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Park S, Rahaman KA, Kim YC, Jeon H, Han HS. Fostering tissue engineering and regenerative medicine to treat musculoskeletal disorders in bone and muscle. Bioact Mater 2024; 40:345-365. [PMID: 38978804 PMCID: PMC11228556 DOI: 10.1016/j.bioactmat.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/26/2024] [Accepted: 06/11/2024] [Indexed: 07/10/2024] Open
Abstract
The musculoskeletal system, which is vital for movement, support, and protection, can be impaired by disorders such as osteoporosis, osteoarthritis, and muscular dystrophy. This review focuses on the advances in tissue engineering and regenerative medicine, specifically aimed at alleviating these disorders. It explores the roles of cell therapy, particularly Mesenchymal Stem Cells (MSCs) and Adipose-Derived Stem Cells (ADSCs), biomaterials, and biomolecules/external stimulations in fostering bone and muscle regeneration. The current research underscores the potential of MSCs and ADSCs despite the persistent challenges of cell scarcity, inconsistent outcomes, and safety concerns. Moreover, integrating exogenous materials such as scaffolds and external stimuli like electrical stimulation and growth factors shows promise in enhancing musculoskeletal regeneration. This review emphasizes the need for comprehensive studies and adopting innovative techniques together to refine and advance these multi-therapeutic strategies, ultimately benefiting patients with musculoskeletal disorders.
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Affiliation(s)
- Soyeon Park
- Biomaterials Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Khandoker Asiqur Rahaman
- Biomaterials Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
| | - Yu-Chan Kim
- Biomaterials Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul 02792, Republic of Korea
| | - Hojeong Jeon
- Biomaterials Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, 02841, Republic of Korea
| | - Hyung-Seop Han
- Biomaterials Research Center, Biomedical Research Division, Korea Institute of Science and Technology, Seoul, 02792, Republic of Korea
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul 02792, Republic of Korea
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Wang HC, Phan TN, Kao CL, Yeh CK, Lin YC. Genetically encoded mediators for sonogenetics and their applications in neuromodulation. Front Cell Neurosci 2023; 17:1326279. [PMID: 38188668 PMCID: PMC10766825 DOI: 10.3389/fncel.2023.1326279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Sonogenetics is an emerging approach that harnesses ultrasound for the manipulation of genetically modified cells. The great penetrability of ultrasound waves enables the non-invasive application of external stimuli to deep tissues, particularly advantageous for brain stimulation. Genetically encoded ultrasound mediators, a set of proteins that respond to ultrasound-induced bio-effects, play a critical role in determining the effectiveness and applications of sonogenetics. In this context, we will provide an overview of these ultrasound-responsive mediators, delve into the molecular mechanisms governing their response to ultrasound stimulation, and summarize their applications in neuromodulation.
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Affiliation(s)
- Hsien-Chu Wang
- Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Thi-Nhan Phan
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Chi-Ling Kao
- Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Chun Lin
- Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
- Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan
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Afshari M, Amini S, Hashemibeni B. Effect of low frequency ultrasound waves on the morphology and viability of cultured human gingival fibroblasts. J Taibah Univ Med Sci 2023; 18:1406-1416. [PMID: 38162872 PMCID: PMC10757313 DOI: 10.1016/j.jtumed.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/13/2023] [Accepted: 05/08/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives The aim of this study was to investigate the effect of the vibration amplitude of mechanical ultrasound waves (27 kHz) on the viability and morphology of human gingival fibroblasts (hGFs) when cultured on a biomaterial substrate. Method hGFs were seeded on tissue culture plates (TCPs) and an Ti6Al4V titanium alloy surface in two groups for three days and seven days of cell culture. The cells were subjected to three vibration amplitudes for 20 min each day. Scanning electron microscope (SEM) images were used to characterize cell morphology. Results Experiments showed that hGF cells became detached from their plates at a vibration amplitude comparable to an intensity of 260 mW/cm2. In addition, hGfs that received a vibrational amplitude comparable to an intensity of 50 mW/cm2 underwent significant proliferation proliferated significantly; however, cells receiving higher amplitudes suffered from adverse effects. Conclusions SEM images of hGFs on titanium disks at vibration amplitude comparable to an intensity 50 mW/cm2 showed a remarkable hexagonal architecture, which we refer to as a honeycomb pattern. On day 6 the observed hGFs on TCPs, proliferated at a higher rate and new cells attached uniformly on the existing layer of cells. These data indicate the effect of cellular tissue as a substrate on the growth of new hGFs under low-intensity ultrasound.
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Affiliation(s)
- Mojtaba Afshari
- Department of Manufacturing, Faculty of Mechanical Engineering, University of Kashan, Kashan, Iran
| | - Saeid Amini
- Department of Manufacturing, Faculty of Mechanical Engineering, University of Kashan, Kashan, Iran
| | - Batool Hashemibeni
- Torabinejad Dentistry Research Center and Department of Anatomical Sciences and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Anatomical Sciences, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Zhang Z, Zhu Z, Zhou P, Zou Y, Yang J, Haick H, Wang Y. Soft Bioelectronics for Therapeutics. ACS NANO 2023; 17:17634-17667. [PMID: 37677154 DOI: 10.1021/acsnano.3c02513] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Soft bioelectronics play an increasingly crucial role in high-precision therapeutics due to their softness, biocompatibility, clinical accuracy, long-term stability, and patient-friendliness. In this review, we provide a comprehensive overview of the latest representative therapeutic applications of advanced soft bioelectronics, ranging from wearable therapeutics for skin wounds, diabetes, ophthalmic diseases, muscle disorders, and other diseases to implantable therapeutics against complex diseases, such as cardiac arrhythmias, cancer, neurological diseases, and others. We also highlight key challenges and opportunities for future clinical translation and commercialization of soft therapeutic bioelectronics toward personalized medicine.
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Affiliation(s)
- Zongman Zhang
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology, 241 Daxue Road, Shantou, Guangdong 515063, China
- The Wolfson Department of Chemical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Zhongtai Zhu
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology, 241 Daxue Road, Shantou, Guangdong 515063, China
| | - Pengcheng Zhou
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology, 241 Daxue Road, Shantou, Guangdong 515063, China
- The Wolfson Department of Chemical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Yunfan Zou
- Department of Biotechnology and Food Engineering, Guangdong Technion-Israel Institute of Technology, 241 Daxue Road, Shantou, Guangdong 515063, China
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Jiawei Yang
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology, 241 Daxue Road, Shantou, Guangdong 515063, China
- The Wolfson Department of Chemical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Hossam Haick
- The Wolfson Department of Chemical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Yan Wang
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology, 241 Daxue Road, Shantou, Guangdong 515063, China
- The Wolfson Department of Chemical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
- Guangdong Provincial Key Laboratory of Materials and Technologies for Energy Conversion, Guangdong Technion-Israel Institute of Technology, 241 Daxue Road, Shantou, Guangdong 515063, China
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Rao K, Kumar KRA, Kumar RM, Marimallappa TR, Pal S, Dutta S. Evaluation of Efficacy of Low-Intensity Pulsed Ultrasound on Comorbidities Following Mandibular Impacted Third Molar Surgery: A Prospective Study. Ann Maxillofac Surg 2023; 13:184-188. [PMID: 38405558 PMCID: PMC10883221 DOI: 10.4103/ams.ams_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/06/2023] [Accepted: 07/19/2023] [Indexed: 02/27/2024] Open
Abstract
Introduction Despite several in vitro and in vivo applications of low-intensity pulsed ultrasound (LIPUS), it remains an under-studied feature of the oral and maxillofacial region. The goal of this in vivo study was to objectively investigate the efficacy of low-intensity pulsed ultrasound on wound healing and related morbidities following surgical removal of an impacted third molar. Materials and Methods The following in vivo prospective, comparative, randomised controlled clinical study was carried out amongst 56 patients who reported to the Department of Oral and Maxillofacial Surgery fulfilling the inclusion criteria. Group A received sham ultrasound, whereas Group B received LIPUS therapy. Based on the group allocated LIPUS 1 MHz, pulsed 20% and dose 1.0 watts/square centimetre (W/cm2)/sham, ultrasound therapy was given on 1st, 2nd and 3rd post-operative days. The assessment of post-operative pain, oedema, trismus and wound healing on preoperative, first, third and seventh postoperative days. Results The quantitative variables of the study were assessed using independent sample t-test, and qualitative variables were assessed using the Chi-square test. The P < 0.05 on third and seventh post-op days for pain, trismus and wound healing in the LIPUS group compared to control group making it statistically significant. There was no statistically significant difference in the reduction of oedema amongst the two groups. Discussion Post-LIPUS application in the patients, postoperative pain was significantly reduced, trismus was noticeably improved and wound healing was satisfactory and can be employed as a complementary technique.
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Affiliation(s)
- Keerthana Rao
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Tumakuru, Karnataka, India
| | - KR Ashok Kumar
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Tumakuru, Karnataka, India
| | - R. Mahesh Kumar
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Tumakuru, Karnataka, India
| | - T. R. Marimallappa
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Tumakuru, Karnataka, India
| | - Supriyo Pal
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Tumakuru, Karnataka, India
| | - Subham Dutta
- Department of Oral and Maxillofacial Surgery, Sri Siddhartha Dental College and Hospital, Tumakuru, Karnataka, India
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Jarit P, Klyve D, Walters R. Long Duration Sonophoresis of Diclofenac to Augment Rehabilitation of Common Musculoskeletal Injuries. GLOBAL JOURNAL OF ORTHOPEDICS RESEARCH 2023; 4:584. [PMID: 36865667 PMCID: PMC9977165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Background The use of long duration sonophoresis (LDS) for musculoskeletal injuries is a new and emerging treatment option for patients undergoing rehabilitation. The treatment is non-invasive, provides multi-hour mechanical stimulus expediating tissue regeneration and deep tissue heat along with local application of therapeutic compound for improved pain relief. The objective of this prospective case study was to evaluate real-world application of diclofenac LDS as an add-on intervention for patients non-responsive to physical therapy alone. Methods Patient who failed to respond to at least 4 weeks of physical therapy were treated with the addition of 2.5% diclofenac LDS daily for 4 weeks. The numerical rating scale, global health improvement score, functional improvement, and treatment satisfaction index were measured to assess pain reduction and quality of life improvement from treatment. Patient outcome data was organized by injury type and patient age groups, and statistically analyzed with ANOVA to assess treatment differences within and between groups. The study was registered on clinicaltrails.gov NCT05254470. Result The study included (n=135) musculoskeletal injury LDS treatments with no adverse events. Patients reported a mean pain reduction from baseline of 4.44 points (p<0.0001) and a 4.85point health improvement score after 4-week of daily sonophoresis treatment. There were no age-related differences in pain reduction, and 97.8% of patients in the study reported functional improvement with the addition of LDS treatment. Significant pain relief was observed in injuries related to tendinopathy, sprain, strain, contusion, bone fracture, and post-surgical recovery. Conclusion The use of LDS significantly reduced pain and improved musculoskeletal function and quality of life for patients. Clinical findings suggest that LDS with 2.5% diclofenac is a viable therapeutic option for practitioners and should be further investigated.
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Affiliation(s)
- Paddy Jarit
- Department of Sport & Orthopaedic Physical Therapy, Fairfield, CT, USA
| | - Dominic Klyve
- Department of Mathematics, Central Washington University, Ellensburg, WI, USA
| | - Rod Walters
- Consultants in Sports Medicine, Columbia, SC, USA
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Shar A, Aboutalebianaraki N, Misiti K, Sip YYL, Zhai L, Razavi M. A novel ultrasound-mediated nanodroplet-based gene delivery system for osteoporosis treatment. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2022; 41:102530. [PMID: 35104672 DOI: 10.1016/j.nano.2022.102530] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/30/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
This project aimed to develop, optimize, and test an ultrasound-responsive targeted nanodroplet system for the delivery of osteoporosis-related silencing gene Cathepsin K small interfering RNA (CTSK siRNA) for osteoporosis treatment. The nanodroplet (ND) is composed of a gas core made from perfluorocarbon, stabilized with albumin, encapsulated with CTSK siRNA, and embedded with alendronate (AL) for bone targeting (CTSK siRNA-ND-AL). Following the development, the responsiveness of CTSK siRNA-ND-AL to a therapeutic ultrasound probe was examined. The results of biocompatibility tests with human bone marrow-derived mesenchymal stem cells proved no significant cell death (P > 0.05). When the CTSK siRNA-ND-AL was supplemented with human osteoclast precursors, they suppressed osteoclastogenesis. Thus, this project establishes the potential of nanotechnology and ultrasound to deliver genes into the osteoclasts. This research also presents a novel ultrasound responsive and targeted nanodroplet platform that can be used as a gene and drug delivery system for various diseases including cancer.
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Affiliation(s)
- Angela Shar
- Biionix™ (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA; Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Nadia Aboutalebianaraki
- Biionix™ (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA; Department of Material Sciences and Engineering, University of Central Florida, Orlando, Florida, USA
| | - Kaylee Misiti
- Biionix™ (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Yuen Yee Li Sip
- Department of Material Sciences and Engineering, University of Central Florida, Orlando, Florida, USA; Nanoscience Technology Center, University of Central Florida, Orlando, Florida, USA
| | - Lei Zhai
- Nanoscience Technology Center, University of Central Florida, Orlando, Florida, USA; Department of Chemistry, University of Central Florida, Orlando, Florida, USA
| | - Mehdi Razavi
- Biionix™ (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA; Department of Material Sciences and Engineering, University of Central Florida, Orlando, Florida, USA.
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Chen FR, Manzi JE, Mehta N, Gulati A, Jones M. A Review of Laser Therapy and Low-Intensity Ultrasound for Chronic Pain States. Curr Pain Headache Rep 2022; 26:57-63. [PMID: 35133560 DOI: 10.1007/s11916-022-01003-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Chronic pain management therapies have expanded quickly over the past decade. In particular, the use of laser therapy and ultrasound in the management of chronic pain has risen in recent years. Understanding the uses of these types of therapies can better equip chronic pain specialists for managing complicated chronic pain syndromes. The purpose of this review was to summarize the current literature regarding laser radiation and ultrasound therapy used for managing chronic pain syndromes. RECENT FINDINGS In summary, there is stronger evidence supporting the usage of laser therapy for managing chronic pain states compared to low-intensity ultrasound therapies. As a monotherapy, laser therapy has proven to be beneficial in managing chronic pain in patients with a variety of pain syndromes. On the other hand, LIUS has less clear benefits as a monotherapy with an uncertain, optimal delivery method established. Both laser therapy and low-intensity ultrasound have proven beneficial in managing various pain syndromes and can be effective interventions, in particular, when utilized in combination therapy.
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Affiliation(s)
- Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Joseph E Manzi
- Department of Interventional Pain Medicine, New-York Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, New York, NY, 10065, USA
| | - Neel Mehta
- Department of Interventional Pain Medicine, New-York Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, New York, NY, 10065, USA
| | - Amitabh Gulati
- Department of Chronic Pain Management, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mark Jones
- Department of Interventional Pain Medicine, New-York Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, New York, NY, 10065, USA. .,Pain Medicine of the South, Knoxville, TN, 37934, USA.
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Walters R, Kasik J, Ettel C, Ortiz R. Evaluation of Sustained Acoustic Medicine for Treating Musculoskeletal Injuries in Military and Sports Medicine. Open Orthop J 2022; 16:e187432502211210. [PMID: 36694709 PMCID: PMC9869494 DOI: 10.2174/18743250-v16-e221130-2022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Musculoskeletal injuries are common in collegiate, professional, and military personnel and require expedited recovery to reduce lost work time. Sustained acoustic medicine (SAM) provides continuous long-duration ultrasound at 3MHz and 132mW/cm2. The treatment is frequently prescribed to treat acute and chronic soft tissue injuries and reduce pain. The objective of this study was to evaluate the efficacy of SAM treatment for musculoskeletal injuries and accelerated recovery. Methods An 18-question electronic survey and panel discussion were conducted on Athletic Trainers (ATs) using SAM treatment in professional, collegiate, and military sports medicine. The survey included both qualitative and quantitative questions. In addition, a panel discussion discussed SAM effectiveness with expert ATs. Power calculation of sampling and statistical evaluation of data was utilized to generalize the results. Results Survey respondents (n=97) and panelists (n=142) included ATs from all National Athletic Trainers Association districts. SAM was primarily used for musculoskeletal injuries (83.9%, p<0.001) with a focus on healing tendons and ligaments (87.3%, p<0.001). SAM treatment was also used on joints (44.8%), large muscle groups (43.7%), and bone (41.4%). SAM provided clinical improvement in under 2 weeks (68.9%, p<0.001) and a 50% reduction in pain medication (63%, p<0.001). In addition, patients were highly receptive to treatment (87.3%, p<0.001), and ATs had a high level of confidence for improved function and returned to work after 30-days of SAM use (81.2%, p<0.001). Conclusion SAM is an effective, safe, easy-to-use, noninvasive, comfortable, and versatile therapeutic for healing musculoskeletal injuries.
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Affiliation(s)
- Rod Walters
- NATA Hall of Fame, Walters Inc. Consultants in Sports Medicine, Columbia, SC, USA
| | - John Kasik
- Atheltic Training and Sports Medicine, University of South Carolina, Columbia, SC, USA
| | - Cassie Ettel
- Atheltic Training, Jacksonville Jaguars, Jacksonville, FL, USA
| | - Ralph Ortiz
- Cayuga Medical Center, Medical Pain Consultants, Dryden, NY, USA,Address correspondence to this author at the Cayuga Medical Center, Medical Pain Consultants, Dryden, NY, USA; Tel: 6078449979;
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Winkler SL, Urbisci AE, Best TM. Sustained acoustic medicine for the treatment of musculoskeletal injuries: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2021; 13:159. [PMID: 34922606 PMCID: PMC8684070 DOI: 10.1186/s13102-021-00383-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Musculoskeletal injuries account for 10 million work-limited days per year and often lead to both acute and/or chronic pain, and increased chances of re-injury or permanent disability. Conservative treatment options include various modalities, nonsteroidal anti-inflammatory drugs, and physical rehabilitation programs. Sustained Acoustic Medicine is an emerging prescription home-use mechanotransductive device to stimulate cellular proliferation, increase microstreaming and cavitation in situ, and to increase tissue profusion and permeability. This research aims to summarize the clinical evidence on Sustained Acoustic Medicine and measurable outcomes in the literature. METHODS A systematic literature review was conducted using PubMed, EBSCOhost, Academic Search Complete, Google Scholar and ClinicalTrials.gov to identify studies evaluating the effects of Sustained Acoustic Medicine on the musculoskeletal system of humans. Articles identified were selected based on inclusion criteria and scored on the Downs and Black checklist. Study design, clinical outcomes and primary findings were extracted from included studies for synthesis and meta-analysis statistics. RESULTS A total of three hundred and seventy-two participants (372) were included in the thirteen clinical research studies reviewed including five (5) level I, four (4) level II and four (4) level IV studies. Sixty-seven (67) participants with neck and back myofascial pain and injury, one hundred and fifty-six (156) participants with moderate to severe knee pain and radiographically confirmed knee osteoarthritis (Kellgren-Lawrence grade II/III), and one hundred forty-nine (149) participants with generalized soft-tissue injury of the elbow, shoulder, back and ankle with limited function. Primary outcomes included daily change in pain intensity, change in Western Ontario McMaster Osteoarthritis Questionnaire, change in Global Rate of Change, and functional outcome measures including dynamometry, grip strength, range-of-motion, and diathermic heating (temperature measurement). CONCLUSION Sustained Acoustic Medicine treatment provides tissue heating and tissue recovery, improved patient function and reduction of pain. When patients failed to respond to physical therapy, Sustained Acoustic Medicine proved to be a useful adjunct to facilitate healing and return to work. As a non-invasive and non-narcotic treatment option with an excellent safety profile, Sustained Acoustic Medicine may be considered a good therapeutic option for practitioners.
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Affiliation(s)
| | | | - Thomas M Best
- UHealth Sports Medicine Institute, University of Miami, Coral Gables, FL, USA.
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Uddin SMZ, Komatsu DE, Motyka T, Petterson S. Low-Intensity Continuous Ultrasound Therapies—A Systematic Review of Current State-of-the-Art and Future Perspectives. J Clin Med 2021; 10:2698. [PMID: 34207333 PMCID: PMC8235587 DOI: 10.3390/jcm10122698] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 01/02/2023] Open
Abstract
Therapeutic ultrasound has been studied for over seven decades for different medical applications. The versatility of ultrasound applications are highly dependent on the frequency, intensity, duration, duty cycle, power, wavelength, and form. In this review article, we will focus on low-intensity continuous ultrasound (LICUS). LICUS has been well-studied for numerous clinical disorders, including tissue regeneration, pain management, neuromodulation, thrombosis, and cancer treatment. PubMed and Google Scholar databases were used to conduct a comprehensive review of all research studying the application of LICUS in pre-clinical and clinical studies. The review includes articles that specify intensity and duty cycle (continuous). Any studies that did not identify these parameters or used high-intensity and pulsed ultrasound were not included in the review. The literature review shows the vast implication of LICUS in many medical fields at the pre-clinical and clinical levels. Its applications depend on variables such as frequency, intensity, duration, and type of medical disorder. Overall, these studies show that LICUS has significant promise, but conflicting data remain regarding the parameters used, and further studies are required to fully realize the potential benefits of LICUS.
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Affiliation(s)
- Sardar M. Z. Uddin
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY 11794, USA;
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Thomas Motyka
- Department of Osteopathic Manipulative Medicine, Campbell University, Buies Creek, NC 27506, USA;
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Draper DO, Best T. Critical survey and panel review of sustained acoustic medicine in the treatment of sports-related musculoskeletal injuries by professional sports athletic trainers. CURRENT ORTHOPAEDIC PRACTICE 2021; 32:139-145. [PMID: 36687557 PMCID: PMC9854278 DOI: 10.1097/bco.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The purpose of our study was two-fold. First, it was to discover American professional sports athletic trainers' (PSAT) use and opinions regarding the treatment with a small, portable ultrasound Sustained Acoustic Medicine (SAM) device on their athletes. Second, it was to discover the effectiveness of SAM treatment in their professional sports players (PSP). Methods There were two ways of collecting data from the PSATs. The first was by written survey. Questions included qualitative and quantitative feedback on SAM device use, clinical applications, and acceptance among PSP. The second part involved a panel discussion of four PSATs, who shared their personal experiences with SAM. Questions focused on the use of the technology, confidence level, manner of application, and communication with PSPs regarding the application of the SAM and recommended treatment protocols. Results The survey found that SAM is wearable, easy to use, comfortable, and that it can be used as a "go-to" device outside of the athletic training facility. PSATs reported an 87% satisfaction and increased confidence in the ability of SAM to accelerate the healing process. Thus, SAM was considered a recommended treatment for professional athletes to use as an adjunct therapy. PSATs agreed that SAM is one of the recommended choices as an adjunct therapy in multiple musculoskeletal injuries. Conclusions The survey and panel discussion concluded that SAM treatment is easy to use with no adverse effects and can be used at multiple stages of the healing process. Level of Evidence Level IV.
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Affiliation(s)
- David O. Draper
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Thomas Best
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami, Coral Gables, Florida
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Madzia A, Agrawal C, Jarit P, Petterson S, Plancher K, Ortiz R. Sustained Acoustic Medicine Combined with A Diclofenac Ultrasound Coupling Patch for the Rapid Symptomatic Relief of Knee Osteoarthritis: Multi-Site Clinical Efficacy Study. Open Orthop J 2020; 14:176-185. [PMID: 33408796 PMCID: PMC7784557 DOI: 10.2174/1874325002014010176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sustained Acoustic Medicine (SAM) is an emerging, non-invasive, non-narcotic, home-use ultrasound therapy for the daily treatment of joint pain. The aim of this multi-site clinical study was to examine the efficacy of long-duration continuous ultrasound combined with a 1% diclofenac ultrasound gel patch in treating pain and improving function in patients with knee osteoarthritis. METHODS The Consolidated Standards of Reporting Trials (CONSORT) were followed. Thirty-two (32) patients (18-males, 14-females) 54 years of average age with moderate to severe knee pain and radiographically confirmed knee osteoarthritis (Kellgren-Lawrence (KL) grade II/III) were enrolled for treatment with the SAM device and diclofenac patch applied daily to the treated knee. SAM ultrasound (3 MHz, 0.132 W/cm2, 1.3 W) and 6 grams of 1% diclofenac were applied with a wearable device for 4 hours daily for 1 week, delivering 18,720 Joules of ultrasound energy per treatment. The primary outcome was the daily change in pain intensity using a numeric rating scale (NRS 0-10), which was assessed prior to intervention (baseline, day 1), before and after each daily treatment, and after 1 week of daily treatment (day 7). Rapid responders were classified as those patients exhibiting greater than a 1-point reduction in pain following the first treatment. Change in Western Ontario McMaster Osteoarthritis Questionnaire (WOMAC) score from baseline to day 7 was the secondary functional outcome measure. Additionally, a series of daily usability and user experience questions related to devising ease of use, functionality, safety, and effectiveness, were collected. Data were analyzed using t-tests and repeated measure ANOVAs. RESULTS The study had a 94% retention rate, and there were no adverse events or study-related complaints across 224 unique treatment sessions. Rapid responders included 75% of the study population. Patients exhibited a significant mean NRS pain reduction over the 7-day study of 2.06-points (50%) for all subjects (n=32, p<0.001) and 2.96-points (70%) for rapid responders (n=24, p<0.001). The WOMAC functional score significantly improved by 351 points for all subjects (n=32, p<0.001), and 510 points for rapid responders (n=24, p<0.001). Over 95% of patients found the device safe, effective and easy to use, and would continue treatment for their knee OA symptoms. CONCLUSION Sustained Acoustic Medicine combined with 1% topical diclofenac rapidly reduced pain and improved function in patients with moderate to severe osteoarthritis-related knee pain. The clinical findings suggest that this treatment approach may be used as a conservative, non-invasive treatment option for patients with knee osteoarthritis. Additional research is warranted on non-weight bearing joints of the musculoskeletal system as well as different topical drugs that could benefit from improved localized delivery.Clinical Trial Registry Number: (NCT04391842).
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Affiliation(s)
- Alex Madzia
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Chirag Agrawal
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Paddy Jarit
- Sport and Orthopaedic Physical Therapy, Fairfield, CT 06824, USA
| | | | - Kevin Plancher
- Albert Einstein College of Medicine, Bronx, NY, New York, USA
- Weill Cornell Medical College, New York, NY 13053, USA
- Plancher Orthopaedics & Sports Medicine, New York, NY 13053, USA
| | - Ralph Ortiz
- Medical Pain Consultants, Dryden, NY 13053, USA
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Best TM, Petterson S, Plancher K. Sustained acoustic medicine as a non-surgical and non-opioid knee osteoarthritis treatment option: a health economic cost-effectiveness analysis for symptom management. J Orthop Surg Res 2020; 15:481. [PMID: 33076955 PMCID: PMC7574225 DOI: 10.1186/s13018-020-01987-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022] Open
Abstract
Background Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management. Methods A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost-effectiveness plot comparing SAM treatment vs. SOC was also generated using 1000 iterations of the model. Lastly, the incremental cost-effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC). Results Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8641 and 0.52 versus SOC at: $6281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-min session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2276. Incremental cost-effectiveness demonstrated that most of the time (84%) SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC. Conclusion In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤ $50,000, it appears that SAM is a cost-effective treatment for knee OA.
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Affiliation(s)
- Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami, Coral Gables, FL, USA.
| | | | - Kevin Plancher
- Orthopaedic Foundation, Stamford, CT, USA.,Department of Orthopaedics, Albert Einstein College of Medicine, New York, NY, USA.,Department of Orthopaedics, Weill Cornell Medical College, New York, NY, USA.,Plancher Orthopaedics & Sports Medicine, New York, NY, USA
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Papadopoulos ES, Mani R. The Role of Ultrasound Therapy in the Management of Musculoskeletal Soft Tissue Pain. INT J LOW EXTR WOUND 2020; 19:350-358. [DOI: 10.1177/1534734620948343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ultrasound is an invaluable physical modality widely used for diagnosis and therapy in humans and animals. It is noninvasive, atraumatic, and may be used repeatedly. As a therapeutic tool, ultrasound has been in use for some 6 decades. Therapeutic ultrasound (TUS) is used for the treatment of musculoskeletal disorders, including acute soft tissue injuries, overuse syndromes, as well as chronic orthopedic and rheumatologic conditions. The aim of this review was to investigate the clinical effectiveness of TUS in musculoskeletal acute and chronic pain, mainly through the control of inflammation and the promotion of soft tissue injury healing. Based on the evidence presented, TUS is clinically effective in some musculoskeletal soft tissue pain conditions, but due to conflicting results in some studies, no specific positive recommendations can be made, nor does it permit exclusion of TUS from clinical practice. In phonophoresis, TUS plays a significant role, without reported adverse effects. There is scope for improving the evidence base with better designed studies.
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Affiliation(s)
| | - Raj Mani
- Shanghai Jiao Tong University, Shanghai, China
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