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Colbath AC, Frye CW. Interactions Between Biologic Therapies and Other Treatment Modalities. Vet Clin North Am Equine Pract 2023; 39:515-523. [PMID: 37442732 DOI: 10.1016/j.cveq.2023.06.002] [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] [Indexed: 07/15/2023] Open
Abstract
Biologic therapies are becoming increasingly utilized by veterinarians. The literature regarding the interaction of biologic therapies with other therapeutics is still in its infancy. Initial studies have examined the effects of exercise, stress, various pharmaceutical interventions, extracorporeal shockwave, therapeutic laser, and hyperbaric oxygen on biologic therapies. Continued research is imperative as owners and veterinarians increasingly choose a multimodal approach to injury and illness. Further, understanding the effects of concurrently administered treatments and pharmaceuticals as well as the health status of the horse is imperative to providing the optimal therapeutic outcome.
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Affiliation(s)
- Aimee C Colbath
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, Box 30, Ithaca, NY 14853, USA.
| | - Christopher W Frye
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, 930 Campus Road, Box 25, Ithaca, NY 14853, USA
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2
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McCarrel TM. Equine Platelet-Rich Plasma. Vet Clin North Am Equine Pract 2023; 39:429-442. [PMID: 37550126 DOI: 10.1016/j.cveq.2023.06.007] [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] [Indexed: 08/09/2023] Open
Abstract
Platelet-rich plasma (PRP) is an orthobiologic therapy composed of platelets, leukocytes, red blood cells, and plasma proteins. PRP has been used for 20 years, but progress determining efficacy has been slow. The definitions and classification of PRP are reviewed, and the use of PRP for tendon, ligament, and joint disease is discussed with a focus on findings of basic science and clinical studies, platelet activation, concurrent administration of nonsteroidal anti-inflammatory drugs, and treatment complications. Finally, the advantages of platelet lysates and freeze-dried platelets are discussed. The promising results of a PRP lysate optimized for antibiofilm and antimicrobial properties are introduced.
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Affiliation(s)
- Taralyn M McCarrel
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA.
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3
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Kim H, Song I, Kang J, Yoo Y. Phase aberration correction for ultrasound imaging guided extracorporeal shock wave therapy (ESWT): Feasibility study. ULTRASONICS 2023; 132:107011. [PMID: 37071943 DOI: 10.1016/j.ultras.2023.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/27/2022] [Accepted: 04/08/2023] [Indexed: 05/03/2023]
Abstract
Image guidance of extracorporeal shock wave therapy (ESWT) is important to enhance its efficacy while lowering pain in patients. Real-time ultrasound imaging is an appropriate modality for image guidance, but its image quality substantially reduces due to severe phase aberration from the different speed of sound between soft tissues and a gel pad, which is utilized to control a therapeutic focal point in ESWT. This paper presents a phase aberration correction method for improving image quality in the ultrasound imaging guided ESWT. To correct an error from phase aberration, a time delay based on a two-layer model with different speeds of sound is calculated for dynamic receive beamforming. For the phantom and in vivo studies, a rubber type gel pad (i.e., 1400 m/s) with a specific thickness (3 or 5-cm) was placed on the top of soft tissue and full scanline RF data were acquired. In the phantom study, with phase aberration correction, image quality was highly increased compared to image reconstructions with a fixed speed of sound (i.e., 1540 or 1400 m/s), i.e., 1.1 vs. 2.2 and 1.3 mm in -6dB lateral resolution and 0.64 vs. 0.61 and 0.56 in contrast-to-noise ratio (CNR), respectively. From an in vivo musculoskeletal (MSK) imaging, the phase aberration correction method provided a clearly improved depiction of muscle fibers in a rectus femoris region. These results indicate that the proposed method enables effective imaging guidance of ESWT by improving image quality of ultrasound imaging in real-time.
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Affiliation(s)
- Hongnam Kim
- Department of Electronic Engineering, Sogang University, Seoul 04107, Korea
| | - Ilseob Song
- Medical Solutions Institute, Sogang University, Seoul 04107, Korea
| | - Jinbum Kang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, United States.
| | - Yangmo Yoo
- Department of Electronic Engineering, Sogang University, Seoul 04107, Korea; Medical Solutions Institute, Sogang University, Seoul 04107, Korea; Department of Biomedical Engineering, Sogang University, Seoul 04107, Korea.
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4
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Carr BJ. Regenerative Medicine and Rehabilitation Therapy in the Canine. Vet Clin North Am Small Anim Pract 2023; 53:801-827. [PMID: 36997410 DOI: 10.1016/j.cvsm.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Regenerative medicine is used in the canine to optimize tissue healing and treat osteoarthritis and soft tissue injuries. Rehabilitation therapy is also often implemented in the treatment and management of musculoskeletal conditions in the canine. Initial experimental studies have shown that regenerative medicine and rehabilitation therapy may work safely and synergistically to enhance tissue healing. Although additional study is required to define optional rehabilitation therapy protocols after regenerative medicine therapy in the canine, certain fundamental principles of rehabilitation therapy still apply to patients treated with regenerative medicine.
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Toner S, Crosby C. Pro-stride and extracorporeal shockwave therapy as treatment of lateral collateral desmopathy of the proximal interphalangeal joint in a Dutch Warmblood gelding. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2023; 64:268-274. [PMID: 36874545 PMCID: PMC9979729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
A 6-year-old chestnut Dutch Warmblood gelding was presented for right front lameness 1 mo after being cast in a stall at a 1.20-meter jumping event. Lameness work-up revealed mild lameness on the right and left front legs, with diffuse swelling over the right front pastern. Ultrasonic evaluation yielded suspicion of collateral desmopathy of the proximal interphalangeal joint that was subsequently confirmed via MRI. Two weeks after initial evaluation, the proximal and distal interphalangeal joints were injected with Pro-Stride Autologous Protein Solution, immediately followed by Extracorporeal Shockwave Therapy of the lateral and medial collateral ligaments. Follow-up at 2 and 3 mo after treatment revealed reduced joint effusion of the proximal and distal interphalangeal joints, as well as improved fiber organization of the associated collateral ligaments. This should inform practitioners that multimodal therapeutic treatments including biologics and stimulation of healing through sound waves can aid in ligamentous injuries in sport horses.
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Affiliation(s)
- Sara Toner
- University of Calgary, Faculty of Veterinary Medicine, 11877 85th Street NW, Calgary, Alberta T3R 1J3 (Toner); TD Equine Veterinary Group, 64134 198 Avenue W, Calgary, Alberta T1S 2W4 (Crosby)
| | - Candice Crosby
- University of Calgary, Faculty of Veterinary Medicine, 11877 85th Street NW, Calgary, Alberta T3R 1J3 (Toner); TD Equine Veterinary Group, 64134 198 Avenue W, Calgary, Alberta T1S 2W4 (Crosby)
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6
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Johnson SA, Richards RB, Frisbie DD, Esselman AM, McClure SR. Equine shock wave therapy ‐ where are we now? Equine Vet J 2022. [DOI: 10.1111/evj.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sherry A. Johnson
- Department of Clinical Sciences Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | | | - David D. Frisbie
- Department of Clinical Sciences Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
| | - Angie M. Esselman
- Department of Clinical Sciences Orthopaedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University Fort Collins Colorado USA
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7
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Carr BJ. Platelet-Rich Plasma as an Orthobiologic: Clinically Relevant Considerations. Vet Clin North Am Small Anim Pract 2022; 52:977-995. [PMID: 35562219 DOI: 10.1016/j.cvsm.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Platelet-rich plasma (PRP) is an autologous blood-derived product processed to concentrate platelets and the associated growth factors. PRP has been shown to be relatively well-tolerated and safe to use for a number of conditions in humans, equines, and canines. There are multiple commercial systems that have been validated for canine use. These systems use a variety of methodologies to produce a PRP product. However, PRP products have been shown to differ greatly between systems. Further study is needed to fully elucidate optimal component concentrations for various indications.
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Affiliation(s)
- Brittany Jean Carr
- The Veterinary Sports Medicine and Rehabilitation Center, 4104 Liberty Highway, Anderson, SC 29621, USA.
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8
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Use of the Shock Wave Therapy in Basic Research and Clinical Applications-From Bench to Bedsite. Biomedicines 2022; 10:biomedicines10030568. [PMID: 35327369 PMCID: PMC8944950 DOI: 10.3390/biomedicines10030568] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
Shock Waves (SW) are acoustic disturbances that propagate through a medium carrying the energy. These specific sonic pulses are composed of two phases—high positive pressure, a rise time < 10 ns, and a tensile wave. Originally Shock Waves were introduced to clinical practice as a part of the lithotripsy therapy focused on disrupting calcific deposits in the body. Since that time, shock wave therapy (SWT) has gone far beyond the original application related to the destruction of kidney stones. In this narrative Review, we present basic clinical applications of the SWT along with the potential therapeutic application in clinical practice.
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Rola P, Włodarczak A, Kulczycki JJ, Barycki M, Furtan Ł, Pęcherzewski M, Szudrowicz M, Włodarczak S, Doroszko A, Lesiak M. Efficacy and safety of shockwave intravascular lithotripsy (S-IVL) in calcified unprotected left main percutaneous coronary intervention - short-term outcomes. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:344-348. [PMID: 35126548 PMCID: PMC8802635 DOI: 10.5114/aic.2021.112524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Left main (LM) disease is associated with a large myocardial ischemic territory. Calcification with co-existing undilatable lesions is a predictor of poor clinical outcomes following LM percutaneous coronary interventions (PCI). AIM To evaluate the safety and efficiency of shockwave intravascular lithotripsy (S-IVL) in highly calcified LM diseases. MATERIAL AND METHODS The study population consisted of sixteen patients qualified for PCI - mainly males (81.3%) with coronary artery disease (CAD) treated with left main S-IVL PCI due to unsuccessful attempts of plaque modification with a non-compliant (NC) balloon catheter, or rotational devices. Clinical success was defined as effective stent delivery and deployment (with less than < 20% in-stent residual stenosis) with preserved coronary flow TIMI-3 (Thrombolysis in Myocardial Infarction) at the end of the procedure. RESULTS The most frequent indication for PCI was acute coronary syndrome (ACS) (62.5%). In these high-risk (average Syntax score 24) patients, clinical success of PCI was achieved in 100% of cases. In the short-term observation, we recorded two major adverse cardiac and cerebrovascular events (MACCE) including one fatal, acute stent thrombosis. CONCLUSIONS Our data suggest that the use of S-IVL is safe and effective as a bail-out strategy to manage LM lesions resistant to high-pressure NC balloon inflation. Despite encouraging initial results, future large studies with long-term observation are required to evaluate the safety and efficacy of S-IVL in LM stenosis.
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Affiliation(s)
- Piotr Rola
- Department of Cardiology, Provincial Specialized Hospital Legnica, Legnica, Poland
| | - Adrian Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Jan J. Kulczycki
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Matuesz Barycki
- Department of Cardiology, Provincial Specialized Hospital Legnica, Legnica, Poland
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital Legnica, Legnica, Poland
| | | | - Marek Szudrowicz
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Adrian Doroszko
- Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Maciej Lesiak
- 1 Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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10
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Fan T, Zhou X, He P, Zhan X, Zheng P, Chen R, Li R, Li R, Wei M, Zhang X, Huang G. Effects of Radial Extracorporeal Shock Wave Therapy on Flexor Spasticity of the Upper Limb in Post-stroke Patients: Study Protocol for a Randomized Controlled Trial. Front Neurol 2021; 12:712512. [PMID: 34566855 PMCID: PMC8459743 DOI: 10.3389/fneur.2021.712512] [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: 05/21/2021] [Accepted: 08/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Flexor spasticity of the upper limb is common in poststroke patients and seriously affects the recovery of upper limb function. However, there are no standard management protocols for this condition. Radial extracorporeal shock wave therapy (rESWT) is widely used for various diseases, some studies reported the effects of ESWT on reducing spasticity, but the mechanism of ESWT to reduce spasticity by affecting the excitability of stretch reflex or non-neural rheological components in spastic muscles or both is not yet clear. A large randomized controlled trial with comprehensive evaluation indicators is still needed. The study is to observe the effect of rESWT on flexor spasticity of the upper limb after stroke and explore its mechanism. Methods: A prospective, randomized, double-blind controlled trial is to be performed. One hundred participants will be recruited from the Inpatient Department of Zhujiang Hospital. Eligible patients will be randomly allocated to either receive three sessions of active rESWT (group A) or sham-placebo rESWT (group B) with 3-day intervals between each session. Assessment will be performed at baseline and at 24 h after each rESWT (t1, t2, and t3). The primary assessment outcome will be the Modified Ashworth Scale, and other assessments include surface electromyography, MyotonPRO digital muscle function evaluation, and infrared thermal imaging. All data will be analyzed using intention-to-treat principles. Multiple imputation by chained equations will be used to address missing data caused by loss to follow-up and nonresponses. Per protocol, analyses will also be performed on the participants who complete other assessments. Statistical analysis will be performed using SPSS software (version 20.0) and the significance level set at p < 0.05. Discussion: This trial aims to analyze the application of rESWT for the management of spasticity after stroke via appropriate assessments. We hypothesized that after receiving active rESWT, patients would show greater improvement of upper limb muscles compared with patients within the sham-placebo group. The rESWT would be an alternative to traditional methods, and the results of this study may provide support for the further study of potential mechanisms. Clinical Trial Registration:www.chictr.org.cn, identifier: ChiCTR1800016144.
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Affiliation(s)
- Tao Fan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Xiangying Zhou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peichen He
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaojia Zhan
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Zheng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rongdong Li
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rihui Li
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mingyang Wei
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xue Zhang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Guozhi Huang
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
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11
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Abstract
The goal of rehabilitation is to restore function and mobility and reduce pain associated with chronic disease. In human medicine, physical therapy is standard of care for acute and chronic injuries and an integral component of postoperative recovery. Although there is a dearth of evidence-based veterinary medical studies in rehabilitation therapy and modalities for forelimb injuries in dogs, some extrapolation from human medicine can be made and applied. When developing a rehabilitation and therapeutic plan, the biomechanics of the affected limb and timeline of tissue healing of the target tissue and/or joint are important to consider.
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Affiliation(s)
- Jennifer A Brown
- Florida Veterinary Rehabilitation and Sports Medicine, 11016 North Dale Mabry Highway, #202, Tampa, FL 33618, USA.
| | - Julia Tomlinson
- Twin Cities Animal Rehabilitation & Sports Medicine Clinic, 12010 Riverwood Drive, Burnsville, MN 55337, USA
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12
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Maleas G, Mageed M. Effectiveness of Platelet-Rich Plasma and Bone Marrow Aspirate Concentrate as Treatments for Chronic Hindlimb Proximal Suspensory Desmopathy. Front Vet Sci 2021; 8:678453. [PMID: 34222402 PMCID: PMC8253571 DOI: 10.3389/fvets.2021.678453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
This retrospective study aimed to evaluate the clinical effect of bone marrow aspirate concentrate (BMAC) and leukocyte rich PRP (LR-PRP) compared to horses undergoing controlled exercise alone in horses with >3 months proximal suspensory desmopathy in hindlimbs (HPSD). Nighty-three horses were divided into three groups according to the treatment: a control (n = 22), LR-PRP (n = 46), and BMAC (n = 25) group. Lameness and ultrasound scores were recorded before treatment (T0) and at 6 months (T1) post-treatment. Records horses considered sound at evaluation and level of performance were additionally registered at 12 months (T2) and 18 months (T3) after treatment. The BMAC cytology profiles from 22 horses were also analysed and compared to clinical outcomes. The results at T1 showed that 9% (2/22) of the horses in the control group were sound compared to 59% (25/46) and 84% (21/25) in the LR-PRP and BMAC groups, respectively. Additionally, ultrasound scores at T1 in the BMAC and LR-PRP groups were improved in comparison with the control group (p = 0.02). At T2, 68% of the horses in the BMAC group and 39% of the horses in the LR-PRP group had returned to the previous performance level. At T3, a significantly higher percentage of horses in the LR-PRP (43%) and BMAC (72%) group were sound when compared to the control (4.6%) group (p = 0.02). Similarly, at T3, significantly more horses of the BMAC (16/25) and of the LR-PRP (15/46) group had returned to the previous or a higher performance level compared to the control (1/22) group (p = 0.01). No correlation was found between long-term clinical outcome and cytology profiles in the BMAC group. In conclusion, long-term outcomes of treatment with LR-PRP or BMAC are significantly better than conventional treatment of the hindlimb chronic PSD in horses. Additionally, BMAC yielded better lameness scores than LR-PRP at short- and long-term follow-up.
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13
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Wei B, Lu J. Characterization of Tendon-Derived Stem Cells and Rescue Tendon Injury. Stem Cell Rev Rep 2021; 17:1534-1551. [PMID: 33651334 DOI: 10.1007/s12015-021-10143-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 12/12/2022]
Abstract
The natural healing ability of tendon is limited, and it cannot restore the native structure and function of tendon injuries. Tendon-derived stem cells (TDSCs) are a new type of pluripotent stem cells with multi-directional differentiation potential and are expected to become a promising cell-seed for the treatment of tendon injuries in the future. In this review, we outline the latest advances in the culture and identification of TDSCs. In addition, the influencing factors on the differentiation of TDSCs are discussed. Moreover, we aim to discuss recent studies to enhance TDSCs treatment of injured tendons. Finally, we identify the limitations of the current understanding of TDSCs biology, the main challenges of using their use, and potential therapeutic strategies to inform cell-based tendon repair.
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Affiliation(s)
- Bing Wei
- School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Jun Lu
- Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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14
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Chang CY, Chen LC, Chou YC, Li TY, Ho TY, Wu YT. The Effectiveness of Platelet-Rich Plasma and Radial Extracorporeal Shock Wave Compared with Platelet-Rich Plasma in the Treatment of Moderate Carpal Tunnel Syndrome. PAIN MEDICINE 2020; 21:1668-1675. [PMID: 31774510 DOI: 10.1093/pm/pnz309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate the combination effect of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) for moderate carpal tunnel syndrome (CTS), compared with PRP alone. DESIGN A randomized, double-blinded, placebo-controlled trial. SETTING A single medical center in Taiwan. PATIENTS Patients diagnosed with moderate CTS. INTERVENTIONS All subjects were administered one dose of ultrasound-guided PRP injection at baseline. After two weeks, one session of rESWT was completed in the intervention group, whereas the control group received one session of sham rESWT. Evaluations were performed at baseline and one, three, and six months post-PRP injection. OUTCOME MEASURES The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was measured as the primary outcome. Electrophysiological study and cross-sectional area (CSA) of the median nerve were used as secondary outcomes. RESULTS All 40 enrolled subjects (male/female: 4/36) completed the study, resulting in an analysis of 32 wrists per group (total: N = 64 wrists). Compared with the control group, the intervention group did not show statistically significantly superior outcomes, except in BCTQs at one month (mean change ± SE = -11.47 ± 1.18 vs -7.06 ± 1.26, P = 0.013) and distal motor latency at three months (mean change ± SE = -0.59 ± 0.09 vs -0.30 ± 0.09, P = 0.031). CONCLUSIONS Combined PRP and one-session rESWT was not superior to PRP alone in treating moderate CTS. Further studies with multiple sessions of ESWT and longer follow-up periods are needed to verify the clinical efficacy of ESWT.
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Affiliation(s)
- Chih-Ya Chang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Liang-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tsung-Yen Ho
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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15
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Colbath AC, Kisiday JD, Phillips JN, Goodrich LR. Can Extracorporeal Shockwave Promote Osteogenesis of Equine Bone Marrow-Derived Mesenchymal Stem Cells In Vitro ?. Stem Cells Dev 2019; 29:110-118. [PMID: 31744386 DOI: 10.1089/scd.2019.0202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Both bone marrow-derived mesenchymal stem cells (BMDMSCs) and extracorporeal shockwave (ESW) have shown promise for enhancing fracture repair. If exposure of BMDMSCs to ESW enhances osteogenic differentiation, these therapies may be combined in vivo or used as a method for preconditioning BMDMSCs. The objective of this study was to determine the effect of ESW on the osteogenic ability of equine BMDMSCs. We hypothesized that ESW would promote osteogenesis evidenced by increased gene expression, alkaline phosphatase (ALPL) expression, slide morphologic score, and protein expression. BMDMSCs were evaluated from six horses. BMDMSCs were culture expanded to passage 3, dissociated, then placed in conical tubes. Treatment cells ("shocked") were exposed to 500 pulses at 0.16 mJ/mm2 energy. Cells were then reseeded and grown in either growth medium or osteogenic medium. Cellular proliferation and trilineage potential were determined. Cellular morphology was scored and cells were harvested at 1, 3, 7, 14, and 21 days for rtPCR gene expression of osteogenic markers [osteonectin (ONT), osteocalcin (OCN), ALPL, collagen type 3 (COL3), and runt-related transcription factor 2 (RUNX2)]. Media supernatants were evaluated for secretion of BMP-2, VEGF, TGFβ, and PGE2 and cellular lysates were evaluated for ALPL production. There was no difference between the proliferative ability of shocked cells versus unshocked cells in either growth medium or osteogenic medium. ALPL production was greater in shocked cells maintained in osteogenic medium versus unshocked cells in osteogenic medium at day 3 (P < 0.005). Independent of media type, ESW caused a decrease in VEGF and TGFβ production at day 3. No significant increases in gene expression were identified by rtPCR. Exposure of BMDMSCs to ESW does not result in negative effects. An initial significant increase in ALPL was detected but no persistent osteogenic effect was observed with cell expansion.
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Affiliation(s)
- Aimee C Colbath
- Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, East Lansing, Michigan
| | - John D Kisiday
- C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado
| | - Jennifer N Phillips
- C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado
| | - Laurie R Goodrich
- Orthopedic Research Center at the C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
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16
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Giunta K, Donnell JR, Donnell AD, Frisbie DD. Prospective randomized comparison of platelet rich plasma to extracorporeal shockwave therapy for treatment of proximal suspensory pain in western performance horses. Res Vet Sci 2019; 126:38-44. [PMID: 31430578 DOI: 10.1016/j.rvsc.2019.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/17/2019] [Accepted: 07/31/2019] [Indexed: 01/11/2023]
Abstract
Proximal suspensory desmitis (PSD) is a frequent cause of lameness in the performance horse. Extracorporeal shockwave therapy (EST) and platelet rich plasma (PRP) have become common treatments for PSD yet clinical data on efficacy is limited. The main objective of this randomized, prospective clinical study was to compare long-term effectiveness of EST and PRP in Western performance horses. One hundred horses with lameness localized to the proximal suspensory ligament received treatment with either PRP or EST following baseline ultrasonographic evaluation. A veterinarian and agent evaluated the horses for lameness independently four days following the first treatment and long-term follow up was obtained from the agent at six and twelve months. Four days post treatment, horses treated with EST had significantly greater lameness improvement compared to PRP. At one-year horses with less severe baseline ultrasound changes (grades 0-1) appeared to respond better (degree of lameness) with EST treatment whereas horses with more severe ultrasound changes (grade 2) responded better to PRP. Horses with baseline lameness graded 1 or 2 were 5.1 times more likely to be back in work at 1 year compared to those presenting with grade 3 or 4. EST treatment was associated with going back to work 3.8 times more at one year compared to PRP independent of baseline ultrasound score. Both PRP and EST can be expected to yield favorable therapeutic responses in Western performance horses with lameness localized to the proximal suspensory region. Baseline ultrasound may guide treatment selection.
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Affiliation(s)
- Kelly Giunta
- Blue Ridge Equine Clinic, 4510 Mockernut Lane, Earlysville, VA 22936, USA.
| | - Josh R Donnell
- La Mesa Equine Lameness Center, 8386 FM 455E, Pilot Point, TX 76258, USA.
| | - Alan D Donnell
- La Mesa Equine Lameness Center, 8386 FM 455E, Pilot Point, TX 76258, USA.
| | - David D Frisbie
- Colorado State University, Equine Orthopaedic Research Center, 300 W Drake Road, Fort Collins, CO 80523, USA.
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Carrozzo U, Toniato M, Harrison A. Assessment of Noninvasive Low-Frequency Ultrasound as a Means of Treating Injuries to Suspensory Ligaments in Horses: A Research Paper. J Equine Vet Sci 2019; 80:80-89. [PMID: 31443840 DOI: 10.1016/j.jevs.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/12/2019] [Indexed: 01/09/2023]
Abstract
Therapeutic ultrasound is a noninvasive technique, which is well tolerated by horses, does not need sedation, and can easily be performed in a routine clinical setting. Twenty-three client-owned sport horses were recruited at Clinica Equina San Biagio and included in this case study. Treatment of the injured suspensory ligament apparatus was administered using an EQ Pro, low-frequency therapeutic unit (38 kHz). The noninvasive treatment consisted of massaging the injured area in combination with a traditional ultrasound gel while maintaining the head of the device in direct contact with the injured area. The results indicate that 20 of the 23 horses in this study benefitted from EQ Pro treatment and, following a routine rehabilitation program, returned to competition status: a success rate of 87%. Furthermore, treatment duration was 3.3 ± 0.4 weeks on average, with a healthy outcome as assessed by ultrasound at 6.8 ± 1.9 weeks. Among the 23 horses in this study, 65% of them benefitted from EQ Pro treatment of a duration of just ≤3.3 weeks. It is concluded that EQ Pro therapy is a promising and effective form of treatment for horses with suspensory ligament injury. It is furthermore rapid and easy to use in the Equine Veterinary Clinic setting and does not require sedation. Future studies should now focus on the mechanisms by which this new treatment activates the healing process of the suspensory ligaments of injured horses.
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Affiliation(s)
- Ugo Carrozzo
- Clinica Equina San Biagio, San Biagio di Argenta, FE, Italy.
| | - Matteo Toniato
- Clinica Equina San Biagio, San Biagio di Argenta, FE, Italy
| | - Adrian Harrison
- Department of Pathobiological Sciences, Faculty of Health & Medical Science, Copenhagen University, Frederiksberg C, Copenhagen, Denmark
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Comparative study of different anticoagulants and coagulants in the evaluation of clinical application of platelet-rich plasma (PRP) standardization. Cell Tissue Bank 2019; 20:61-75. [DOI: 10.1007/s10561-019-09753-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/30/2019] [Indexed: 12/18/2022]
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