Instrumented assisted soft tissue mobilization vs extracorporeal shock wave therapy in treatment of myofascial pain syndrome

BACKGROUND Active myofascial trigger points(TrPs)often occur in the upper region of the upper trapezius(UT)muscle.These TrPs can be a significant source of neck,shoulder,and upper back pain and headaches.These TrPs and their related pain and disability can adversely affect an individual’s everyday routine functioning,work-related productivity,and general quality of life.AIM To investigate the effects of instrument assisted soft tissue mobilization(IASTM)vs extracorporeal shock wave therapy(ESWT)on the TrPs of the UT muscle.METHODS A randomized,single-blind,comparative clinical study was conducted at the Medical Center of the Egyptian Railway Station in Cairo.Forty patients(28 females and 12 males),aged between 20-years-old and 40-years-old,with active myofascial TrPs in the UT muscle were randomly assigned to two equal groups(A and B).Group A received IASTM,while group B received ESWT.Each group was treated twice weekly for 2 weeks.Both groups received muscle energy technique for the UT muscle.Patients were evaluated twice(pre-and posttreatment)for pain intensity using the visual analogue scale and for pain pressure threshold(PPT)using a pressure algometer.RESULTS Comparing the pre-and post-treatment mean values for all variables for group A,there were significant differences in pain intensity for TrP1 and TrP2(P=0.0001)and PPT for TrP1(P=0.0002)and TrP2(P=0.0001).Also,for group B,there were significant differences between the pre-and post-treatment pain intensity for TrP1 and TrP2 and PPT for TrP1 and TrP2(P=0.0001).There were no significant differences between the two groups in the post-treatment mean values of pain intensity for TrP1(P=0.9)and TrP2(P=0.76)and PPT for TrP1(P=0.09)and for TrP2(P=0.91).CONCLUSION IASTM and ESWT are effective methods for improving pain and PPT in patients with UT muscle TrPs.There is no significant difference between either treatment method.

Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis:A systematic review and metaanalysis

BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA.METHODS We searched PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar from inception to September 20,2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA.The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data analyses were performed using Review Manager 5.0 software.RESULTS A total of 341 articles were screened from five electronic databases(PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar)after excluding duplicates.Ultimately,eight trials involving 471 subjects were included in present systematic review and meta-analysis.The mean PEDro scale score was 6.6.Mulligan mobilization was more effective in alleviating pain[standardized mean difference(SMD)=0.60;95%confidence interval(CI):0.17 to 1.03,P=0.007;I2=60%,P=0.020]and improving Western Ontario and McMaster Universities function score(SMD=7.41;95%CI:2.36 to 12.47,P=0.004;I2=92%,P=0.000).There was no difference in the effect of the two kinds of mobilization on improving the range of motion(SMD=9.63;95%CI:-1.23 to 20.48,P=0.080;I2=97%,P=0.000).CONCLUSION Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.

Effectiveness of exercise in hepatic fat mobilization in nonalcoholic fatty liver disease: Systematic review

AIM: To investigate the efficacy of exercise interventions on hepatic fat mobilization in non-alcoholic fatty liver disease(NAFLD) patients.METHODS: Ovid-Medline, Pub Med, EMBASE and Cochrane database were searched for randomized trials and prospective cohort studies in adults aged ≥ 18 which investigated the effects of at least 8 wk of exercise only or combination with diet on NAFLD from 2010 to 2016. The search terms used to identify articles, in which exercise was clearly described by type, duration, intensity and frequency were: "NASH", "NAFLD", "nonalcoholic steatohepatitis", "non-alcoholic fatty liver disease", "fat", "steatosis", "diet", "exercise", "MR spectroscopy" and "liver biopsy". NAFLD diagnosis, as well as the outcome measures, was confirmed by either hydrogen-magnetic resonance spectroscopy(H-MRS) or biopsy. Trials that included dietary interventions along with exercise were accepted if they met all criteria. RESULTS: Eight studies met selection criteria(6 with exercise only, 2 with diet and exercise with a total of 433 adult participants). Training interventions ranged between 8 and 48 wk in duration with a prescribed exercise frequency of 3 to 7 d per week, at intensities between 45% and 75% of VO2 peak. The most commonly used imaging modality was H-MRS and one study utilized biopsy. The effect of intervention on fat mobilization was 30.2% in the exercise only group and 49.8% in diet and exercise group. There was no difference between aerobic and resistance exercise intervention, although only one study compared thetwo interventions. The beneficial effects of exercise on intrahepatic triglyceride(IHTG) were seen even in the absence of significant weight loss. Although combining an exercise program with dietary interventions augmented the reduction in IHTG, as well as improved measures of glucose control and/or insulin sensitivity, exercise only significantly decreased hepatic lipid contents.CONCLUSION: Prescribed exercise in subjects with NAFLD reduces IHTG independent of dietary intervention. Diet and exercise was more effective than exercise alone in reducing IHTG.

An elasto-plastic constitutive model for soft rock considering mobilization of strength

A new elasto-plastic constitutive model is presented in the framework of plasticity theory. The strength characteristics of a diatomaceous soft rock is investigated. The friction angle and cohesion of soft rock are mobilized as a function of plastic strain. A hyperbolic hardening function for the mobilized friction and a mixed parabolic and exponential equation for the mobilized cohesion are proposed. In view of the unified strength theory and the mobilizations of strength components, a yield function is given. A plastic potential function is determined by using the non-associated plastic flow rule. An elasto-plastic constitutive model is developed and verified. The results indicate that the proposed model can predict the behavior of soft rock accurately. The advantages of the proposed constitutive model are analyzed. The evidences support that the proposed constitutive model is a mixed hardening/softening model. A hump hardening/softening function for mobilized friction is extended to a more generalized condition.

Chinese preparation Xuesaitong promotes the mobilization of bone marrow mesenchymal stem cells in rats with cerebral infarction

After cerebral ischemia, bone marrow mesenchymal stem cells are mobilized and travel from the bone marrow through peripheral circulation to the focal point of ischemia to initiate tissue regeneration. However, the number of bone marrow mesenchymal stem cells mobilized into peripheral circulation is not enough to exert therapeutic effects, and the method by which blood circulation is promoted to remove blood stasis influences stem cell homing. The main ingredient of Xuesaitong capsules is Panax notoginseng saponins, and Xuesaitong is one of the main drugs used for promoting blood circulation and removing blood stasis. We established rat models of cerebral infarction by occlusion of the middle cerebral artery and then intragastrically administered Xuesaitong capsules（20, 40 and 60 mg/kg per day） for 28 successive days. Enzyme-linked immunosorbent assay showed that in rats with cerebral infarction, middle- and high-dose Xuesaitong significantly increased the level of stem cell factors and the number of CD117-positive cells in plasma and bone marrow and significantly decreased the number of CD54-and CD106-positive cells in plasma and bone marrow. The effect of low-dose Xuesaitong on these factors was not obvious. These findings demonstrate that middle- and high-dose Xuesaitong and hence Panax notoginseng saponins promote and increase the level and mobilization of bone marrow mesenchymal stem cells in peripheral blood.

Bio-Mobilization of Potassium from Clay Minerals: I. By Ectomycorrhizas

A pot experiment was carried out to investigate effect of ectomycorrhizal fungi on eucalyptus growth and K bio-mobilization from soils and clay minerals. In the experiment, sands mixed with soil, KCI-saturated vermiculate and mica, respectively, were used to nurse eucalyptus seedlings which were nonectomycorrhized or ectomycorrhized by an ectomycorrhizal fungus Pisolithus tinctorius strain XCI (Pt XC1) isolated from a forest soil from Xichang, Sichuan Province, China, and a worldwide well-known ectomycorrhizal fungus Pisolithus tinctorius strain 2144 (Pt 2144) obtained in Australia. More depletion of HCl-soluble K by mycorrhizas from the soil and minerals than nonmycorrhizas suggested that mycorrhizas had a great ability to mobilize K present in the interlayer and feldspar. Mycorrhizal seedlings depressed greatly K digested with HF-HCIO4 from substrates after consecutive extractions of soils and minerals by water, ammonium cetate and boiling HCl, while nonmycorrhizal seedlings reduced it little if any, showing that the mycorrhizal seedlings could mobilize and then utilize the structural K in mineral lattice. Ectomycorrhizal fungi played a very important role not only in promoting the growth of eucalyptus seedlings but also in mobilizing K in soils and minerals. The infection of Pt XC1 led to a better growth of eucalyptus seedlings and more K accumulation in the seedlings than that of Pt 2144. The large differences in K accumulation by the seedlings might be due to different abilities of the two ectomycorrhizal fungi to mobilize K in interlayer and lattice pools in the clay minerals.

Mobilization of Phosphorus by Naturally Occurring Or－ganic Acids in Oxisols and Ultisols

Citric and malic acids at concentrations of 0.1, 1.0, 10, and 100 mmol/L were added to three Ultisolsand one Oxisol. The amount of P in solution increased with increasing organic acid concentrations, while theaniount of Fe- and Al-bound P decreased. This result suggested that naturally occurring products of organicmatter decomposition could increase the P availability to plants in soils where there is a relatively large poolof Fe- and Al-bound P.The interactions between citric and malic acids at the above concentrations. and P added at rates of10, 20, 40, and 80 mg/kg were determined. At zero levels of organic acids, all added P became either labileor bound, and greater proportions remained soluble as the concentration of organic acids increased, whichsuggested that organic acids reduced fixation of dissolved P in Fe- and AI-rich soils.Agricultural practices which increase organic matter input on P-deficient acid soiIs could decrease Pdeficiency. This would be important in many tropical and subtropical regions where these soils are common,and where the costs of fertilizers and lime are relatively high.

Autologous peripheral blood stem cell mobilization following dose-adjusted cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy alone or in combination with rituximab in treating high-risk non-Hodgkin's lymphoma

Background: The regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone(CHOP) is an eicient treatment of non-Hodgkin's lymphoma(NHL). This study aimed to assess the eicacy and toxicity of dose-adjusted CHOP alone or in combination with rituximab(R-CHOP) by examining the stem cell mobilization in NHL patients. Factors afecting the collection of CD34+ cells were also explored.Methods: Our retrospective study included 39 patients eligible for autologous stem cell transplantation: 14 patients who expressed CD20 and were inancially eligible received R-CHOP for autologous peripheral blood stem cell(APBSC) mobilization; the remaining 25 patients received CHOP.Results: The median CD34+ cell yield was 7.01 × 106 cells/kg body weight(range 1.49–28.39 × 106 cells/kg body weight), with only two patients failing to meet the target CD34+ cell harvest of ber of apheresis procedures per patient was 1(range 1–3). The≥2.0 APBS× 106 cells/kg body weight. The median numC mobilization yield of the CHOP group appeared to be higher than that of the R-CHOP group(P response(CR) rate in = 0.005), whereas the success rate was similar between groups. R-CHOP elevated the completeB cell lymphoma patients as compared with CHOP(P = 0.01). No signiicant diferences in toxicity or engraftment were observed between the two groups.Conclusion: The present study demonstrated that dose-adjusted CHOP chemotherapy efectively mobilized APBSCs in NHL patients and that the addition of rituximab to dose-adjusted CHOP chemotherapy elevated the CR rate for patients with B-cell lymphoma.

Stem Reserve Mobilization and Sink Activity in Wheat under Drought Conditions

The effect of water deficit on stem reserve mobilization and sink activity in wheat (Triticum aestivum L.) cultivars, viz., C306 (drought tolerant) and PBW343 (drought sensitive) was studied. Drought was maintained in pot raised plants by withholding irrigation at 95 days after sowing (DAS), i.e. just five days before the initiation of anthesis. Drought induced a significant reduction in mean biomass of all the internodes of sensitive cultivar as compared to those of tolerant one. Mobilized dry matter and mobilization efficiency were observed to be higher in the internodes of tolerant cultivar, both under control and stress conditions, which resulted in enhanced translocation of stem reserves to the grains. Water soluble carbohydrates (WSC), which mainly occur as fructans, were observed to be higher in the internodes of tolerant cultivar than those of sensitive one. When drought was applied, fructans were mobilized more effectively from the internodes of tolerant cultivar. A significantly higher sucrose synthase activity in the grains of tolerant cultivar, under drought conditions, increased the sink strength by unloading the assimilates in the sink, thereby increasing further mobilization of assimilates to the grains. Grains of sensitive cultivar attained maturity much earlier as compared to the tolerant one, both under control and stress conditions. The longer duration of grain maturation in tolerant cultivar supported enhanced mobilization of stem reserves, thus restricting heavy decrease in grain yield, under stress conditions, as compared to the sensitive cultivar. It may, therefore, be concluded that certain characteristics viz., enhanced capability of fructan storage, higher mobilization efficiency, stronger sink activity and longer duration of grain maturation might help the drought tolerant cultivar in coping the stress

Nonlinear criterion for strength mobilization in brittle failure of rock and its extension to the tunnel scale

As underground excavations are getting deeper and field stresses increase, the behavior of intact rock blocks plays an increasingly important role in understanding and estimating the overall rock mass strength. To model the brittle behavior of intact rock blocks, the stress–strain curve is usually idealized considering a linear strength mobilization approach(cohesion-weakening-friction-strengthening, CWFS),however, it is well recognized that rock presents a nonlinear behavior in terms of the confining stress.This study extends the strength mobilization in brittle failure of rock using nonlinear criteria. To determine the model parameters, a standard statistical method that uses the complete laboratory stress–strain curves of the intact rock is employed. Several hypotheses of linear and nonlinear models are statistically compared for different types of rock and confining stress levels. Results demonstrate that the best approach to model the brittle failure of rock is to consider a nonlinear strength envelope, such as the Hoek-Brown criterion assuming a residual uniaxial compressive strength different from zero and a mi parameter that increases, both with simultaneous mobilization. This model helps to recreate highconfining conditions and a more realistic transition between peak and post-peak strength. The obtained parameters are discussed and compared with literature values to verify the validity and to develop guidelines for the estimation of parameters, providing an objective mobilization criterion. Finally, the nonlinear model was applied to a finite element code and extended to a tunnel scale in the brittle rock under high-stress conditions. A reasonable fit between the simulations and the in-situ overbreak measurements was found.

Brassinosteroid and gibberellin coordinate rice seed germination and embryo growth by regulating glutelin mobilization

Seed germination is the beginning of a new lifecycle,and involves many complex physiological and biochemical reactions including seed reserve mobilization in the endosperm and nutrient transport and reuse in the embryo.Although glutelin is a dominant storage protein in rice,its contribution to seed germination and its regulatory mechanisms are mostly unknown.Gibberellin (GA) and brassinosteroid (BR),two major growth-promoting phytohormones,also play positive roles in controlling seed germination.However,how GA and BR interact and coordinate seed germination and facilitate glutelin mobilization remains unclear.In the present study,biochemical and physiological analyses of seed germination indicated that both GA and BR promote seed germination and post-germination growth.Exogenous application of GA restored germination defects caused by BR deficiency or insensitivity.Proteomic and q RT-PCR results showed that the expression of several glutelin proteins and their encoding genes was induced by BR and GA in the embryo.Expression assays suggested that the increased accumulation of glutelin protein in the embryo was due to the accelerated degradation of glutelin by a cysteine proteinase (REP-1) in the endosperm.The breakdown of glutelin in the endosperm showed a strict positive correspondence with the length of the shoot.The GluA2 mutation led to reduced degradation rate of glutelin and defects in seed germination,and the promotion effect of GA on seed germination was weakened in the glua2mutant.In vitro culture assay of rice embryos showed that glutelin mobilization functioned downstream of the GA and BR pathways to promote shoot elongation.These findings suggest a mechanism that mediates crosstalk between BR and GA in co-regulating rice seed germination and embryo growth.

Mobilization of Peripheral Blood Stem Cells Using Regimen Combining Docetaxel with Granulocyte Colony-stimulating Factor in Breast Cancer Patients

Objective：To evaluate the effectiveness and safety of the mobilization of peripheral blood hematopoietic stem cells by combining docetaxel with granulocyte colony-stimulating factor（G-CSF） in breast cancer patients.Methods：A total of 57 breast cancer patients were treated with docetaxel 120 mg/m2.When the white blood cell（WBC） count decreased to 1.0×109/L,patients were given G-CSF 5-g/kg daily by subcutaneous injection until the end of apheresis.Peripheral blood mononuclear cells（MNC） were isolated by Cobe Spectra Apheresis System.The percentage of CD34＋ cell was assayed by flow cytometry.Results：At a median 6 of days（range 3-8） after the administration of docetaxel,the median WBC count decreased to 1.08×109/L（range 0.20-2.31）.The median duration of G-CSF mobilization was 3 days（range 2-7）.The MNC collection was conducted 8-12 days（median 10 days） after docetaxel treatment.The median MNC was 5.35×108/kg（range 0.59-14.07）,the median CD34＋ cell count was 2.43×106/kg（range 0.16-16.69）.The CD34＋ cell count was higher than 1.00×106/kg in 47 of 57 cases（82.46%） and higher than 2.00×106/kg in 36 cases（63.16%）.The CD34＋ cell count was higher than 2.00×106/kg in 27 collections（23.68%）.The MNC count and the CD34＋ cell count were correlated with the bottom of WBC after docetaxel chemotherapy（r=0.364,0.502,P=0.005,0.000）.The CD34＋ cell count was correlated with the MNC count（r=0.597,P=0.000）.The mobilization and apheresis were well tolerated in all patients.Mild perioral numbness and numbness of hand or feet were observed in 3 cases.No serious adverse events were reported.Conclusion：Mobilization of peripheral blood hematopoietic stem cell by combining docetaxel with G-CSF was effective and safety in breast cancer patients.

Evolution of deformation property and strength component mobilization for thermally treated Beishan granite under compression

The cohesion weakening and friction strengthening(CWFS)model for rock reveals the strength components mobilization process during progressive brittle failure process of rock,which is very helpful in understanding mechanical properties of rock.However,the used incremental cyclic loading−unloading compression test for the determination of strength components is very complicated,which limits the application of CWFS model.In this paper,incremental cyclic loading−unloading compression test was firstly carried out to study the evolution of deformation and the strength properties of Beishan granite after various temperatures treated under different confining pressures.We found the axial and lateral unloading modulus are closely related to the applied stress and damage state of rock.Based on these findings,we can accurately determine the plastic strain during the entire failure process using conventional tri-axial compression test data.Furthermore,a strength component(cohesive and frictional strength)determination method was developed using conventional triaxial compression test.Using this method,we analyzed the variation of strength mobilization and deformation properties of Beishan granite after various temperatures treated.At last,a non-simultaneous strength mobilization model for thermally treated granite was obtained and verified by numerical simulation,which demonstrated the effectiveness of the proposed strength determination method.

Impact of parathyroid hormone on bone marrow-derived stem cell mobilization and migration

Parathyroid hormone(PTH) is well-known as the principal regulator of calcium homeostasis in the human body and controls bone metabolism via actions on the survival and activation of osteoblasts. The intermittent administration of PTH has been shown to stimulate bone production in mice and men and therefore PTH administration has been recently approved for the treatment of osteoporosis. Besides to its physiological role in bone remodelling PTH has been demonstrated to influence and expand the bone marrow stem cell niche where hematopoietic stem cells, capable of both self-renewal and differentiation, reside. Moreover, intermittent PTH treatment is capable to induce mobilization of progenitor cells from the bone marrow into the bloodstream. This novel function of PTH on modulating the activity of the stem cell niche in the bone marrow as well as on mobilization and regeneration of bone marrow-derived stem cells offers new therapeutic options in bone marrow and stem cell transplantation as well as in the field of ischemic disorders.

Radix Ilicis Pubescentis total flavonoids combined with mobilization of bone marrow stem cells to protect against cerebral ischemia/reperfusion injury

Previous studies have shown that Radix Ilicis Pubescentis total flavonoids have a neuroprotective effect, but it remains unclear whether Radix Ilicis Pubescentis total flavonoids have a synergistic effect with the recombinant human granulocyte colony stimulating factor-mobilized bone marrow stem cell transplantation on cerebral ischemia/reperfusion injury. Rat ischemia models were administered 0.3, 0.15 and 0.075 g/kg Radix Ilicis Pubescentis total flavonoids from 3 days before modeling to 2 days after injury. Results showed that Radix Ilicis Pubescentis total flavonoids could reduce pathological injury in rats with cerebral ischemia/reperfusion injury. The number of Nissl bodies increased, Bax protein expression decreased, Bcl-2 protein expression increased and the number of CD34-positive cells increased. Therefore, Radix Ilicis Pubescentis total flavonoids can improve the bone marrow stem cell mobilization effect, enhance the anti-apoptotic ability of nerve cells, and have a neuroprotective effect on cerebral ischemia/reperfusion injury in rats.

Molecular mechanism of non-alcoholic fatty liver disease induced and aggravated by chronic stress through HSL/ATGL-FFA which promotes fat mobilization

Objective:To study the effects of social stress(CS)and social stress combined with high-fat diet on fat mobilization as a candidate mechanism for the induction or aggravation of non-alcoholic fatty liver disease(NAFLD).Methods:Thirty-two male Wistar rats(250±10 g)were randomly allocated to a blank control group(BC),a high-fat diet group(HFD),a CS group,and a combined CS and high-fat diet group(CS t HFD).Rats were sacrificed and tissues were collected after 8 weeks.Liver and body mass were measured and used to calculate the liver index.Serum aspartate aminotransferase(AST),alanine aminotransferase(ALT),and free fatty acids(FFAs)were measured.Liver sections were examined microscopically after oil red O and hematoxylin and eosin staining.The relative mRNA expression of acetyl-CoA carboxylase(ACCase),hydroxymethylglutaryl coenzyme A(HMG-CoA)reductase in liver,and hormone-sensitive lipase(HSL),and adipose triglyceride lipase(ATGL)in subcutaneous adipose tissue,were measured by real-time PCR.The liver concentrations of triglyceride,reactive oxygen species,and ACCase were measured by ELISA and HSL activity was determined using turbidimetry.Results:NAFLD developed in the CS,HFD,and CS t HFD groups,with the most severe NAFLD being in the CS t HFD group.Serum AST,ALT,and FFA,liver index,and hepatic triglyceride,FFA,and tumor necrosis factor-a were significantly higher in both the CS and CS t HFD groups.However,food intake and ACCase mRNA expression were lower.The mRNA expression of HSL and ATGL in adipose tissue was much higher,and HSL activity was higher in the CS group than in the BC group,and in the CS t HFD group than in the HFD group.Conclusion:We have successfully established two models of stress-induced NAFLD,suggesting stress can induce and aggravate NAFLD by promoting fat mobilization through upregulation of HSL and ATGL.

Hydrogeochemical characteristics and its role in controlling arsenic mobilization in a shallow aquifer

The relevance of groundwater hydrogeochemistry to explain the occurrence and distribution of arsenic in groundwater is of great interest.The insightful discussions on the control of shallow groundwater(<50 m)hydrogeochemistry in arsenic mobilization are known to be a viable tool to explain the arsenic menace in shallow groundwater.The present investigation emphasizes the hydrogeochemical driver and/or control over the reductive dissolution of Fe-bearing host minerals and thereby releasing arsenic into the shallow groundwater of the study area.The study suggests that hydrogeochemical evolution is mainly governed by carbonate minerals dissolution,silicate weathering,and competitive ion-exchange processes in the shallow aquifers(<50 m).The present study also indicates the prevalence of carbonate minerals dissolution over silicate weathering.The emergence of Cl^(-)concentration in the shallow groundwater founds the possibilities of anthropogenic inputs into the shallow aquifers(<50 m).The reducing environment in shallow aquifers(<50 m)of the study area is evident in the reductive dissolution of Febearing shallow aquifer minerals which absorb arsenic in the solid phase and mobilize arsenic onto shallow groundwater.The study opted for many statistical approaches to delineate the correlation among major and minor ionic constituents of the groundwater which are very helpful to understand the comprehensive mechanism of arsenic mobilization into shallow groundwater.

Early mobilization for mechanically ventilated patients in the intensive care unit:a systematic review and meta-analysis

Background: Early mobilization(EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation(MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.Methods: A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality.Secondary outcomes were adverse effects and length of stay(LOS) in intensive care unit(ICU) and hospital.Results: Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.Conclusions: This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.

Systematic evaluation and trial sequential analysis of warming acupuncture combined with joint mobilization in the treatment of scapulohumeral periarthritis

Objective:To evaluate the clinical efficacy of warming acupuncture combined with joint mobilization for the treatment of scapulohumeral periarthritis.Methods:A search for published randomized controlled trials(RCT)investigating warming acupuncture combined with joint mobilization for the treatment of scapulohumeral periarthritis was performed using the Cochrane Library,PubMed,Embase,and Web of Science databases.According to requirements of the Cochrane systematic review,all evaluations of RCT investigating warming acupuncture with joint mobilization in the treatment of scapulohumeral periarthritis were performed via method quality assessment,data extraction,and data analysis.Revman 5.3 and Stata 12.0 statistical software were used for the meta-analysis,and the trial sequential analysis(TSA)software estimated the required information size for each outcome.Results:A total of 14 articles were retrieved for meta-analysis,which included 551 cases in the treatment group and 539 cases in the control group.Meta-analysis showed that:(1)warming acupuncture combined with joint mobilization improved total efficiency[OR=6.16,95%CI(3.79,10.00),Z=7.34;P<0.001),TSA results confirmed the results of the meta-analysis;(2)warming acupuncture combined with joint mobilization improved the cure rate[OR=2.84,95%CI(2.19,3.70),P<0.001],TSA results revealed that no further tests were needed to verify;(3)warming acupuncture combined with joint mobilization reduced the number of treatments required for healing[MD=-7.49,95%CI(-9.75,-5.23),P<0.001],TSA results confirmed the results of the meta-analysis;(4)in comparing visual analog scale scores before and after treatment,meta-analysis result showed that:SMD=-2.01,95%CI(-2.37,-1.65),P<0.001,the difference was statistically significant,TSA results confirmed the results of the meta-analysis.Conclusion:Warming acupuncture combined with joint mobilization had a significant effect on the treatment of scapulohumeral periarthritis.

Mechanisms of cholecystokinin-induced calcium mobilization in gastric antral interstitial cells of Cajal

AIM:To investigate the effect of sulfated cholecystokinin-8(CCK-8S) on calcium mobilization in cultured murine gastric antral interstitial cells of Cajal(ICC) and its possible mechanisms.METHODS:ICC were isolated from the gastric antrum of mice and cultured.Immunofluorescence staining with a monoclonal antibody for c-Kit was used to identify ICC.The responsiveness of ICC to CCK-8S was measured using Fluo-3/AM based digital microfluorimetric measurement of intracellular Ca2+ concentration([Ca2+]i).A confocal laser scanning microscope was used to monitor [Ca2+]i changes.The selective CCK1 receptor antagonist lorglumide,the intracellular Ca2+-ATPase inhibitor thapsigargin,the type Ⅲ inositol 1,4,5-triphosphate(InsP3) receptor blocker xestospongin C and the L-type voltage-operated Ca2+ channel inhibitor nifedipine were used to examine the mecha-nisms of [Ca2+]i elevation caused by CCK-8S.Immunoprecipitation and Western blotting were used to determine the regulatory effect of PKC on phosphorylation of type Ⅲ InsP3 receptor(InsP3R3) in ICC.Protein kinase C(PKC) activator phorbol 12-myristate 13-acetate(PMA) and inhibitor chelerythrine were used to assess the role of PKC in the CCK-8S-evoked [Ca2+]i increment of ICC.RESULTS:ICC were successfully isolated from the gastric antrum of mice and cultured.Cultured ICC were identified by immunofluorescence staining.When given 80 nmol/L or more than 80 nmol/L CCK-8S,the [Ca2+]i in ICC increased and 100 nmol/L CCK-8S significantly increased the mean [Ca2+]i by 59.30% ± 4.85%(P < 0.01).Pretreatment of ICC with 5 μmol/L lorglumide inhibited 100 nmol/L CCK-8S-induced [Ca2+]i increment from 59.30% ± 4.85% to 14.97% ± 9.05%(P < 0.01),suggesting a CCK1R-mediated event.Emptying of intracellular calcium stores by thapsigargin(5 μmol/L) prevented CCK-8S(100 nmol/L) from inducing a [Ca2+]i increase.Moreover,pretreatment with xestospongin C(1 μmol/L) could also abolish the CCK-8S-induced effect,indicating that Ca2+ release from InsP3R-operated stores appeared to be a major mechanism responsible for CCK-8S-induced calcium mobilization in ICC.On the other hand,by removing extracellular calcium or blocking the L-type voltage-operated calcium channel with nifedipine,a smaller but significant rise in the [Ca2+]i could be still elicited by CCK-8S.These data suggest that the [Ca2+]i release is not stimulated or activated by the influx of extracellular Ca2+ in ICC,but the influx of extracellular Ca2+ can facilitate the [Ca2+]i increase evoked by CCK-8S.CCK-8S increased the phosphorylation of InsP3R3,which could be prevented by chelerythrine.Pretreatment with lorglumide(5 μmol/L) could significantly reduce the CCK-8S intensified phosphorylation of InsP3R3.In the positive control group,treatment of cells with PMA also resulted in an enhanced phosphorylation of InsP3R3.Pretreatment with various concentrations of PMA(10 nmol/L-10 μmol/L) apparently inhibited the effect of CCK-8S and the effect of100 nmol/L PMA was most obvious.Likewise,the effect of CCK-8S was augmented by the pretreatment with chelerythrine(10 nmol/L-10 μmol/L) and 100 nmol/L chelerythrine exhibited the maximum effect.CONCLUSION:CCK-8S increases [Ca2+]i in ICC via the CCK1 receptor.This effect depends on the release of InsP3R-operated Ca2+ stores,which is negatively regulated by PKC-mediated phosphorylation of InsP3R3.