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration; Research Unit of Trauma Care, Tissue Repair and Regeneration, Chinese Academy of Medical Sciences, 2019RU051, Beijing, 100048, China
| | - Xiao-Bing Fu
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, Chinese PLA General Hospital and PLA Medical College; PLA Key Laboratory of Tissue Repair and Regenerative Medicine and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration; Research Unit of Trauma Care, Tissue Repair and Regeneration, Chinese Academy of Medical Sciences, 2019RU051, Beijing, 100048, China.
| | - Yu-Feng Jiang
- Department of Tissue Regeneration and Wound Repair, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Xiao-Yan Sun
- Research Center for Tissue Repair and Regeneration Affiliated to the Medical Innovation Research Department, Chinese PLA General Hospital and PLA Medical College; PLA Key Laboratory of Tissue Repair and Regenerative Medicine and Beijing Key Research Laboratory of Skin Injury, Repair and Regeneration; Research Unit of Trauma Care, Tissue Repair and Regeneration, Chinese Academy of Medical Sciences, 2019RU051, Beijing, 100048, China.
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Lucha-López MO, Hidalgo-García C, Monti-Ballano S, Márquez-Gonzalvo S, Krauss J, Tricás-Vidal HJ, Tricás-Moreno JM. Diacutaneous Fibrolysis: An Update on Research into Musculoskeletal and Neural Clinical Entities. Biomedicines 2023; 11:3122. [PMID: 38137343 PMCID: PMC10741169 DOI: 10.3390/biomedicines11123122] [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: 11/10/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Diacutaneous Fibrolysis (DF) is an instrumentally assisted manual therapy technique defined as "a specific instrumental intervention for normalizing the musculoskeletal system function after a precise diagnosis and preserving the skin's integrity". The aim of this technique is soft tissue mobilization with the assistance of specially designed, hook-shaped steel instruments in different musculoskeletal structures, such as the myofascia, aponeurosis, tendons, ligaments and scar tissues. Due to discrepant results between previous reviews and the quite abundant new evidence provided by recently published randomized clinical trials, we propound this narrative review to provide an update on the scientific evidence related to the fundamentals and clinical efficacy of DF. Current evidence primarily supports the mechanical effect of DF on connective soft tissues. Diminished deep tendon reflex and rigidity have been registered after the implementation of DF in healthy subjects. Though there is still much to uncover, scientific evidence supports the use of the technique for the clinical treatment of subacromial impingement syndrome, chronic lateral epicondylalgia, chronic patellofemoral pain syndrome, mild to moderate carpal tunnel syndrome, hamstring shortening, temporomandibular disorders, tension-type headache and chronic low back pain. Additional data are essential for better recommendations in the clinical practice of DF.
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Affiliation(s)
- María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - Sofía Monti-Ballano
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - Sergio Márquez-Gonzalvo
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - John Krauss
- School of Health Sciences, Oakland University, Rochester, MI 48309, USA;
| | - Héctor José Tricás-Vidal
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
| | - José Miguel Tricás-Moreno
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (H.J.T.-V.); (J.M.T.-M.)
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Schetzsle S, Lin WWC, Purushothaman P, Ding J, Kwan P, Tredget EE. Serial Casting as an Effective Method for Burn Scar Contracture Rehabilitation: A Case Series. J Burn Care Res 2023; 44:1062-1072. [PMID: 37254900 DOI: 10.1093/jbcr/irad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Indexed: 06/01/2023]
Abstract
Guidelines and protocols for orthoses in burn scar contracture rehabilitation are limited. The current study aims to determine the optimal frequency of casting, potentially facilitating the development of a serial casting protocol. Previous literature supporting casting has low generalizability due to methodology limitations. Seven patients with burn scar contracted joints, who did not respond to traditional therapy, were recruited in this study. Patients were serially casted once, three times, or five times a week. Joint range of motion was maximized with stretching and exercise techniques before every new cast application. Across all patients, active range of motion increased from 65.8 ± 27.8° to 108.1 ± 23.3° with casting; or from 57.8 ± 16.2% to 96.7 ± 2.9% of normal. Similarly, scars improved from 9.5 ± 1.5 to 4.9 ± 1.4 on the Modified Vancouver Scar Scale score. This therapeutic effect was achieved within an average of 8.5 ± 3.7 d and 4.0 ± 2.2 new cast applications. Given the study findings, the procedures outlined could be used to develop a standardized serial casting protocol for burn scar contracture rehabilitation.
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Affiliation(s)
- Stephanie Schetzsle
- Department of Surgery, Firefighters Burn Treatment Unit, University of Alberta Hospital, Edmonton, AB, CanadaT6G 2B7
| | - Weber Wei Chiang Lin
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Prabhu Purushothaman
- Department of Surgery, Firefighters Burn Treatment Unit, University of Alberta Hospital, Edmonton, AB, CanadaT6G 2B7
| | - Jie Ding
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Peter Kwan
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
| | - Edward E Tredget
- Wound Healing Research Group, Department of Surgery, University of Alberta, Division of Plastic and Reconstructive Surgery and Critical Care, Department of Surgery, University of Alberta, Edmonton, AB, CanadaT6G 2S2
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The Effect of Remote Myofascial Release on Chronic Nonspecific Low Back Pain With Hamstrings Tightness. J Sport Rehabil 2023:1-8. [PMID: 36928003 DOI: 10.1123/jsr.2022-0141] [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: 04/08/2022] [Revised: 12/03/2022] [Accepted: 01/17/2023] [Indexed: 03/18/2023]
Abstract
CONTEXT Anatomy trains theory states that performing techniques in any part of the superficial myofascial backline can remotely treat other parts of this pathway. Due to the connections of different parts of the superficial backline, it is possible to influence the hamstring by performing the technique in the lumbar area. As chronic nonspecific low back pain (LBP) may lead to or be caused by hamstring tightness, remote myofascial release (MFR) techniques using the superficial backline can help improve hamstring tightness. OBJECTIVE This study aimed to evaluate the effect of remote MFR on hamstring tightness for those with chronic nonspecific LBP. DESIGN Single-blind, parallel design. SETTING The present study was performed at the clinical setting of Tarbiat Modares University in Iran. METHODS This study included 40 participants (20 males and 20 females) who were 40.5 (5.3) years old with chronic nonspecific LBP and hamstring tightness. INTERVENTIONS Participants were randomly divided into the lumbar MFR (remote area) and hamstring MFR groups. Participants underwent 4 sessions of MFR for 2 weeks. MAIN OUTCOME MEASURES A passive knee-extension (PKE) test was used for muscle tightness evaluation 3 times. RESULTS Repeated-measure analysis of variance test showed that after the lumbar and hamstring MFR, the PKE was significantly reduced in both legs: lumbar MFR (right knee: from 61.04° [2.17°] to 51.01° [4.11°], P ≤ .003 and left knee: from 63.02° [3.12°] to 52.09° [2.48°], P ≤ .004) and hamstring MFR (right knee: from 62.01° [4.32°] to 50.50° [7.18°], P ≤ .001 and left knee: from 63.11° [2.56°] to 51.32° [5.31°], P ≤ .002). Least Significant Difference (LSD) post hoc test results showed that the 2 groups were not significantly different after the MFR (P ≥ .05). Also, the intraclass correlation coefficient index showed that the PKE test has excellent reliability (intraclass correlation coefficient, .910 for the right limb and .915 for the left limb). The minimal detectable change at the 95% confidence interval indicated that a change greater than or equal to 6° is required to exceed the threshold of the error PKE test, respectively. CONCLUSION The present study showed that the remote MFR technique to the lumbar region demonstrated the same significant results in decreasing hamstring tightness as was noted in hamstring MFR to both limbs in patients with chronic nonspecific LBP.
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Koller T, Meier P, Pasquale C, Rüegg C. [Physiotherapeutic Scar Therapy for Large Scars]. PRAXIS 2022; 111:927-938. [PMID: 36475363 DOI: 10.1024/1661-8157/a003951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Physiotherapeutic Scar Therapy for Large Scars Abstract. Deep dermal defects can result from burns, necrotizing fasciitis, and severe soft tissue trauma. Physiological scar restriction during wound healing becomes increasingly relevant in proportion to the area affected. It is massively restrictive for the general mobility of patients. External mechanical influences (activity or immobilization in everyday life) can cause pronounced scar strands and adhesions to form. Overloading ends in a renewed inflammatory reaction and thus in further restriction. Adequate mechanical stimuli can positively influence the scar tissue. The current state of research does not allow a direct transfer to the clinical treatment of large-area scars. However, the continuous clinical implementation of study results regarding the mechanosensitivity of isolated fibroblasts and the constant adaptation of manual techniques have resulted in an evidence-based foundation for manual scar therapy. Early manual treatment in combination with appropriate compression therapy is important.
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Affiliation(s)
- Thomas Koller
- Orthopädische und Handchirurgische Rehabilitation, Rehaklinik Bellikon, Bellikon, Schweiz
| | - Patrick Meier
- Orthopädische und Handchirurgische Rehabilitation, Rehaklinik Bellikon, Bellikon, Schweiz
| | - Caterina Pasquale
- Physiotherapie Ergotherapie, Universitätsspital Zürich, Zürich, Schweiz
| | - Christine Rüegg
- Orthopädische und Handchirurgische Rehabilitation, Rehaklinik Bellikon, Bellikon, Schweiz
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9
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Król M, Kupnicka P, Bosiacki M, Chlubek D. Mechanisms Underlying Anti-Inflammatory and Anti-Cancer Properties of Stretching-A Review. Int J Mol Sci 2022; 23:ijms231710127. [PMID: 36077525 PMCID: PMC9456560 DOI: 10.3390/ijms231710127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023] Open
Abstract
Stretching is one of the popular elements in physiotherapy and rehabilitation. When correctly guided, it can help minimize or slow down the disabling effects of chronic health conditions. Most likely, the benefits are associated with reducing inflammation; recent studies demonstrate that this effect from stretching is not just systemic but also local. In this review, we present the current body of knowledge on the anti-inflammatory properties of stretching at a molecular level. A total of 22 papers, focusing on anti-inflammatory and anti-cancer properties of stretching, have been selected and reviewed. We show the regulation of oxidative stress, the expression of pro- and anti-inflammatory genes and mediators, and remodeling of the extracellular matrix, expressed by changes in collagen and matrix metalloproteinases levels, in tissues subjected to stretching. We point out that a better understanding of the anti-inflammatory properties of stretching may result in increasing its importance in treatment and recovery from diseases such as osteoarthritis, systemic sclerosis, and cancer.
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Affiliation(s)
- Małgorzata Król
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Patrycja Kupnicka
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
- Correspondence:
| | - Mateusz Bosiacki
- Chair and Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University, Żołnierska 54, 71-210 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
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10
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Smoot BJ, Mastick J, Shepherd J, Paul SM, Kober KM, Cooper BA, Conley YP, Dixit N, Hammer MJ, Fu MR, Abrams G, Miaskowski C. Use of Dual-Energy X-Ray Absorptiometry to Assess Soft Tissue Composition in Breast Cancer Survivors With and Without Lymphedema. Lymphat Res Biol 2022; 20:391-397. [PMID: 34793255 PMCID: PMC9422781 DOI: 10.1089/lrb.2021.0030] [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] [Indexed: 11/12/2022] Open
Abstract
Background: In patients with lymphedema (LE), in addition to hand dominance, between-group comparisons of interlimb soft tissue differences need to account for differences in whole-body adiposity, measured directly by dual energy X-ray absorptiometry (DXA) or indirectly by body mass index. No study has evaluated the effects of hand dominance and whole-body adiposity on limb composition in patients with LE. This study's purpose was to compare soft tissue composition of affected and unaffected limbs of women with breast cancer, who did and did not have LE, controlling for dominance and percent body fat. Methods and Results: Whole-body DXA scans were acquired and included measures of percent body fat, upper limb total mass, upper limb fat mass, and upper limb fat-free mass. Participants were classified into one of three groups: women without LE; women with only subjective LE; and women with objective signs of LE at the time of assessment. Differences among the LE groups were evaluated using analysis of variance (ANOVA) and Chi-square analyses. Analysis of covariance (ANCOVA) was used to control for percent body fat and for the affected limb dominance. Compared to women without LE, women with objective signs of LE have greater total limb mass, fat mass, and fat-free mass in their affected limbs, independent of affected side dominance and percent body fat. In addition, the interlimb differences in total mass, fat mass, and fat-free mass were greater for the women with objective signs of LE, compared to the other two groups. Conclusions: DXA is useful in identifying soft tissue changes in patients with LE. Given that limb circumferences measure only changes in limb volume and that bioimpedance provides estimates of extracellular fluid, DXA has the advantage of being able to estimate the volumes of specific tissues in the limb.
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Affiliation(s)
- Betty J. Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - John Shepherd
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Steven M. Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M. Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A. Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Niharika Dixit
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Mei R. Fu
- School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Gary Abrams
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Medicine, University of California San Francisco, San Francisco, California, USA
- School of Nursing, University of California San Francisco, San Francisco, California, USA
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11
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Hu CF, Chen CPC, Tsui PH, Chen CN, Hsu CC. Stretch-Induced Healing of Injured Muscles Is Associated With Myogenesis and Decreased Fibrosis. Am J Sports Med 2022; 50:1679-1686. [PMID: 35315294 DOI: 10.1177/03635465221083995] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Alghouth therapeutic stretching exercise has been applied to accelerate the healing of injured skeletal muscles, mechanisms behind the mechanical stretch-induced muscle recovery remain unclear. PURPOSE To examine stretch-associated antifibrotic and myogenic responses in injured muscles and to evaluate the feasibility of the ultrasonic Nakagami parametric index (NPI) in assessing muscle morphology during recovery. STUDY DESIGN Controlled laboratory study. METHODS Skeletal muscle fibrosis was induced in the right hind legs of 48 rats by making a posterior transverse incision in the gastrocnemius muscle; the left hind legs remained intact as a comparative normal reference. After surgery, the 48 rats were randomly divided into the stretch (S) and control (C) groups. The S group received stretching interventions on the injured hind leg from week 3 to week 7 after surgery, while the C group did not receive stretching throughout the study period. The muscle fibrosis percentage and the ultrasonic NPI were examined sequentially after surgery. Relative expressions of myogenesis-related proteins, including myoblast determination protein 1 (MyoD), myogenin, and embryonic myosin heavy chain (MHCemb), were also evaluated during the follow-up. RESULTS Mean fibrosis percentages in the injured hind leg were approximately 25% at week 3 in both groups, but they were significantly decreased by approximately 20% from week 4 to the end of the follow-up in the S group only (all, P < .05). Upon injury, the NPI values of injured hind legs in both groups dramatically dropped. Within the S group, stretching increased the NPI values of injured hind legs, which approached those of control hind legs at weeks 6 and 7. The highest MyoD, myogenin, and MHCemb levels were observed at week 6 in both groups. The NPI values corresponded to the MyoD expression in the S group during the follow-up. CONCLUSION Stretching induced a decrease in muscle fibrosis and an increase in myogenesis in injured muscles. The NPI values correspond to the myogenesis process. CLINICAL RELEVANCE The NPI may be capable of continuously monitoring the injured skeletal muscle morphology during the healing process in clinical settings.
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Affiliation(s)
- Ching-Fang Hu
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Carl Pai-Chu Chen
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiao-Nan Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chin Hsu
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Pérez‐Llanes R, Donoso‐Úbeda E, Meroño‐Gallut J, Ucero‐Lozano R, Cuesta‐Barriuso R. Safety and efficacy of a self-induced myofascial release protocol using a foam roller in patients with haemophilic knee arthropathy. Haemophilia 2022; 28:326-333. [PMID: 35098608 PMCID: PMC9303237 DOI: 10.1111/hae.14498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Haemophilic knee arthropathy presents functional and structural alterations and chronic pain. Self-induced myofascial release aims to treat fascial restrictions and improve functionality. AIM This study investigated the safety and effectiveness of a self-induced myofascial release protocol in patients with haemophilic knee arthropathy. METHODS Twenty-five patients with bilateral haemophilic knee arthropathy were recruited (n = 50 knees). The patients followed an intervention protocol, with daily exercises for 8 weeks. The dependent variables were: safety of the technique (periodic telephone monitoring), joint state (Haemophilia Joint Health Score), pain intensity (visual analogue scale), pressure pain threshold (pressure dynamometer), range of motion (universal goniometer) and hamstring flexibility (Fingertip-To-Floor test). The resulting values were measured at baseline (T0) and after the intervention (T1). Paired t-test compared the means between the assessments. Effect size was obtained using Cohen's d mean difference formula. The minimum detectable change of each variable was calculated. RESULTS There were no cases of joint bleeding either during or after the procedure. The results showed improvements after the experimental period in joint state (Mean difference [MD]: 1.38; 95% confidence interval [95%CI]: .94;1.81), pain intensity (MD: 1.19; 95%CI: .70;1.67), pressure pain threshold (MD: -23.25; 95%CI: -26.25;-19.84), flexion (MD: -4.36; 95%CI: -5.70;-3.01), loss of extension (MD: 4.10; 95%CI: 3.01;5.18) and hamstring flexibility (MD: 3.54; 95%CI: 2.61;4.46). CONCLUSIONS Myofascial self-release using a foam roller is safe in patients with haemophilic knee arthropathy. A myofascial self-release protocol can improve perceived pain, range of motion and knee joint status, as well as hamstring flexibility in patients with haemophilic knee arthropathy.
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Affiliation(s)
- Raúl Pérez‐Llanes
- Department of Physical Therapy, Faculty of Health SciencesCatholic University of MurciaMurciaSpain
| | - Elena Donoso‐Úbeda
- Department of Physical Therapy, Faculty of Health SciencesCatholic University of MurciaMurciaSpain
| | | | | | - Rubén Cuesta‐Barriuso
- Department of Surgery and Medical‐Surgical Specialties, Faculty of MedicineUniversity of OviedoOviedoSpain
- Royal Victoria Eugenia FoundationMadridSpain
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Bruce J, Mazuquin B, Mistry P, Rees S, Canaway A, Hossain A, Williamson E, Padfield EJ, Lall R, Richmond H, Chowdhury L, Lait C, Petrou S, Booth K, Lamb SE, Vidya R, Thompson AM. Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT. Health Technol Assess 2022; 26:1-124. [PMID: 35220995 DOI: 10.3310/jknz2003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Upper limb problems are common after breast cancer treatment. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. DESIGN This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). SETTING Breast cancer centres, secondary care. PARTICIPANTS Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. INTERVENTIONS All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies). MAIN OUTCOME MEASURES The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded. RESULTS Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants' mean age was 58.1 years (standard deviation 12.1 years; range 28-88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of -7.81, 95% confidence interval -12.44 to -3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference -8.74, 95% confidence interval -13.71 to -3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (-£387, 95% CI -£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial. LIMITATIONS Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported. CONCLUSIONS This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life. FUTURE WORK Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems. TRIAL REGISTRATION This trial is registered as ISRCTN35358984. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Bruno Mazuquin
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Pankaj Mistry
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sophie Rees
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
| | - Esther Williamson
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Padfield
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Helen Richmond
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Loraine Chowdhury
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Clare Lait
- Gloucestershire Care Services NHS Trust, Gloucester, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katie Booth
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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França MED, Sinhorim L, Martins DF, Schleip R, Machado-Pereira NAMM, de Souza GM, Horewicz VV, Santos GM. Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Front Physiol 2020; 11:587373. [PMID: 33424619 PMCID: PMC7793886 DOI: 10.3389/fphys.2020.587373] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-β1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-β1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.
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Affiliation(s)
- Maria Elisa Duarte França
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Larissa Sinhorim
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil.,Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Daniel Fernandes Martins
- Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Robert Schleip
- Department of Sport and Health Sciences, Associate Professorship of Conservative and Rehabilitative Orthopedics, Technical University of Munich, Munich, Germany.,Department for Medical Professions, DIPLOMA Hochschule Bad Sooden-Allendorf, Bad Sooden-Allendorf, Germany
| | - Nicolas A M M Machado-Pereira
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Gabriel Melo de Souza
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Verônica Vargas Horewicz
- Neurosciences Experimental Laboratory (LANEX), Postgraduate Program in Health Sciences (PPGCS), University of Southern Santa Catarina, Palhoça, Brazil
| | - Gilmar Moraes Santos
- Posture and Balance Laboratory (LAPEQ), College of Health Sciences and Sports, Santa Catarina State University (UDESC), Florianópolis, Brazil
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15
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França MED, Sinhorim L, Martins DF, Schleip R, Machado-Pereira NAMM, de Souza GM, Horewicz VV, Santos GM. Manipulation of the Fascial System Applied During Acute Inflammation of the Connective Tissue of the Thoracolumbar Region Affects Transforming Growth Factor-β1 and Interleukin-4 Levels: Experimental Study in Mice. Front Physiol 2020. [DOI: 10.58737310.3389/fphys.2020.587373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fascia can become rigid and assume a fibrotic pattern due to inflammatory processes. Manipulation of the fascial system (MFS), manual technique targeting connective tissues, is commonly used in clinical practice in pain management. We aimed to verify MFS effects on the connective tissue inflammatory changes in mice. Swiss Mus musculus male mice (n = 44) were distributed into groups: carrageenan without treatment (Car, n = 11), carrageenan with MFS (Car + MFS, n = 12), saline without treatment (n = 10), and saline with MFS (saline + MFS, n = 11). Interleukin 4 (IL-4), IL-6, tumor necrosis factor (TNF), transforming growth factor β1 (TGF-β1), and monocyte chemoattractant protein 1 (MCP-1) levels were verified by enzyme-linked immunosorbent assay. Neutrophil (Ly-6G), macrophage (F4/80), and nitric oxide synthase 2 (NOS-2) were identified using Western blot. The MFS protocol was applied from the first to the third day after inflammation of the connective tissue of the thoracolumbar region. There was a significant MFS effect on IL-4 (p = 0.02) and TGF-β1 (p = 0.04), without increasing MCP-1, TNF, and IL-6 levels (p > 0.05) on thoracolumbar region from Car + MFS, in comparison with saline. Ly-6G in Car + MFS presented lower levels when compared with saline (p = 0.003) or saline + MFS (0.003). NOS-2 levels were lower in Car + MFS than in saline + MFS (p = 0.0195) or saline (p = 0.003). MFS may have an anti-inflammatory effect, based on TGF-β1 and IL-4. IL-4 may have inhibited neutrophil migration. Lower levels of NOS-2 may be linked to the lack of macrophages, which are responsible for NOS-2 expression.
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16
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Fibrosis following Acute Skeletal Muscle Injury: Mitigation and Reversal Potential in the Clinic. JOURNAL OF SPORTS MEDICINE 2020; 2020:7059057. [PMID: 33376749 PMCID: PMC7745048 DOI: 10.1155/2020/7059057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022]
Abstract
Skeletal muscle injuries occur often in athletics and in daily life. In minor injuries, muscles are able to regenerate completely and recover their functional capabilities. However, in the case of severe injuries, the injured muscle cannot recover to a functional level because of the formation of fibrous scar tissue. The physical barrier of scars is significantly challenged in both research and clinical treatment. Fibrous scar tissue not only limits cells' migration, but also contributes to normal tissue biomechanical properties. This scar formation creates an unsuitable environment for tissue structure resulting in frequent pain. Antifibrosis treatment is one of the major strategies used to augment muscle regeneration and accelerate its functional recovery. This review will discuss the currently available methods for improving muscle regeneration with a specific focus on antifibrosis applications. We also discussed several novel hypotheses and clinical applications in muscle fibrosis treatment currently in practice.
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Establishment of a Novel Porcine Model to Study the Impact of Active Stretching on a Local Carrageenan-Induced Inflammation. Am J Phys Med Rehabil 2020; 99:1012-1019. [PMID: 32427602 DOI: 10.1097/phm.0000000000001465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Active stretching of the body is integral to complementary mind-body therapies such as yoga, as well as physical therapy, yet the biologic mechanisms underlying its therapeutic effects remain largely unknown. A previous study showed the impact of active stretching on inflammatory processes in rats. The present study tested the feasibility of using a porcine model, with a closer resemblance to human anatomy, to study the effects of active stretching in the resolution of localized inflammation. DESIGN A total of 12 pigs were trained to stretch before subcutaneous bilateral Carrageenan injection in the back at the L3 vertebrae, 2 cm from the midline. Animals were randomized to no-stretch or stretch, twice a day for 5 mins over 48 hrs. Animals were euthanized for tissue collection 48 hrs postinjection. RESULTS The procedure was well tolerated by the pigs. On average, lesion area was significantly smaller by 36% in the stretch group compared with the no-stretch group (P = 0.03). CONCLUSION This porcine model shows promise for studying the impact of active stretching on inflammation-resolution mechanisms. These results are relevant to understanding the stretching-related therapeutic mechanisms of mind-body therapies. Future studies with larger samples are warranted.
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Mechanosensitive Aspects of Cell Biology in Manual Scar Therapy for Deep Dermal Defects. Int J Mol Sci 2020; 21:ijms21062055. [PMID: 32192136 PMCID: PMC7139679 DOI: 10.3390/ijms21062055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 01/06/2023] Open
Abstract
Deep dermal defects can result from burns, necrotizing fasciitis and severe soft tissue trauma. Physiological scar restriction during wound healing becomes increasingly relevant in proportion to the affected area. This massively restricts the general mobility of patients. External mechanical influences (activity or immobilization in everyday life) can lead to the formation of marked scar strands and adhesions. Overloading results in a renewed inflammatory reaction and thus in further restriction. Appropriate mechanical stimuli can have a positive influence on the scar tissue. “Use determines function,” and even minimal external forces are sufficient to cause functional alignment (mechanotransduction). The first and second remarkable increases in connective tissue resistance (R1 and R2) seem to be relevant clinical indications of adequate dosage in the proliferation and remodulation phase, making it possible to counteract potential overdosage in deep dermal defects. The current state of research does not allow a direct transfer to the clinical treatment of large scars. However, the continuous clinical implementation of study results with regard to the mechanosensitivity of isolated fibroblasts, and the constant adaptation of manual techniques, has nevertheless created an evidence-base for manual scar therapy. The manual dosages are adapted to tissue physiology and to respective wound healing phases. Clinical observations show improved mobility of the affected regions and fewer relapses into the inflammatory phase due to mechanical overload.
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19
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Skaria AM. Incision Lines on the Female Breast. Dermatology 2020; 236:248-250. [PMID: 31982871 DOI: 10.1159/000505541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/19/2019] [Indexed: 01/22/2023] Open
Affiliation(s)
- Andreas M Skaria
- Centre de Dermatochirurgie, University of Bern, Vevey, Switzerland,
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20
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Skaria AM. Incision Lines: Active Movement as a Major Biodynamic Factor of Scarring. Dermatology 2020; 237:70-72. [PMID: 31972559 DOI: 10.1159/000505540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Andreas M Skaria
- Centre de Dermatochirurgie, University of Bern, Vevey, Switzerland,
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21
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Paley CA, Johnson MI. Investigation into the Effects of Using Two Or Four Acupuncture Needles with Bidirectional Rotation on Experimentally-Induced Contact Heat Pain in Healthy Subjects. Acupunct Med 2018; 33:23-9. [DOI: 10.1136/acupmed-2014-010617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives There is growing evidence from experimental studies that the acupuncture dose or technique influences the speed of onset of hypoalgesia. The aim of this study was to investigate the effects of acupuncture using two or four needles on experimental contact thermal pain in healthy volunteers. Methods Forty two participants were randomised into three groups: four-needle group (LI4, LI11, LI10, TE5), two-needle group (verum at LI4, LI11 and mock at LI10, TE5) and mock acupuncture group (LI4, LI11, LI10, TE5). Each participant rated pain intensity (visual analogue scale, VAS) to a series of noxious stimuli administered to the forearm 2°C above the heat pain threshold during needling and immediately after removal of the needles. Results Experimentally-induced heat pain intensity (VAS) during and after the intervention was lower than pre-intervention but there were no statistically significant differences in this change between groups. There were no statistically significant differences between groups in the time taken for pain intensity to decrease by 33% from pre-intervention. However, a 33% decrease in pain intensity within 3 min of needle insertion was observed for 13 participants (92.9%) in the four-needle group compared with 66.7% of participants in the two-needle group and 57.1% in the mock acupuncture group. There was less variance in VAS in the four-needle group, suggesting more consistency in hypoalgesic response when using more needles. Conclusions There is tentative evidence that four needles may be superior to two needles in generating rapid onset hypoalgesia. The findings suggest that further investigation is warranted.
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Affiliation(s)
- Carole A Paley
- Research & Development, Research Office, Airedale NHS Foundation Trust, Keighley, UK
- Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, UK
- Leeds Pallium Research Group, Leeds, UK
| | - Mark I Johnson
- Faculty of Health and Social Sciences, Leeds Metropolitan University, Leeds, UK
- Leeds Pallium Research Group, Leeds, UK
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Altomare M, Monte-Alto-Costa A. Manual Mobilization of Subcutaneous Fibrosis in Mice. J Manipulative Physiol Ther 2018; 41:359-362. [PMID: 29933891 DOI: 10.1016/j.jmpt.2017.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 10/23/2017] [Accepted: 10/27/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to induce the remodeling of subcutaneous fibrosis in mice by the manual mobilization of skin and subcutaneous tissue. METHODS Seven days after the induction of subcutaneous fibrosis, mice were divided into 3 groups: control, stretch, and manual mobilization. Stretch was achieved by elongating the trunk, and manual mobilization was achieved by using the indicator fingertip of both hands, side by side, touching the back and performing a brief stretch. Stretch or manual mobilization was performed once a day for 7 days. RESULTS Fibrosis was present in the subcutaneous tissue of control animals, whereas brief stretch and manual mobilization were found to reduce fibrosis. CONCLUSIONS Mechanical stimulation through manual mobilization, or brief stretching, reduced subcutaneous fibrosis after tissue injury.
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Affiliation(s)
- Mariane Altomare
- Tissue Repair Laboratory, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Richmond H, Lait C, Srikesavan C, Williamson E, Moser J, Newman M, Betteley L, Fordham B, Rees S, Lamb SE, Bruce J. Development of an exercise intervention for the prevention of musculoskeletal shoulder problems after breast cancer treatment: the prevention of shoulder problems trial (UK PROSPER). BMC Health Serv Res 2018; 18:463. [PMID: 29914494 PMCID: PMC6006920 DOI: 10.1186/s12913-018-3280-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background Musculoskeletal shoulder problems are common after breast cancer treatment. There is some evidence to suggest that early postoperative exercise is safe and may improve shoulder function. We describe the development and delivery of a complex intervention for evaluation within a randomised controlled trial (RCT), designed to target prevention of musculoskeletal shoulder problems after breast cancer surgery (The Prevention of Shoulder Problems Trial; PROSPER). Methods A pragmatic, multicentre RCT to compare the clinical and cost-effectiveness of best practice usual care versus a physiotherapy-led exercise and behavioural support intervention in women at high risk of shoulder problems after breast cancer treatment. PROSPER will recruit 350 women from approximately 15 UK centres, with follow-up at 6 and 12 months. The primary outcome is shoulder function at 12 months; secondary outcomes include postoperative pain, health related quality of life, adverse events and healthcare resource use. A multi-phased approach was used to develop the PROSPER intervention which was underpinned by existing evidence and modified for implementation after input from clinical experts and women with breast cancer. The intervention was tested and refined further after qualitative interviews with patients newly diagnosed with breast cancer; a pilot RCT was then conducted at three UK clinical centres. Discussion The PROSPER intervention incorporates three main components: shoulder-specific exercises targeting range of movement and strength; general physical activity; and behavioural strategies to encourage adherence and support exercise behaviour. The final PROSPER intervention is fully manualised with clear, documented pathways for clinical assessment, exercise prescription, use of behavioural strategies, and with guidance for treatment of postoperative complications. This paper adheres to TIDieR and CERT recommendations for the transparent, comprehensive and explicit reporting of complex interventions. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN 35358984.
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Affiliation(s)
- Helen Richmond
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Clare Lait
- Gloucestershire Care Services NHS Trust, 1010 Gloucester Business Park, Pioneer Avenue, Brockworth, Gloucester, GL, 3 4AW, UK
| | - Cynthia Srikesavan
- Botnar Research Centre, Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Esther Williamson
- Botnar Research Centre, Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Jane Moser
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7HE, UK
| | - Meredith Newman
- Botnar Research Centre, Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.,Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7HE, UK
| | - Lauren Betteley
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Beth Fordham
- Botnar Research Centre, Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Sophie Rees
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Sarah E Lamb
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK.,Botnar Research Centre, Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK.
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Peviani SM, Guzzoni V, Pinheiro-Dardis CM, Silva YPD, Fioravante ACR, Sagawa AH, Delfino GB, Durigan JLQ, Salvini TF. Regulation of extracellular matrix elements and sarcomerogenesis in response to different periods of passive stretching in the soleus muscle of rats. Sci Rep 2018; 8:9010. [PMID: 29899346 PMCID: PMC5998085 DOI: 10.1038/s41598-018-27239-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/21/2018] [Indexed: 01/02/2023] Open
Abstract
Stretching is a common method used to prevent muscle shortening and improve limited mobility. However, the effect of different time periods on stretching-induced adaptation of the extracellular matrix and its regulatory elements have yet to be investigated. We aimed to evaluate the expression of fibrillar collagens, sarcomerogenesis, metalloproteinase (MMP) activity and gene expression of the extracellular matrix (ECM) regulators in the soleus (SOL) muscle of rats submitted to different stretching periods. The soleus muscles were submitted to 10 sets of passive stretching over 10 (St 10d) or 15 days (St 15d) (1 min per set, with 30 seconds' rest between sets). Sarcomerogenesis, muscle cross-sectional area (CSA), and MMP activity and mRNA levels in collagen (type I, III and IV), connective tissue growth factor (CTGF), growth factor-beta (TGF-β), and lysyl oxidase (LOX) were analyzed. Passive stretching over both time periods mitigated COL-I deposition in the SOL muscle of rats. Paradoxically, 10 days of passive stretching induced COL-I and COL-III synthesis, with concomitant upregulation of TGF-β1 and CTGF at a transcriptional level. These responses may be associated with lower LOX mRNA levels in SOL muscles submitted to 10 passive stretching sessions. Moreover, sarcomerogenesis was observed after 15 days of stretching, suggesting that stretching-induced muscle adaptations are time-dependent responses.
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Affiliation(s)
- Sabrina M Peviani
- Department of Physical Therapy, São Carlos Federal University, São Carlos, São Paulo State, Brazil.
| | - Vinicius Guzzoni
- Postdoctoral Fellowship, University of Brasília, Brasília, Federal District, Brazil
| | - Clara M Pinheiro-Dardis
- Department of Physical Therapy, São Carlos Federal University, São Carlos, São Paulo State, Brazil
| | - Yara P da Silva
- Department of Physical Therapy, São Carlos Federal University, São Carlos, São Paulo State, Brazil
| | - Alisson C R Fioravante
- Department of Physical Therapy, São Carlos Federal University, São Carlos, São Paulo State, Brazil
| | - Adriana H Sagawa
- Department of Physical Therapy, São Carlos Federal University, São Carlos, São Paulo State, Brazil
| | - Gabriel B Delfino
- Department of Physical Therapy, São Carlos Federal University, São Carlos, São Paulo State, Brazil
| | - João L Q Durigan
- Graduate Program in Rehabilitation Sciences, University of Brasilia, Brasília, Federal District, Brazil
| | - Tania F Salvini
- Department of Physical Therapy, São Carlos Federal University, São Carlos, São Paulo State, Brazil
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25
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Stretching Reduces Tumor Growth in a Mouse Breast Cancer Model. Sci Rep 2018; 8:7864. [PMID: 29777149 PMCID: PMC5959865 DOI: 10.1038/s41598-018-26198-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022] Open
Abstract
There is growing interest in developing non-pharmacological treatments that could boost natural defenses against cancer and contribute to primary and secondary cancer prevention. Recent studies have shown that gentle daily stretching for 10 minutes can reduce local connective tissue inflammation and fibrosis. Because mechanical factors within the stroma can influence the tumor microenvironment, we hypothesized that stretching would reduce the growth of tumors implanted within locally stretched tissues and tested this hypothesis in a mouse orthotopic breast cancer model. Female FVB mice (N = 66) underwent bilateral injection of p53/PTEN double-null primary mouse mammary tumor cells into the third mammary fat pad. Mice were randomized to stretch vs. no stretch, and treated for 10 minutes once a day, for four weeks. Tumor volume at end-point was 52% smaller in the stretch group, compared to the no-stretch group (p < 0.001) in the absence of any other treatment. Cytotoxic immune responses were activated and levels of Specialized Pro-Resolving Mediators were elevated in the stretch group. These results suggest a link between immune exhaustion, inflammation resolution and tumor growth. Stretching is a gentle, non-pharmacological intervention that could become an important component of cancer treatment and prevention.
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Langevin HM, Bishop J, Maple R, Badger GJ, Fox JR. Effect of Stretching on Thoracolumbar Fascia Injury and Movement Restriction in a Porcine Model. Am J Phys Med Rehabil 2018; 97:187-191. [PMID: 28901961 PMCID: PMC7411307 DOI: 10.1097/phm.0000000000000824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stretching of fascia is an important component of manual and movement therapies. We previously showed that in pigs, a unilateral thoracolumbar fascia injury combined with movement restriction (hobble) produced contralateral loss of fascia mobility (shear strain during passive trunk flexion measured with ultrasound) similar to findings in human subjects with chronic low back pain. We now tested whether such abnormalities could be reversed by removing the hobble with or without daily stretching for 1 mo. DESIGN Thirty pigs were randomized to control, injury, or injury + hobble for 8 wks. The hobble restricted hip extension ipsilateral to the injury. At week 8, the injury + hobble group was subdivided into continued hobble, removed hobble, and removed hobble + stretching (passively extending the hip for 10 min daily). RESULTS Removing hobbles restored normal gait speed but did not restore fascia mobility. Daily passive stretching was not superior to removing hobbles, as there was no significant improvement in fascia mobility with either treatment group (removed hobble or stretching). CONCLUSIONS Reduced fascia mobility in response to injury and movement restriction worsens over time and persists even when movement is restored. Reversing fascia abnormalities may require either longer than 1 mo or a different treatment "dose" or modality.
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Affiliation(s)
- Helene M Langevin
- From the Department of Neurological Sciences, University of Vermont, Burlington, Vermont (HML, JB, RM, JRF); Department of Medical Biostatistics, University of Vermont, Burlington, Vermont (GJB); and Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (HML)
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Chen J, Li Y, Wang B, Yang J, Heng BC, Yang Z, Ge Z, Lin J. TGF-β1 affinity peptides incorporated within a chitosan sponge scaffold can significantly enhance cartilage regeneration. J Mater Chem B 2018; 6:675-687. [DOI: 10.1039/c7tb02132a] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Scaffold incorporated with affinity peptides can efficiently promote cartilage regeneration without exogenous addition of growth factors and cells.
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Affiliation(s)
- Jiaqing Chen
- Department of Biomedical Engineering
- College of Engineering
- Peking University
- Beijing
- P. R. China
| | - Yijiang Li
- Department of Biomedical Engineering
- College of Engineering
- Peking University
- Beijing
- P. R. China
| | - Bin Wang
- Arthritis Clinic and Research Center
- Peking University People's Hospital
- Beijing
- P. R. China
| | - Jiabei Yang
- Department of Biomedical Engineering
- College of Engineering
- Peking University
- Beijing
- P. R. China
| | - Boon Chin Heng
- Faculty of Dentistry
- Department of Endodontology
- The University of Hong Kong
- Pokfulam
- P. R. China
| | - Zheng Yang
- Tissue Engineering Program
- Life Sciences Institute
- National University of Singapore
- Singapore 117510
- Singapore
| | - Zigang Ge
- Department of Biomedical Engineering
- College of Engineering
- Peking University
- Beijing
- P. R. China
| | - Jianhao Lin
- Arthritis Clinic and Research Center
- Peking University People's Hospital
- Beijing
- P. R. China
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Biological effects of direct and indirect manipulation of the fascial system. Narrative review. J Bodyw Mov Ther 2017; 21:435-445. [DOI: 10.1016/j.jbmt.2017.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/16/2016] [Accepted: 01/03/2017] [Indexed: 01/08/2023]
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Xiong Y, Berrueta L, Urso K, Olenich S, Muskaj I, Badger GJ, Aliprantis A, Lafyatis R, Langevin HM. Stretching Reduces Skin Thickness and Improves Subcutaneous Tissue Mobility in a Murine Model of Systemic Sclerosis. Front Immunol 2017; 8:124. [PMID: 28261202 PMCID: PMC5311037 DOI: 10.3389/fimmu.2017.00124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/25/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Although physical therapy can help preserve mobility in patients with systemic sclerosis (SSc), stretching has not been used systematically as a treatment to prevent or reverse the disease process. We previously showed in rodent models that stretching promotes the resolution of connective tissue inflammation and reduces new collagen formation after injury. Here, we tested the hypothesis that stretching would impact scleroderma development using a mouse sclerodermatous graft-versus-host disease (sclGvHD) model. Methods The model consists in the adoptive transfer (allogeneic) of splenocytes from B10.D2 mice (graft) into Rag2−/− BALB/c hosts (sclGvHD), resulting in skin inflammation followed by fibrosis over 4 weeks. SclGvHD mice and controls were randomized to stretching in vivo for 10 min daily versus no stretching. Results Weekly ultrasound measurements of skin thickness and subcutaneous tissue mobility in the back (relative tissue displacement during passive trunk motion) successfully captured the different phases of the sclGvHD model. Stretching reduced skin thickness and increased subcutaneous tissue mobility compared to no stretching at week 3. Stretching also reduced the expression of CCL2 and ADAM8 in the skin at week 4, which are two genes known to be upregulated in both murine sclGvHD and the inflammatory subset of human SSc. However, there was no evidence that stretching attenuated inflammation at week 2. Conclusion Daily stretching for 10 min can improve skin thickness and mobility in the absence of any other treatment in the sclGvHD murine model. These pre-clinical results suggest that a systematic investigation of stretching as a therapeutic modality is warranted in patients with SSc.
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Affiliation(s)
- Ying Xiong
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Lisbeth Berrueta
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Katia Urso
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Sara Olenich
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Igla Muskaj
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont , Burlington, VT , USA
| | - Antonios Aliprantis
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Robert Lafyatis
- University of Pittsburgh, School of Medicine , Pittsburgh, PA , USA
| | - Helene M Langevin
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
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30
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Zhang YT, Li-Tsang CW, Au RK. A Systematic Review on the Effect of Mechanical Stretch on Hypertrophic Scars after Burn Injuries. Hong Kong J Occup Ther 2017; 29:1-9. [PMID: 30186067 PMCID: PMC6092002 DOI: 10.1016/j.hkjot.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 02/05/2023] Open
Abstract
Objective/Background To review the effect of mechanical stretch on hypertrophic scars after burn
injuries. Methods A systematic review of all controlled trials related to the effect of
mechanical stretch on post burn hypertrophic scars was conducted. Studies of
conservative scar managements that applied mechanical forces parallel to the
scar surface, including stretching exercise, massage, and splinting, were
appraised. Eligible studies published in English between 1995 and 2016 were
extracted from The Cochrane Library, MEDLINE, CINAHL, Science direct,
SPORTDiscus, and Physiotherapy Evidence Database Scale (PEDro). The journals
were further screened with inclusion and exclusion criteria. PEDro was
selected for further analysis and appraisal. Results There were 853 articles identified. After a standardized screening mechanism
stipulated, only nine full-text articles were selected for critical
appraisal using PEDro. There were five articles of high quality, two of fair
quality, and two of poor quality. Detailed training regime and outcomes of
nine studies were summarised, including two studies with stretching
exercise, six studies with massage, and one study with splinting. The
physical parameters of scar assessments and the range of motion on affected
areas were compared. Conclusion From extensive literature search, there was no strong evidence indicating the
positive effect of mechanical stretch using stretching exercise, massage, or
splinting on hypertrophic scars. A firm conclusion cannot be drawn for the
discrepancy of outcome measures and varied effectiveness. Most of the
included studies lacked objective evaluation or control group for
comparison. Further high quality studies with larger sample size and using
standardized measurements are needed.
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Affiliation(s)
- Yu-ting Zhang
- Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Rehabilitation
Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Cecilia W.P. Li-Tsang
- Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of
Rehabilitation Sciences, The Hong Kong Polytechnic University, Room QT509, 5/F,
Block QT, Hung Horn, Kowloon, Hong Kong, China. E-mail address:
| | - Ricky K.C. Au
- Department of Rehabilitation
Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Effect of myofascial induction therapy on post-c-section scars, more than one and a half years old. Pilot study. J Bodyw Mov Ther 2017; 21:197-204. [DOI: 10.1016/j.jbmt.2016.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/10/2016] [Accepted: 07/07/2016] [Indexed: 11/17/2022]
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Langevin HM, Keely P, Mao J, Hodge LM, Schleip R, Deng G, Hinz B, Swartz MA, de Valois BA, Zick S, Findley T. Connecting (T)issues: How Research in Fascia Biology Can Impact Integrative Oncology. Cancer Res 2016; 76:6159-6162. [DOI: 10.1158/0008-5472.can-16-0753] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/20/2016] [Indexed: 11/16/2022]
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Moortgat P, Anthonissen M, Meirte J, Van Daele U, Maertens K. The physical and physiological effects of vacuum massage on the different skin layers: a current status of the literature. BURNS & TRAUMA 2016; 4:34. [PMID: 27660766 PMCID: PMC5027633 DOI: 10.1186/s41038-016-0053-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/23/2016] [Indexed: 11/10/2022]
Abstract
Vacuum massage is a non-invasive mechanical massage technique performed with a mechanical device that lifts the skin by means of suction, creates a skin fold and mobilises that skin fold. In the late 1970s, this therapy was introduced to treat traumatic or burn scars. Although vacuum massage was invented to treat burns and scars, one can find very little literature on the effects of this intervention. Therefore, the aim of this review is to present an overview of the available literature on the physical and physiological effects of vacuum massage on epidermal and dermal skin structures in order to find the underlying working mechanisms that could benefit the healing of burns and scars. The discussion contains translational analysis of the results and provides recommendations for future research on the topic. An extended search for publications was performed using PubMed, Web of Science and Google Scholar. Two authors independently identified and checked each study against the inclusion criteria. Nineteen articles were included in the qualitative synthesis. The two most reported physical effects of vacuum massage were improvement of the tissue hardness and the elasticity of the skin. Besides physical effects, a variety of physiological effects are reported in literature, for example, an increased number of fibroblasts and collagen fibres accompanied by an alteration of fibroblast phenotype and collagen orientation. Little information was found on the decrease of pain and itch due to vacuum massage. Although vacuum massage initially had been developed for the treatment of burn scars, this literature review found little evidence for the efficacy of this treatment. Variations in duration, amplitude or frequency of the treatment have a substantial influence on collagen restructuring and reorientation, thus implying possible beneficial influences on the healing potential by mechanotransduction pathways. Vacuum massage may release the mechanical tension associated with scar retraction and thus induce apoptosis of myofibroblasts. Suggestions for future research include upscaling the study design, investigating the molecular pathways and dose dependency, comparing effects in different stages of repair, including evolutive parameters and the use of more objective assessment tools.
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Affiliation(s)
- Peter Moortgat
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, B-2170 Antwerp, Belgium
| | - Mieke Anthonissen
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, B-2170 Antwerp, Belgium ; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, box 1500, 3001 Heverlee, Belgium
| | - Jill Meirte
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, B-2170 Antwerp, Belgium ; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Ulrike Van Daele
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Koen Maertens
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, B-2170 Antwerp, Belgium ; Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
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Bove GM, Harris MY, Zhao H, Barbe MF. Manual therapy as an effective treatment for fibrosis in a rat model of upper extremity overuse injury. J Neurol Sci 2016; 361:168-80. [PMID: 26810536 PMCID: PMC4729290 DOI: 10.1016/j.jns.2015.12.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 01/08/2023]
Abstract
Key clinical features of carpal tunnel syndrome and other types of cumulative trauma disorders of the hand and wrist include pain and functional disabilities. Mechanistic details remain under investigation but may involve tissue inflammation and/or fibrosis. We examined the effectiveness of modeled manual therapy (MMT) as a treatment for sensorimotor behavior declines and increased fibrogenic processes occurring in forearm tissues of rats performing a high repetition high force (HRHF) reaching and grasping task for 12 weeks. Young adult, female rats were examined: food restricted control rats (FRC, n=12); rats that were trained for 6 weeks before performing the HRHF task for 12 weeks with no treatment (HRHF-CON, n=11); and HRHF task rats received modeled manual therapy (HRHF-MMT, n=5) for 5 days/week for the duration of the 12-week of task. Rats receiving the MMT expressed fewer discomfort-related behaviors, and performed progressively better in the HRHF task. Grip strength, while decreased after training, improved following MMT. Fibrotic nerve and connective tissue changes (increased collagen and TGF-β1 deposition) present in 12-week HRHF-CON rats were significantly decreased in 12-week HRHF-MMT rats. These observations support the investigation of manual therapy as a preventative for repetitive motion disorders.
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Affiliation(s)
- Geoffrey M Bove
- Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME 04005, USA
| | - Michele Y Harris
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Huaqing Zhao
- Department of Clinical Sciences and Biostatistical Consulting Center, Temple University School of Medicine, Philadelphia, PA, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA.
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Zotz TG, Capriglione LGA, Zotz R, Noronha L, Viola De Azevedo ML, Fiuza Martins HR, Silveira Gomes AR. Acute effects of stretching exercise on the soleus muscle of female aged rats. Acta Histochem 2016; 118:1-9. [PMID: 26651952 DOI: 10.1016/j.acthis.2015.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 12/25/2022]
Abstract
UNLABELLED It has been shown that stretching exercises can improve the flexibility and independence of the elderly. However, although these exercises commonly constitute training programs, the morphological adaptations induced by stretching exercises in aged skeletal muscle are still unclear. OBJECTIVE To assess the acute effects of passive mechanical static stretching on the morphology, sarcomerogenesis and modulation of important components of the extracellular matrix of the soleus muscle of aged female rats. METHODS Fifteen old female rats with 26 months were divided into two groups: stretching (n=8, SG) and control (n=7, CG): The stretching protocol consisted of 4 repetitions each of 1 min with 30s interval between sets. Stretching was performed on the left soleus muscle, 3 times a week for 1 week. After three sessions, the rats were anesthetized to remove the left soleus muscle, and then euthanized. The following analyses were carried out: muscle fiber cross-sectional area and serial sarcomere number; immunohistochemistry for the quantification of collagen I, III and TGFβ-1. RESULTS a decrease in muscle fiber cross-sectional area of the SG was observed when compared to the CG (p=0.0001, Kruskal-Wallis); the percentage of type I collagen was significantly lower in the SG when compared to the CG (p=0.01, Kruskal-Wallis), as well as the percentage of TGFβ-1 (p=0.04, Kruskal-Wallis); collagen III was significantly higher in the SG than in the CG (7.06±6.88% vs 4.92±5.30%, p=0.01, Kruskal-Wallis). CONCLUSION Although the acute stretching induced muscle hypotrophy, an antifibrotic action was detected.
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Berrueta L, Muskaj I, Olenich S, Butler T, Badger GJ, Colas RA, Spite M, Serhan CN, Langevin HM. Stretching Impacts Inflammation Resolution in Connective Tissue. J Cell Physiol 2015; 231:1621-7. [PMID: 26588184 DOI: 10.1002/jcp.25263] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 12/12/2022]
Abstract
Acute inflammation is accompanied from its outset by the release of specialized pro-resolving mediators (SPMs), including resolvins, that orchestrate the resolution of local inflammation. We showed earlier that, in rats with subcutaneous inflammation of the back induced by carrageenan, stretching for 10 min twice daily reduced inflammation and improved pain, 2 weeks after carrageenan injection. In this study, we hypothesized that stretching of connective tissue activates local pro-resolving mechanisms within the tissue in the acute phase of inflammation. In rats injected with carrageenan and randomized to stretch versus no stretch for 48 h, stretching reduced inflammatory lesion thickness and neutrophil count, and increased resolvin (RvD1) concentrations within lesions. Furthermore, subcutaneous resolvin injection mimicked the effect of stretching. In ex vivo experiments, stretching of connective tissue reduced the migration of neutrophils and increased tissue RvD1 concentration. These results demonstrate a direct mechanical impact of stretching on inflammation-regulation mechanisms within connective tissue.
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Affiliation(s)
- Lisbeth Berrueta
- Department of Medicine, Division of Preventive Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Igla Muskaj
- Department of Medicine, Division of Preventive Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara Olenich
- Department of Medicine, Division of Preventive Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Taylor Butler
- Department of Medicine, Division of Preventive Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Romain A Colas
- Department of Anesthesiology, Center for Experimental Therapeutics and Reperfusion Injury, Perioperative and Pain Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Matthew Spite
- Department of Anesthesiology, Center for Experimental Therapeutics and Reperfusion Injury, Perioperative and Pain Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles N Serhan
- Department of Anesthesiology, Center for Experimental Therapeutics and Reperfusion Injury, Perioperative and Pain Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Helene M Langevin
- Department of Medicine, Division of Preventive Medicine, Harvard Institutes of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurological Sciences, University of Vermont College of Medicine, Vermont
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Faturi FM, Franco RC, Gigo-Benato D, Turi AC, Silva-Couto MA, Messa SP, Russo TL. Intermittent stretching induces fibrosis in denervated rat muscle. Muscle Nerve 2015; 53:118-26. [PMID: 25960249 DOI: 10.1002/mus.24702] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/28/2015] [Accepted: 05/04/2015] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Stretching (St) has been used for treating denervated muscles. However, its effectiveness and safety claims require further study. METHODS Rats were divided into: (1) those with denervated (D) muscles, evaluated 7 or 15 days after sciatic nerve crush injury; (2) those with D muscles submitted to St during 7 or 15 days; and (3) those with normal muscles. Muscle fiber cross-sectional area, serial sarcomere number, sarcomere length, and connective tissue density were measured. MMP-2, MMP-9, TIMP-1, TGF-β1, and myostatin mRNAs were determined by real-time polymerase chain reaction. MMP-2 and MMP-9 activity was evaluated by zymography. Collagen I was localized using immunofluorescence. RESULTS St did not prevent muscle atrophy due to denervation, but it increased fibrosis and collagen I deposition at day 15. St also upregulated MMP-9 and TGF-β1 gene expressions at day 7, and myostatin at day 15. CONCLUSIONS Stretching denervated muscle does not prevent atrophy, but it increases fibrosis via temporal modulation of TGF-β1/myostatin and MMP-9 cascades.
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Affiliation(s)
- Fernanda M Faturi
- Research Laboratory of Neurological Physiotherapy, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Rúbia C Franco
- Research Laboratory of Neurological Physiotherapy, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Davilene Gigo-Benato
- Research Laboratory of Neurological Physiotherapy, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Andriette C Turi
- Research Laboratory of Neurological Physiotherapy, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Marcela A Silva-Couto
- Research Laboratory of Neurological Physiotherapy, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Sabrina P Messa
- Laboratory of Muscle Plasticity, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Thiago L Russo
- Research Laboratory of Neurological Physiotherapy, Department of Physiotherapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
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Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction - Underlying mechanisms and treatment - Part II. J Bodyw Mov Ther 2015; 19:526-43. [PMID: 26118526 DOI: 10.1016/j.jbmt.2015.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 02/07/2023]
Abstract
This paper offers an extensive review of the main fascia-mediated mechanisms underlying various therapeutic processes of clinical relevance for manual therapy. The concept of somatic dysfunction is revisited in light of the several fascial influences that may come into play during and after manual treatment. A change in perspective is thus proposed: from a nociceptive model that for decades has viewed somatic dysfunction as a neurologically-mediated phenomenon, to a unifying neuro-fascial model that integrates neural influences into a multifactorial and multidimensional interpretation of manual therapeutic effects as being partially, if not entirely, mediated by the fascia. By taking into consideration a wide spectrum of fascia-related factors - from cell-based mechanisms to cognitive and behavioural influences - a model emerges suggesting, amongst other results, a multidisciplinary-approach to the intervention of somatic dysfunction. Finally, it is proposed that a sixth osteopathic 'meta-model' - the connective tissue-fascial model - be added to the existing five models in osteopathic philosophy as the main interface between all body systems, thus providing a structural and functional framework for the body's homoeostatic potential and its inherent abilities to heal.
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Affiliation(s)
- Paolo Tozzi
- School of Osteopathy C.R.O.M.O.N., Rome, Italy; C.O.ME. Collaboration, Pescara, Italy.
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Ozawa J, Kurose T, Kawamata S, Kaneguchi A, Moriyama H, Kito N. Regulation of connective tissue remodeling in the early phase of denervation in a rat skeletal muscle. Biomed Res 2014; 34:251-8. [PMID: 24190237 DOI: 10.2220/biomedres.34.251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Denervation alters the metabolism of the extracellular matrix (ECM) in skeletal muscle; however, the underlying mechanisms of ECM remodeling are not fully understood. The aim of this study was to elucidate the dynamic features of the ECM regulatory process in the early phase of denervated skeletal muscle in male Wistar rats. We investigated the expression of collagens (total, type I, and type III), transforming growth factor beta 1 (TGF-β1), and matrix metalloproteases (MMPs) together with their endogenous inhibitors (TIMPs), at the mRNA and/or protein level in the soleus muscles of control animals and at days 3, 7, and 14 post-denervation. Expression of mRNA encoding collagens was decreased at days 3 and 7, and had recovered by day 14, in parallel with total collagen protein content. Content of TGF-β1 protein was elevated sequentially, up to a maximum of 158% at day 14 post-denervation (P < 0.05), as was TIMP-2 mRNA expression (272% at day 14), whereas MMP-1, MMP-2, and TIMP-1 mRNA expression was not affected at any stage. The initial reduction of collagen mRNA may be responsible for hypoactivity caused by the disappearance of contractile function. Recovery of collagen mRNA/protein at day 14 may be due mainly to the suppressive effects of TGF-β1 on collagen degradation via TIMP-2 upregulation.
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Affiliation(s)
- Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashi-Hiroshima, Hiroshima, Japan
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Longhurst JC, Tjen-A-Looi S. Acupuncture regulation of blood pressure: two decades of research. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 111:257-71. [PMID: 24215927 DOI: 10.1016/b978-0-12-411545-3.00013-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Although mechanisms underlying acupuncture regulation of pain have been studied by a number of laboratories in many countries, much less is known about its ability to modulate cardiovascular function. In the last two decades, our laboratory has systematically investigated the peripheral and central neural mechanisms underlying acupuncture regulation of blood pressure. These observations account for acupuncture's distant actions and, to some extent, its local actions, with respect to the site of needling. Four fundamental findings have advanced our knowledge. First, point-specific effects of acupuncture underlie its cardiovascular actions. Second, variable regions in the supraspinal and spinal central nervous system that receive input from somatic afferent stimulation account for acupuncture's ability to modulate blood pressure. Thus, depending on the underlying situation, for example, high or low blood pressure, acupuncture modifies autonomic outflow by reducing activity in brain stem nuclei that participate in the primary response. Third, repetitive acupuncture through a molecular mechanism can cause prolonged cardiovascular effects that far outlast acupuncture stimulation. Fourth, there is a range of cardiovascular responsiveness to acupuncture that depends, at least in part, on interactions between neural modulators that synaptically regulate autonomic function in the brain stem. Thus, acupuncture has the capability of profoundly regulating cardiovascular function in patients with disease, for example, hypertension, and the experimental laboratory is directing best approaches to study its actions in humans.
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Affiliation(s)
- John C Longhurst
- Department of Medicine, Physiology and Biophysics, and Pharmacology, School of Medicine, University of California, Medical Sciences, Irvine, California, USA.
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KLINGLER WERNER, JURKAT-ROTT KARIN, LEHMANN-HORN FRANK, SCHLEIP ROBERT. The role of fibrosis in Duchenne muscular dystrophy. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2012; 31:184-95. [PMID: 23620650 PMCID: PMC3631802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Muscular dystrophies such as Duchenne muscular dystrophy (DMD) are usually approached as dysfunctions of the affected skeletal myofibres and their force transmission. Comparatively little attention has been given to the increase in connective tissue (fibrosis) which accompanies these muscular changes. Interestingly, an increase in endomysial tissue is apparent long before any muscular degeneration can be observed. Fibrosis is the result of a reactive or reparative process involving mechanical, humoral and cellular factors. Originating from vulnerable myofibres, muscle cell necrosis and inflammatory processes are present in DMD. Muscular recovery is limited due to the limited number and capacity of satellite cells. Hence, a proactive and multimodal approach is necessary in order to activate protective mechanisms and to hinder catabolic and tissue degrading pathways. Several avenues are discussed in terms of potential antifibrotic therapy approaches. These include pharmaceutical, nutritional, exercise-based and other mechanostimulatory modalities (such as massage or yoga-like stretching) with the intention of exerting an anti-inflammatory and antifibrotic effect on the affected muscular tissues. A preventive intervention at an early age is crucial, based on the early and seemingly non-reversible nature of the fibrotic tissue changes. Since consistent assessment is essential, different measurement technologies are discussed.
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Affiliation(s)
- WERNER KLINGLER
- Division of Neurophysiology, Ulm University, Ulm, Germany;, Department of Neuroanaesthesiology, Neurosurgical University Hospital Günzburg,Ulm University, Ulm, Germany
| | | | | | - ROBERT SCHLEIP
- Division of Neurophysiology, Ulm University, Ulm, Germany;,Address for correspondence: Robert Schleip, Division of Neurophysiology, Ulm University, Albert-Einstein-Allee 11, D-89081 Ulm., Germany Tel. +49 731 500 23251. Fax +49 731 5012 23257 - E-mail:
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Corey SM, Vizzard MA, Bouffard NA, Badger GJ, Langevin HM. Stretching of the back improves gait, mechanical sensitivity and connective tissue inflammation in a rodent model. PLoS One 2012; 7:e29831. [PMID: 22238664 PMCID: PMC3253101 DOI: 10.1371/journal.pone.0029831] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 12/06/2011] [Indexed: 11/19/2022] Open
Abstract
The role played by nonspecialized connective tissues in chronic non-specific low back pain is not well understood. In a recent ultrasound study, human subjects with chronic low back pain had altered connective tissue structure compared to human subjects without low back pain, suggesting the presence of inflammation and/or fibrosis in the low back pain subjects. Mechanical input in the form of static tissue stretch has been shown in vitro and in vivo to have anti-inflammatory and anti-fibrotic effects. To better understand the pathophysiology of lumbar nonspecialized connective tissue as well as potential mechanisms underlying therapeutic effects of tissue stretch, we developed a carrageenan-induced inflammation model in the low back of a rodent. Induction of inflammation in the lumbar connective tissues resulted in altered gait, increased mechanical sensitivity of the tissues of the low back, and local macrophage infiltration. Mechanical input was then applied to this model as in vivo tissue stretch for 10 minutes twice a day for 12 days. In vivo tissue stretch mitigated the inflammation-induced changes leading to restored stride length and intrastep distance, decreased mechanical sensitivity of the back and reduced macrophage expression in the nonspecialized connective tissues of the low back. This study highlights the need for further investigation into the contribution of connective tissue to low back pain and the need for a better understanding of how interventions involving mechanical stretch could provide maximal therapeutic benefit. This tissue stretch research is relevant to body-based treatments such as yoga or massage, and to some stretch techniques used with physical therapy.
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Affiliation(s)
- Sarah M Corey
- Department of Neurology, University of Vermont, Burlington, Vermont, United States of America.
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Agha R, Ogawa R, Pietramaggiori G, Orgill DP. A Review of the Role of Mechanical Forces in Cutaneous Wound Healing. J Surg Res 2011; 171:700-8. [DOI: 10.1016/j.jss.2011.07.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 06/17/2011] [Accepted: 07/07/2011] [Indexed: 12/14/2022]
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Lauche R, Cramer H, Choi KE, Rampp T, Saha FJ, Dobos GJ, Musial F. The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain--a randomised controlled pilot study. Altern Ther Health Med 2011; 11:63. [PMID: 21843336 PMCID: PMC3224248 DOI: 10.1186/1472-6882-11-63] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 08/15/2011] [Indexed: 11/17/2022]
Abstract
Background In this preliminary trial we investigated the effects of dry cupping, an ancient method for treating pain syndromes, on patients with chronic non-specific neck pain. Sensory mechanical thresholds and the participants' self-reported outcome measures of pain and quality of life were evaluated. Methods Fifty patients (50.5 ± 11.9 years) were randomised to a treatment group (TG) or a waiting-list control group (WL). Patients in the TG received a series of 5 cupping treatments over a period of 2 weeks; the control group did not. Self-reported outcome measures before and after the cupping series included the following: Pain at rest (PR) and maximal pain related to movement (PM) on a 100-mm visual analogue scale (VAS), pain diary (PD) data on a 0-10 numeric rating scale (NRS), Neck Disability Index (NDI), and health-related quality of life (SF-36). In addition, the mechanical-detection thresholds (MDT), vibration-detection thresholds (VDT), and pressure-pain thresholds (PPT) were determined at pain-related and control areas. Results Patients of the TG had significantly less pain after cupping therapy than patients of the WL group (PR: Δ-22.5 mm, p = 0.00002; PM: Δ-17.8 mm, p = 0.01). Pain diaries (PD) revealed that neck pain decreased gradually in the TG patients and that pain reported by the two groups differed significantly after the fifth cupping session (Δ-1.1, p = 0.001). There were also significant differences in the SF-36 subscales for bodily pain (Δ13.8, p = 0.006) and vitality (Δ10.2, p = 0.006). Group differences in PPT were significant at pain-related and control areas (all p < 0.05), but were not significant for MDT or VDT. Conclusions A series of five dry cupping treatments appeared to be effective in relieving chronic non-specific neck pain. Not only subjective measures improved, but also mechanical pain sensitivity differed significantly between the two groups, suggesting that cupping has an influence on functional pain processing. Trial registration The trial was registered at clinicaltrials.gov (NCT01289964).
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Ayala P, Desai TA. Integrin α3 blockade enhances microtopographical down-regulation of α-smooth muscle actin: role of microtopography in ECM regulation. Integr Biol (Camb) 2011; 3:733-41. [PMID: 21666923 DOI: 10.1039/c1ib00012h] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Development of functional engineered matrices for regenerative therapies can benefit from an understanding of how physical cues at the microscale affect cell behavior. In this work, we use microfabricated systems to study how stiffness and microscale topographical cues in the form of "micropegs" affect extracellular matrix synthesis. Previous work from our lab has shown that microtopographical cues in 2D and 3D systems decrease cellular proliferation and regulate matrix synthesis. In this work, the combined role of stiffness and topography on ECM synthesis is investigated in a 2D micropeg system. These studies show that fibroblasts cultured on polydimethylsiloxane (PDMS) substrates with micropegs have reduced expression of collagen type I (Col I) and collagen type VI (Col VI) compared to fibroblasts cultured on flat substrates. In addition, cells on micropegged substrates exhibit down-regulation of other important regulators of ECM synthesis such as α-smooth muscle actin (α-SMA), and integrin α3 (Int α3). Interestingly, this effect is dependent on the contractility and adhesion of the cells. When cultured in the presence of RhoA kinase (ROCK) and myosin light chain kinase (MLCK) inhibitors, no significant differences in the expression of collagen, α-SMA, Int α3, and TGFB1 are observed. Additionally, disruptions in cell adhesion prevent microtopographical regulation of ECM synthesis. When using an antibody to block the extracellular domain of Int α3, no differences in the expression of collagen are observed and blocking Int α3 results in enhanced down-regulation of α-SMA on the stiffer micropegged substrates. These findings demonstrate that regulation of extracellular matrix production by cells on a synthetic substrate can be guided via physical cues at the microscale, and add to the body of knowledge on the role of integrin-mediated mechanotransduction.
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Affiliation(s)
- Perla Ayala
- UCSF/UC Berkeley Joint Graduate Group in Bioengineering, USA
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Schubert AG. Exertional compartment syndrome: review of the literature and proposed rehabilitation guidelines following surgical release. Int J Sports Phys Ther 2011; 6:126-141. [PMID: 21713230 PMCID: PMC3109896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND There is little published information regarding postoperative management of patients with Chronic Exertional Compartment Syndrome (CECS). Reports of recurrence of symptoms following surgical decompression exist, and are not uncommon depending on the specific technique used. Recurrence suggests that more time and effort may need to be spent on implementing strategic post-operative rehabilitation management in order to avoid repeat surgical intervention or prolonged symptoms. OBJECTIVE To summarize relevant literature regarding CECS and propose scientifically-based guidelines for rehab following compartment release with the rationale based on tissue healing, muscle loading, and scar tissue formation and consideration of all tissues contained in the involved compartment. LITERATURE REVIEW A LITERATURE SEARCH WAS PERFORMED IN PUBMED, SPORTDISCUS, CINAHL, PEDRO, AND GOOGLE SCHOLAR USING THE PHRASE: "chronic exertional compartment syndrome." RESULTS No specific rehabilitation guidelines following surgical compartment release for lower extremity CECS were found in the literature search performed for this clinical commentary. DISCUSSION The development of the proposed post-operative guidelines may allow for improved long-term outcomes following anterior compartment release. SUMMARY Adequate description of long-term follow-up of outcomes following compartment release for CECS is lacking in current literature. The proposed guidelines for rehab following compartment release include consideration of tissue healing, muscle loading, scar tissue formation, and consideration of soft tissues contained in the involved compartment. Utilization of the proposed guidelines may allow for future research to be performed in order to assess outcomes following surgical intervention for CECS.
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Affiliation(s)
- Amy G Schubert
- University of Wisconsin Hospital and Clinics Sports Medicine, Madison, WI (USA)
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Ledoux M, Beauchet A, Fermanian C, Boileau C, Jondeau G, Saiag P. A case-control study of cutaneous signs in adult patients with Marfan disease: Diagnostic value of striae. J Am Acad Dermatol 2011; 64:290-5. [DOI: 10.1016/j.jaad.2010.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 01/07/2010] [Accepted: 01/18/2010] [Indexed: 11/30/2022]
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Ayala P, Lopez JI, Desai TA. Microtopographical cues in 3D attenuate fibrotic phenotype and extracellular matrix deposition: implications for tissue regeneration. Tissue Eng Part A 2011; 16:2519-27. [PMID: 20235832 DOI: 10.1089/ten.tea.2009.0815] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent studies have highlighted the role of external biophysical cues on cell morphology and function. In particular, substrate geometry and rigidity in two dimensions has been shown to impact cell growth, death, differentiation, and motility. Knowledge of how these physical cues affect cell function in three dimensions is critical for successful development of novel regenerative therapies. In this work, the effect of discrete micromechanical cues in three-dimensional (3D) system on cell proliferation, gene expression, and extracellular matrix synthesis was investigated. Poly(ethylene glycol) dimethacrylate hydrogel microrods were fabricated using photolithography and suspended in gel to create a 3D culture with microscale cues of defined mechanical properties in the physiological range (2-50 kPa). These microrods significantly affected fibroblast proliferation, matrix production, and gene expression. Cultures with stiff microrods reduced fibroblast proliferation and downregulated expression of key extracellular matrix proteins involved in scar tissue formation. In addition, the contractility marker alpha smooth muscle actin and adhesion molecule integrin alpha3 were also significantly downregulated. Cultures with soft microrods had no significant difference on fibroblast proliferation and expression of Cyclin D1, alpha smooth muscle actin, and integrin alpha3 compared to cultures with no microrods. Here, we present a new platform of potentially injectable microrods with tunable elasticity; in addition, we show that cell proliferation and gene expression are influenced by discrete physical cues in 3D.
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Affiliation(s)
- Perla Ayala
- Joint Graduate Group in Bioengineering, University of California San Francisco-University of California Berkeley, San Francisco, California, USA
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Wang HQ, Wei YY, Wu ZX, Luo ZJ. Impact of leg lengthening on viscoelastic properties of the deep fascia. BMC Musculoskelet Disord 2009; 10:105. [PMID: 19698092 PMCID: PMC2734753 DOI: 10.1186/1471-2474-10-105] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 08/21/2009] [Indexed: 01/14/2023] Open
Abstract
Background Despite the morphological alterations of the deep fascia subjected to leg lengthening have been investigated in cellular and extracellular aspects, the impact of leg lengthening on viscoelastic properties of the deep fascia remains largely unknown. This study aimed to address the changes of viscoelastic properties of the deep fascia during leg lengthening using uniaxial tensile test. Methods Animal model of leg lengthening was established in New Zealand white rabbits. Distraction was initiated at a rate of 1 mm/day and 2 mm/day in two steps, and preceded until increases of 10% and 20% in the initial length of tibia had been achieved. The deep fascia specimens of 30 mm × 10 mm were clamped with the Instron 1122 tensile tester at room temperature with a constant tensile rate of 5 mm/min. After 5 load-download tensile tests had been performed, the specimens were elongated until rupture. The load-displacement curves were automatically generated. Results The normal deep fascia showed typical viscoelastic rule of collagenous tissues. Each experimental group of the deep fascia after leg lengthening kept the properties. The curves of the deep fascia at a rate of 1 mm/day with 20% increase in tibia length were the closest to those of normal deep fascia. The ultimate tension strength and the strain at rupture on average of normal deep fascia were 2.69 N (8.97 mN/mm2) and 14.11%, respectively. The increases in ultimate tension strength and strain at rupture of the deep fascia after leg lengthening were statistically significant. Conclusion The deep fascia subjected to leg lengthening exhibits viscoelastic properties as collagenous tissues without lengthening other than increased strain and strength. Notwithstanding different lengthening schemes result in varied viscoelastic properties changes, the most comparable viscoelastic properties to be demonstrated are under the scheme of a distraction rate of 1 mm/day and 20% increase in tibia length.
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Affiliation(s)
- Hai-Qiang Wang
- Institute of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
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Abstract
Although fasciae have long interested clinicians in a multitude of different clinical and paramedical disciplines, there have been few attempts to unite the ensuing diverse literature into a single review. The current article gives an anatomical perspective that extends from the gross to the molecular level. For expediency, it deals only with fascia in the limbs and back. Particular focus is directed towards deep fascia and thus consideration is given to structures such as the fascia lata, thoracolumbar fascia, plantar and palmar fascia, along with regional specializations of deep fascia such as retinacula and fibrous pulleys. However, equal emphasis is placed on general aspects of fascial structure and function, including its innervation and cellular composition. Among the many functions of fascia considered in detail are its ectoskeletal role (as a soft tissue skeleton for muscle attachments), its importance for creating osteofascial compartments for muscles, encouraging venous return in the lower limb, dissipating stress concentration at entheses and acting as a protective sheet for underlying structures. Emphasis is placed on recognizing the continuity of fascia between regions and appreciating its key role in coordinating muscular activity and acting as a body-wide proprioceptive organ. Such considerations far outweigh the significance of viewing fascia in a regional context alone.
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Affiliation(s)
- Mike Benjamin
- School of Biosciences, Cardiff University, Cardiff, UK.
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