Extracorporeal Shock Wave Therapy as Regenerative Medicine in Knee Osteoarthritis: Pre-Experiment for Matrix Metalloproteinase-3 Evaluation

BACKGROUND

Knee osteoarthritis (KOA) is currently treated by regenerative therapies that aim to inhibit arthritic degeneration. Extracorporeal shock wave therapy (ESWT) is one of the physical regenerative approaches used for KOA management. However, little is known regarding the impact of shock wave treatment on matrix metalloproteinase-3 (MMP-3), which is one of the enzymes mediating cartilage degradation.

OBJECTIVES

To evaluate the effect of ESWT on MMP-3 levels and pain intensity in patients with KOA.

METHODS

Fourteen patients diagnosed with Kellgren Lawrence, grades 2 and 3 KOA were recruited for the study. ESWT piezo shockwave was applied once a week for six weeks. MMP-3 levels in the blood were measured pre-test, mid-test (three weeks after therapy) and post-test (one week after the last session) by enzyme-linked immunosorbent assay (ELISA). The perceived pain was recorded at each session by the Wong Becker Face Scale.

RESULTS

The median pre-test, mid-test and post-test MMP-3 levels were 19.92 ng/mL, 15.89 ng/mL and 18.82 ng/mL, respectively, and there were significant differences between the pre-test and mid-test, and the pre-test and post-test values (p < 0.05). The pain scores also decreased significantly over the period of intervention.

CONCLUSION

MMP-3 levels decreased significantly in KOA patients after ESWT, and the decline was most obvious after 3 weeks of therapy. Therefore, EWST should be considered as a suitable treatment option for KOA.

Effect of Transcutaneous Auricular Vagus Nerve Stimulation Addition on Disability in Chronic Low Back Pain Patients: A Randomized Controlled Study

Background & objective: Low back pain is a common problem, especially in the young and middle-aged working people, and is often very resistant to the conventional management. We evaluated the impact of transcutaneous auricular vagus nerve stimulation (tVNS), applied in conjunction with an exercise treatment program, on disability in chronic low back pain patients. Methodology: The study was conducted from June to October 2022. Twenty-two patients aged 42.18 ± 9.91 y, with Numerical Pain Rating Scale (NPRS) score 5.64 ± 1.09 and Roland Morris Disability Questionnaire (RMDQ) score 10 ± 4.670, were randomly assigned to two groups. The control group received only exercise therapy (EXC group, n = 11), and the intervention group received exercise and tVNS therapy (EXC + tVNS group, n = 11). The primary outcome was RMDQ, measured before and after the intervention. Result: The mean RMDQ was significantly improved in both groups. In the intervention group the improvement was from 9.45 ± 4.44 to 2.18 ± 2.71 (P = 0.000), in the control group it was from 10.55 ± 5.05 to 2.36 ± 2.06 (P = 0.001). Inter-group comparison showed no significant difference. The effect size of the control group (2.12) was similar with the intervention group (1.98). Conclusion: Addition of 2-weeks tVNS to exercise therapy did not show superior effect on disability improvement compared to exercise only in chronic low back pain. Exercise alone was sufficient to improve the mean RMDQ. Abbreviations: CLBP: Chronic low back pain; EXC: Exercise; tVNS: Transcutaneous auricular vagus nerve stimulation; NPRS: Numerical pain rating scale; RMDQ: Roland Morris disability questionnaire Key words: Chronic low back pain; Disability; Exercise; Transcutaneous Auricular Vagus Nerve Stimulation Citation: Uzlifatin Y, Arfianti L, Wardhani IL,  Hidayati HB, Melaniani S. Effect of transcutaneous auricular vagus nerve stimulation in addition to exercise on disability in chronic low back pain patients: a randomized controlled study. Anaesth. pain intensive care 2022;27(1):73−81; DOI: 10.35975/apic.v27i1.2084 Received: December 07, 2022; Reviewed: December 28, 2022; Accepted: January 11, 2022

Cultural validation and language translation of the scientific SCI exercise guidelines for use in Indonesia, Japan, Korea, and Thailand

CONTEXT

Indonesia, Japan, Korea, Thailand.

OBJECTIVE

To culturally validate and translate the Scientific Exercise Guidelines for Adults with Spinal Cord Injury (SEG-SCI) for use in four Asian countries.

DESIGN

Systematic Review.

PARTICIPANTS

N/A.

METHODS

A systematic review was conducted to identify all published English- and local-language studies conducted in Indonesia, Japan, Korea, and Thailand, testing the effects of exercise training interventions on fitness and cardiometabolic health in adults with acute or chronic SCI. Protocols and results from high-quality controlled studies were compared with the SEG-SCI. Forward and backward translation processes were used to translate the guidelines into Bahasa Indonesian, Japanese, Korean and Thai languages.

RESULTS

Fifteen studies met the review criteria. At least one study from each country implemented exercise prescriptions that met or exceeded the SEG-SCI. Two were controlled studies. In those two studies, relative to control conditions, participants in exercise conditions achieved significant improvements in fitness or cardiometabolic health outcomes only when the exercise intervention protocol met or exceeded the SEG-SCI. During the language translation processes, end-users confirmed that SEG-SCI language and terminology were clear.

CONCLUSION

Clinical researchers in Indonesia, Japan, Korea and Thailand have implemented exercise protocols that meet or exceed the SCI-SEG. Results of high-quality studies align with the SEG-SCI recommendations. Based on this evidence, we recommend that the SEG-SCI be adopted in these countries. The cultural validation and translation of the SEG-SCI is an important step towards establishing consistent SCI exercise prescriptions in research, clinical and community settings around the world.

Effects of Otago Exercise Program on serum Interleukin-6 level in older women

Background

Otago Exercise Program (OEP) has been demonstrated to minimize the risk of falling in older adults by improving muscular strength and balance. Meanwhile, reduced IL-6 level serves as a biomarker of regular physical activity.

Objective

Analyzing OEP effect on decreased IL-6 level in elderly women.

Methods

This study used a randomized control trial design from October 2020 to May 2021. 26 participants were divided into a treatment group (13 participants) and a control group (13 participants). The treatment group received OEP for 8 weeks, in which the OEP was carried out 3 times during the first week. On the other hand, the control group did not get intervention. The IL-6 level was measured 2 times, before and after OEP. The measurement results were analyzed using paired t-test and independent t-test, which were declared significant if p < 0.05.

Results

The participants' average IL-6 level at pretest and posttest was 4.77 ± 1.71 pg/mL and 4.57 ± 1.74 pg/mL, respectively. The IL-16 level of the treatment group at pretest and posttest was 4.22 ± 1.72 pg/mL and 3.97 ± 1.67 pg/mL, respectively (t = 1.058; 95% CI = −0.770 – 0.267; p = 0.311). Meanwhile, the IL-6 level of the control group at pretest and posttest was 5.30 ± 1.59 pg/mL and 5.16 ± 1.65 pg/mL, respectively (t = 0.382; 95% CI = −0.969 – 0.680; p = 0.709). The ΔIL-6 level in the treatment and control group was −0.25 ± 0.85 pg/mL and −0.14 ± 1.36 pg/mL, respectively (t = 0.240; 95% CI = −1.030 – 0.815; p = 0.813).

Conclusion

The OEP didn't lower serum IL-6 levels after eight weeks.

•

Otago Exercise Program (OEP) is an easy exercise that increases physical activity.

•

The OEP can reduce interleukin-6 (IL-6) level when performed >8 weeks (3 x/weeks).

•

The OEP minimizes the risk of fractures in elderly women.

Correlation between Fatigue and Ability to Perform Activities of Daily Living in Myasthenia Gravis Patients

BACKGROUND: Myasthenia Gravis (MG) is an autoimmune disease of the neuromuscular junction that has autoantibodies that can be found in most cases. Fatigue and skeletal muscle weakness are the pathognomonic symptoms of MG and can be severely disabling, interfering with a patient’s ability to pursue activities of daily living, limiting their work, family, and social lives. AIM: This study aimed to analyze the correlation between fatigue and the ability to perform activity of daily living (ADL) among patients with MG. METHOD: Fatigue severity scale (FSS) was used to measure the fatigue and MG-ADL scale was used to evaluate the patient’s ability to perform ADL. Rank-Spearman test was used to assess the correlation between fatigue and patient’s ability to perform daily activities. RESULTS: Thirty-one patients (nine males and 22 females) with MG were included and classified into three subgroups of fatigue: Non-fatigue (FSS <4), borderline (4 < FSS < 5), and fatigue (FSS >5). There was a significant correlation between fatigue and the patient’s ability to perform ADL (p = 0.005; p = 0.488) with CI 95%. CONCLUSION: Fatigue in patients with MG correlates with the ability to perform ADL.

High-Fat Diet Increases Serum HDL, but Not for LDL and HDL/LDL Ratio in MICE

The use of a ketogenic diet with an increased proportion of fat is rampant lately, both as a therapy or even lifestyle. The use of a ketogenic diet is feared to cause dyslipidemia. It will also lead to atherosclerosis and thrombosis. This study aimed to determine the effect of a high-fat diet on HDL, LDL, and HDL/LDL ratio in mice. Thirty male Mus Musculus, 2-3 mo, 15-25 g divided into five groups diet. K1 (12% fat, 20% protein, 62% carb), K2 (30% fat, 60%protein), K3 (45% fat, 45% protein), K4 (60% fat, 30% protein) and K5 (75% fat, 15% protein) for 4 weeks. Feed and water by adlibitum. Blood for serum was taken from the ventricle, while in the measurement of HDL serum level, the LDL used ELISA. Normality of data analyzed by Shapiro Wilk, and homogeneity by Levene test. HDL serum was analyzed using equality test followed by Games Howell, LDL serum and ratio of HDL/LDL was tested by ANOVA followed by LSD with significance 0,05. HDL serum in K1 (62,50±9.94) mg/dL, K2 (78,40±18,76) mg/dL, K3 (79,00±3,81) mg/dL, K4 (80,00±2,16) mg/dL, and K5 (83,50±5,62) mg/dL with p<0,05 in K1, K2 to K3, K4 and K5. LDL serum in K1 (21,67± 4,80) mg/dL, K2 (23,00±12,70) mg/dL, K3 (18,40±4,34) mg/dL, K4 (24,00 ±1,83) mg/dL and K5 (22,00 ± 4,08) mg/dL with p>0,05. Ratio HDL/LDL K1 (3,01±0,91), K2 (4,10±1,86), K3 (4,53±1,5), K4 (3,35±0,34), and K5 (3,96 ± 1,25) with p>0,05.

The impact of child care on child development in daycare and at home

Background: The insufficient amount of time allocated by working parents is one of the causes of reduced interaction between parents and children. Consequently, the solution of entrusting children to daycare centres remains a choice. The development of children aged 3–72 months is extremely significant because the brain volume develops to reach 95% of the adult brain volume. This makes the stimulation provided by caregivers extremely important. This study aimed to identify differences in the development of children entrusted to daycare centres compared to the home care. Methods: The study was performed in Surabaya, Indonesia. The total sample was divided into 2 groups of children aged 3–72 months, one group was cared for at home, and the other in the daycare setting. The subjects were assessed using Indonesia’s Prescreening Developmental Questionnaire (PDQ) to determine their development. The assessment was conducted twice, with the second evaluation taking place 6 months after the first analysis. Results: We analysed data from 193 children. The children cared for at home differed significantly (53.3%) from the children entrusted to daycare centres (38.8%) in the first assessment, while in the second assessment 44.4% of the former group experienced a disruption of their personal-social skills, compared 38.8% in the latter. Gross motor and speech-language skills changed significantly improved in 6 months’ evaluations. Conclusion: There were no differences between the development of children being cared for at home and those that were entrusted to daycare centres over 6 months of continuous evaluation.

THE EXPRESSION OF TGF-1 AFTER LOW LEVEL LASER THERAPY IN INFLAMMATION ANIMAL MODEL

Pain is the most common complaints in everyday practice. Pain is a clinical manifestation caused by stimuli due to potential tissue damage. Low level laser therapy (LLLT) has been used in reducing pain. One of indicator tissue healing is activation of transforming growth factor -b1(TGF-b1). Tissue healing will eliminate the pain. Do LLLT stimulate TGF-b1 expression? The objective of this study was to investigate the expression of TGF-b1 in low level laser therapy. Thirty male Wistar rats, body weight 250 – 300 gram, 3 month old, were divided into 3 groups, negative control (n=10), positive control (n=10) and treatment groups (n=10). The positive control and treatment groups were injected with Complete’s Freund Adjuvant (CFA) 100 mL at left footpad. The treatment group treated with low level laser therapy Lasermed type 2100 wavelength 905 nm, out power 25-500 mW, dose 1 joule/cm2;5 times with interval 24 hours on left footpad. Samples were taken from the skin of footpad and immunohistochemical examination with monoclonal antibody anti- TGF-b1. Calculations carried out on brown reaction in macrophage cell. Data were analyzed using the Games Howell with SPSS 17. There were significant differences in the expression of TGF-b1 in treatment group (15.8±3.1) compared with the positive control group (3.9±1.1) and negative control group (4.6±2.1). There were no significant differences between expression TGF-b1 in positive control group and negative control group. In conclusion, low level laser therapy increased the expression of TGF-b1.