Elevated fluid and glycosaminoglycan content in the Achilles tendon contribute to higher intratendinous pressures:Implications for Achilles tendinopathy

Background:Tendinopathy alters the compositional properties of the Achilles tendon by increasing fluid and glycosaminoglycan content.It has been speculated that these changes may affect intratendinous pressure,but the extent of this relationship remains unclear.Therefore,we aimed to investigate the impact of elevated fluid and glycosaminoglycan content on Achilles tendon intratendinous pressure and to determine whether hyaluronidase(HYAL) therapy can intervene in this potential relationship.Methods:Twenty paired fresh-frozen cadaveric Achilles tendons were mounted in a tensile-testing machine and loaded up to 5% strain.Intratendinous resting(at 0% strain) and dynamic pressure(at 5% strain) were assessed using the microcapillary infusion technique.First,intratendinous pressure was measured under native conditions before and after infusion of 2 mL physiological saline.Next,80 mg of glycosaminoglycans were administered bilaterally to the paired tendons.The right tendons were additionally treated with 1500 units of HYAL.Finally,both groups were retested,and the glycosaminoglycan content was analyzed.Results:It was found that both elevated fluid and glycosaminoglycan content resulted in higher intratendinous resting and dynamic pressures(p <0.001).HYAL treatment induced a 2.3-fold reduction in glycosaminoglycan content(p=0.002) and restored intratendinous pressures.Conclusion:The results of this study demonstrated that elevated fluid and glycosaminoglycan content in Achilles tendinopathy contribute to increased intratendinous re sting and dynamic pressures,which can be explained by the associated increased volume and reduced permeability of the tendon matrix,respectively.HYAL degrades glycosaminoglycans sufficiently to lower intratendinous pressures and may,therefore,serve as a promising treatment.

Neuroimaging mechanisms of high-frequency repetitive transcranial magnetic stimulation for treatment of amnestic mild cognitive impairment:a double-blind randomized sham-controlled trial

Individuals with amnestic mild cognitive impairment(aMCI)have a high risk of developing Alzheimer’s disease.Although repetitive transcranial magnetic stimulation(rTMS)is considered a potentially effective treatment for cognitive impairment in patients with aMCI,the neuroimaging mechanisms are poorly understood.Therefore,we performed a double-blind randomized sham-controlled trial in which rTMS was applied to the left dorsolateral prefrontal cortex of aMCI patients recruited from a community near the Third Hospital Affiliated to Sun Yat-sen University,China.Twenty-four patients with aMCI were randomly assigned to receive true rTMS(treatment group,n=12,6 men and 6 women;age 65.08±4.89 years)or sham stimulation(sham group,n=12,5 men and 7 women;age 64.67±4.77 years).rTMS parameters included a stimulation frequency of 10 Hz,stimulation duration of 2 seconds,stimulation interval of 8 seconds,20 repetitions at 80%of the motor threshold,and 400 pulses per session.rTMS/sham stimulation was performed five times per week over a period of 4 consecutive weeks.Our results showed that compared with baseline,Montreal Cognitive Assessment scores were significantly increased and the value of the amplitude of low-frequency fluctuation(ALFF)was significantly increased at the end of treatment and 1 month after treatment.Compared with the sham group,the ALFF values in the right inferior frontal gyrus,triangular part of the inferior frontal gyrus,right precuneus,left angular gyrus,and right supramarginal gyrus were significantly increased,and the ALFF values in the right superior frontal gyrus were significantly decreased in the treatment group.These findings suggest that high-frequency rTMS can effectively improve cognitive function in aMCI patients and alter spontaneous brain activity in cognitive-related brain areas.This study was approved by the Ethics Committee of Shenzhen Baoan Hospital of Southern Medical University,China(approval No.BYL20190901)on September 3,2019 and registered in the Chinese Clinical Trials Registry(registration No.ChiCTR1900028180)on December 14,2019.

Short-term effects of cupping and scraping therapy for chronic nonspecific low-back pain:A prospective,multicenter randomized trial

Background As one of the most common musculoskeletal ailments,chronic nonspecific low-back pain(CNLBP)causes persistent disability and substantial medical expenses.Epidemiological evidence shows that the incidence rate of CNLBP in young and middle-aged people who are demanded rapidly recovery and social contribution is rising.Recent guidelines indicate a reduced role for medicines in the management of CNLBP.Objective The present study investigates the short-term effects of cupping and scraping therapy using a medicated balm,compared to nonsteroidal anti-inflammatory drug(NSAID)with a capsaicin plaster,in the treatment of CNLBP.Design,setting,participants and interventions We designed a prospective multicenter randomized clinical trial enrolling patients from January 1,2022 to December 31,2022.A total of 156 patients with CNLBP were randomized into two parallel groups.Diclofenac sodium-sustained release tablets were administered orally to participants in the control group for one week while a capsaicin plaster was applied externally.Patients in the test group were treated with cupping and scraping using a medical device and medicated balm.Main outcome measures Primary outcome was pain recorded using the visual analogue scale(VAS).Two secondary outcomes were recorded using the Japanese Orthopedic Association low-back pain scale(JOA)and the traditional Chinese medicine(TCM)syndrome integral scale(TCMS)as assessment tools.Results Between baseline and postintervention,all changes in outcome metric scales were statistically significant(P<0.001).Compared to the control group,patients in the test group had a significantly greater treatment effect in all outcome variables,as indicated by lower VAS and TCMS scores and higher JOA scores,after the one-week intervention period(P<0.001).Further,according to the findings of multivariate linear regression analysis,the participants’pain(VAS score)was related to their marital status,age,smoking habits and body mass index.No adverse reactions were reported for any participants in this trial.Conclusion The effectiveness of TCM combined with the new physiotherapy tool is superior to that of NSAID combined with topical plasters,regarding to pain intensity,TCM symptoms and quality of life.The TCM plus physiotherapy also showed more stable and long-lasting therapeutic effects.

The Strategy to Encourage the Bed Ridden Paraplegic Patient to Keep Fit at Home with the Development of Exercise Machine

Major drawbacks in caring for patients with physical limitations is that the conventional machines being used in most hospitals look like cages and the features and functions are not convenient for the user at home. As a result, the bed ridden paraplegic patients are unable to use the machines contenfly. The aim of this research is to show a solution to earing for bed ridden paraplegic patients, in order for them to keep fit at home, and to develop the exercise machine based on the disabled patients＇ needs--focusing on, full function, strength, safety and its practical usage. The method of study consists of five steps as follows： （1） home visiting for collecting general data, （2） checking the patient＇s ability and surveying patient＇s requirement, （3） setting ultimate goals from multi-professionals including family physician, rehabilitation doctor, physiotherapist, nurses and engineers, （4） designing the machine using software and building the prototype, and （5） testing a machine at the patient＇s home. The result of satisfaction after re-strengthening for a month was compared, at different times, between two disabled male patients of different ages and level of spine injury using two different types of exercise machines： MODEL1 and 2. One solution in dealing with health problems of the bed ridden paraplegic patients is a well-developed exercise programme from the multidisciplinary team. This helps the patients to exercise as suggested by diet, mental health support, as well as, exercise equipment which can provide many other benefits to bed ridden paraplegic patients. Moreover, with the development of the exercise machine, corrects inequality in health for handicap patients, specifically to tantamount with normal patients.

Effects of Needle-knife Therapy on iNOS Activity and NO Content in Skeletal Muscles in the L_3 Transverse Process Syndrome Model Rat

Objective: To study on relationship of inducible nitric oxide synthase (iNOS) activity and nitric oxide (NO) content in the injured local soft tissue with injured degrees of the soft tissue in the third lumbar vertebrae (L3) transverse process syndrome model rat and to observe the effect of needle-knife therapy. Methods: One hundred and sixty male SD rats were randomly divided into normal group, model group, aminoguanidine (AG) group, needle-knife group, 40 rats in each group. The L3 transverse process syndrome rat model was established, and after treatment of needle-knife and AG, iNOS activities and NO contents and histomorpholocal changes in the soft tissues around L3 transverse process on 1, 3, 7 and 14 days were observed in the groups. Results: Compared with the normal group, iNOS activity and NO content in the model group were significantly increased (P<0.01); Compared with the model group, iNOS activities and NO contents were significantly decreased in both the needle-knife group and the AG group (both P<0.01); And both iNOS activities and NO contents were identical with both local inflammation response and injured degrees of the injured tissue in the groups. Conclusion: Needle-knife therapy can significantly inhibit generation of NO, alleviate inflammatory response and injured degree of the injured soft tissue, improve microcirculation, prevent formation of pathological scar tissue, and promote repair of the chronic soft tissue injury.

Status of adult inpatient burn rehabilitation in Europe: are we neglecting metabolic outcomes?

Background:Hypermetabolism,muscle wasting and insulin resistance are challenging yet important rehabilitation targets in the management of burns.In the absence of concrete practice guidelines,however,it remains unclear how these metabolic targets are currently managed.This study aimed to describe the current practice of inpatient rehabilitation across Europe.Methods:An electronic survey was distributed by the European Burn Association to burn centres throughout Europe,comprising generic and profession-specific questions directed at therapists,medical doctors and dieticians.Questions concerned exercise prescription,metabolic management and treatment priorities,motivation and knowledge of burn-induced metabolic sequelae.Odds ratios were computed to analyse associations between data derived from the responses of treatment priorities and knowledge of burn-induced metabolic sequelae.Results:Fifty-nine clinicians with 12.3±9 years of professional experience in burns,representing 18 out of 91 burn centres(response rate,19.8%)across eight European countries responded.Resistance and aerobic exercises were only provided by 42%and 38%of therapists to intubated patients,87%and 65%once out-of-bed mobility was possible and 97%and 83%once patients were able to leave their hospital room,respectively.The assessment of resting energy expenditure by indirect calorimetry,muscle wasting and insulin resistance was carried out by only 40.7%,15.3%and 7.4%respondents,respectively,with large variability in employed frequency and methods.Not all clinicians changed their care in cases of hypermetabolism(59.3%),muscle wasting(70.4%)or insulin resistance(44.4%),and large variations in management strategies were reported.Significant interdisciplinary variation was present in treatment goal importance ratings,motivation and knowledge of burn-induced metabolic sequelae.The prevention of metabolic sequelae was regarded as the least important treatment goal,while the restoration of functional status was rated as the most important.Knowledge of burn-induced metabolic sequelae was linked to higher importance ratings of metabolic sequelae as a therapy goal(odds ratio,4.63;95%CI,1.50–14.25;p<0.01).Conclusion:This survey reveals considerable non-uniformity around multiple aspects of inpatient rehabilitation across European burn care,including,most notably,a potential neglect of metabolic outcomes.The results contribute to the necessary groundwork to formulate practice guidelines for inpatient burn rehabilitation.

The physical and physiological effects of vacuum massage on the different skin layers: a current status of the literature

Vacuum massage is a non-invasive mechanical massage technique performed with a mechanical device that lifts the skin by means of suction,creates a skin fold and mobilises that skin fold.In the late 1970s,this therapy was introduced to treat traumatic or burn scars.Although vacuum massage was invented to treat burns and scars,one can find very little literature on the effects of this intervention.Therefore,the aim of this review is to present an overview of the available literature on the physical and physiological effects of vacuum massage on epidermal and dermal skin structures in order to find the underlying working mechanisms that could benefit the healing of burns and scars.The discussion contains translational analysis of the results and provides recommendations for future research on the topic.An extended search for publications was performed using PubMed,Web of Science and Google Scholar.Two authors independently identified and checked each study against the inclusion criteria.Nineteen articles were included in the qualitative synthesis.The two most reported physical effects of vacuum massage were improvement of the tissue hardness and the elasticity of the skin.Besides physical effects,a variety of physiological effects are reported in literature,for example,an increased number of fibroblasts and collagen fibres accompanied by an alteration of fibroblast phenotype and collagen orientation.Little information was found on the decrease of pain and itch due to vacuum massage.Although vacuum massage initially had been developed for the treatment of burn scars,this literature review found little evidence for the efficacy of this treatment.Variations in duration,amplitude or frequency of the treatment have a substantial influence on collagen restructuring and reorientation,thus implying possible beneficial influences on the healing potential by mechanotransduction pathways.Vacuum massage may release the mechanical tension associated with scar retraction and thus induce apoptosis of myofibroblasts.Suggestions for future research include upscaling the study design,investigating the molecular pathways and dose dependency,comparing effects in different stages of repair,including evolutive parameters and the use of more objective assessment tools.

Measuring the immeasurable? Operationalising social capital in health research

During the last decennia, social capital has been a popular topic in social sciences. However, the concept is often used as a “catch all” for divers social characteristics. Consensus on how the concept should be measured is lacking. This keeps health researchers from drawing firm conclusions on the influence of social capital on health and hampers the decision on which social capital indicators to use in health research. This study compares five ways to operationalise social capital (generalized trust, a social network index, an expanded social network index, bonding, bridging and linking social capital and a multidimensional social capital index) in their ability to explain self-rated health and pain. To evaluate the models’ capacity to explain health, two logistic regression models were built, resulting in Nagelkerke R2 measures. Data were collected in a cross-sectional study in eight neighbourhoods in the region of Ghent (Belgium) by randomly sampling 50 adult inhabitants per neighbourhood. Findings show that the explanation of the observed variance in health by the studied social capital models ranges from 1.9% to 23.1%, but is more pronounced for self-rated health than for pain. The multidimensional social capital index explains most of the variance in health, but poses an important strain on the respondents due to a large number of surveyquestions. With some prudence, we presume that the explanatory added value of the more extended social capital models is rather limited from a practical point of view as the addition in explained variance of the other models seems not in relation to the number of questions needed. Researchers should weigh up the pros and cons of different manners to measure social capital carefully, taking the goals and focus of their study into account.

Tuina plus Cupping Therapy for 60 Cases of Infantile Cough

Objective： To observe the clinical effect oftuina plus cupping therapy for infantile cough. Methods： Sixty subjects were mainly treated with pinching and pushing the spine, coordinating with the tuina manipulations and cupping therapy based on syndrome differentiation. Results： Among the 60 patients, 40 cases were cured and 20 cases got improved, the total effective rate was 100%. Conclusion： Tuina plus cupping therapy works effectively on infantile cough and without adverse reactions.