Comparative study of the efficacy of the topical application of hydrocortisone, therapeutic ultrasound and phonophoresis on the tissue repair process in rat tendons

A comparative study of passive drug diffusion through human skin via intercellular and sweat duct route: effect of aging

A method of drug delivery that could provide control over medicine reaching the bloodstream for systemic circulation would be of immense importance. This work presents a comparative study of the temporal and spatial variation of drugs diffusing passively through two separate routes of human skin, namely intercellular (ICR) and sweat duct route (SDR). An analysis is carried out for two age groups (young < 40 years and old > 60 years of age). Governing equations based on Fick's law for mass transfer have been solved numerically using an in-house developed code. The code has been validated thoroughly with numerical and experimental work from the literature. Each skin route is modeled into three compartments sandwiched between the donor and receiver compartments. To understand the role of diffusion and partition coefficient on drug permeation, four drugs, namely hydrocortisone, trans-cinnamic acid, caffeine, and benzoic acid, are considered. The drug diffusion rate is found greater through ICR as compared to SDR. Further, the amount of drugs diffusing through both routes increases with age. Desirable drug characteristic is inferred to be a lower value of partition coefficient and a higher value of diffusion coefficient. This study could lead to real-time assessment of drugs reaching the bloodstream and beyond.

Ultrasound-Activated Sensitizers and Applications

Modalities for photo-triggered anticancer therapy are usually limited by their low penetrative depth. Sonotheranostics especially sonodynamic therapy (SDT), which is different from photodynamic therapy (PDT) by the use of highly penetrating acoustic waves to activate a class of sound-responsive materials called sonosensitizers, has gained significant interest in recent years. The effect of SDT is closely related to the structural and physicochemical properties of the sonosensitizers, which has led to the development of new sound-activated materials as sonosensitizers for various biomedical applications. This Review provides a summary and discussion of the types of novel sonosensitizers developed in the last few years and outlines their specific designs and the potential challenges. The applications of sonosensitizers with various functions such as for imaging and drug delivery as well as in combination with other treatment modalities would provide new strategies for disease therapy.

Human adipose-derived Mesenchymal stem cells, low-intensity pulsed ultrasound, or their combination for the treatment of knee osteoarthritis: study protocol for a first-in-man randomized controlled trial

Background

Human adipose-derived Mesenchymal stem cells (HADMSCs) have proven their efficacy in treating osteoarthritis (OA), in earlier preclinical and clinical studies. As the tissue repairers are under the control of mechanical and biochemical signals, improving regeneration outcomes using such signals has of late been the focus of attention. Among mechanical stimuli, low-intensity pulsed ultrasound (LIPUS) has recently shown promise both in vitro and in vivo. This study will investigate the potential of LIPUS in enhancing the regeneration process of an osteoarthritic knee joint.

Methods

This study involves a prospective, randomized, placebo-controlled, and single-blind trial based on the SPIRIT guidelines, and aims to recruit 96 patients initially diagnosed with knee osteoarthritis, following American College of Rheumatology criteria. Patients will be randomized in a 1:1:1 ratio to receive Intraarticular HADMSCs injection with LIPUS, Intraarticular HADMSCs injection with shame LIPUS, or Normal saline with LIPUS. The primary outcome is Western Ontario and McMaster Universities Index of OA (WOMAC) score, while the secondary outcomes will be other knee structural changes, and lower limb muscle strength such as the knee cartilage thickness measured by MRI. Blinded assessments will be performed at baseline (1 month prior to treatment), 1 month, 3 months, and 6 months following the interventions.

Discussion

This trial will be the first clinical study to comprehensively investigate the safety and efficacy of LIPUS on stem cell therapy in OA patients. The results may provide evidence of the effectiveness of LIPUS in improving stem cell therapy and deliver valuable information for the design of subsequent trials.

Trial registration

This study had been prospectively registered with the Chinese Clinical Trials Registry. registration number: ChiCTR1900025907 at September 14, 2019.

Collagen Fibers in the Healing Process of Rat Achilles Tendon Rupture Using Different Times of Ultrasound Therapy

Objective: The aim of this study was to evaluate the organization of collagen fibers in the healing process of rat Achilles tendon rupture using different times of ultrasound therapy (TUS). Approach: Forty Wistar rats were selected. Among these, 32 were submitted to total tenotomy of the calcaneous tendon and divided into 5 groups: control group (CG, n = 8), without tenotomy or any treatment; tenotomy group (n = 8), with tenotomy and without treatment; TUS groups-TUS3 (n = 8), TUS4 (n = 8), and TUS5 (n = 8)-submitted to tenotomy and treated with TUS for 3, 4, and 5 min per effective radiating area (ERA), respectively. The animals were sacrificed on the 12th postoperative day. The tendons were surgically removed for analysis of the collagen fiber organization using the birefringence technique (OR, optical retardation). Results: The collagen fibers exhibited better aggregation and organization in the UST3, TUS4, and TUS5 groups compared with CG (p < 0.05). The TUS5 group had better response rates in intergroup comparison. Innovation: The dose response of therapeutic TUS is influenced by many variables. The scientific evidence to support the dosimetry is insufficient. The application time is an important variable to be considered in TUS. In this study, the longer the application time, the better for organization and aggregation of collagen fibers in the rat tendon. Conclusion: TUS applied for 5 min per ERA presented higher dose response to the organization of collagen fibers in the healing process of rat Achilles tendon rupture.

Efficiency of the combination of physical therapy modalities with topical nonsteroidal anti-inflammatory drugs for treatment of pain in rheumatology

Pain is the most common syndrome in rheumatology. NSAIDs are often used in its treatment. But they have limitations associated with side effects. An advantage of topical drugs and physical factors (electrophoresis, phonophoresis) combination is the use of low doses of the drug and a decrease in time, to achieve a therapeutic effect, reduce the risk of adverse reactions, increase the concentration of the drug in the inflammation focus, prolonged action (creating a drug depot in tissues). Ketoprofen gel (“Artrocol gel”) is one of the representatives of this pharmacological group. Physicochemical properties help ketoprofen to penetrate easily through the skin and create a therapeutic concentration in the underlying tissues. Objective. To assess the effectiveness of ketoprofen gel (“Arthrocol gel”) electrophonophoresis in the treatment of pain in rheumatological patients. Materials and methods. The study was carried out on the basis of Physiotherapy Department of Vinnytsia Regional Clinical Hospital named after M. I. Pirogov. All patients treated according to the unified clinical protocols were divided into experimental group (EG) and control group (CG). Patients of EG (98 persons) underwent electrophonophoresis with ketoprofen gel once a day for a week. In CG (43 persons) ketoprofen gel was used without electrophonophoresis. The intensity of the pain syndrome is monitored using a visual analog scale (VAS) of Huskisson at rest and during movement. A week later, the patient and the doctor evaluated satisfaction with the results of treatment on the scale: not effective, insufficient, satisfactory, good, excellent. Results. There was a persistent decrease in the intensity of pain syndrome in patients of both groups. The VAS scores were lower in the EG starting from the 3rd day of treatment. The intensity of the acute pain syndrome after 1-week treatment at rest (t = 4.71, p < 0.001) and during the movement (t = 3.84,  p < 0.001) more decrease in EG. Satisfaction with the results of treatment was higher in EG.

Low Intensity Ultrasound for Promoting Soft Tissue Healing: A Systematic Review of the Literature and Medical Technology

Therapeutic ultrasound has been studied and used for the past seven decades to treat musculoskeletal injuries. Recently, a significant body of animal and human research has focused on the biomechanical effects of daily-applied, low intensity therapeutic ultrasound (LITUS) on soft tissue recovery. We performed a systematic review of the last two decades of LITUS literature to examine the effects on tendon, skeletal muscle, ligament, and tendon-bone junction injuries. LITUS facilitated tendon healing, with increased tensile strength and improved collagen alignment. For skeletal muscle and ligament injuries, LITUS increased cell proliferation during myoregeneration and improved tissue biomechanics (ultimate load, stiffness, energy absorption). LITUS aided tendon-bone junction healing through improved tissue function. Scientific evidence supports the use of LITUS to treat soft tissue injuries, and improve outcomes for musculoskeletal injuries and post-operative recovery. Lastly, we discuss the use of LITUS devices facilitating daily applied therapy in the home setting.

Sustained acoustic medicine: wearable, long duration ultrasonic therapy for the treatment of tendinopathy

OBJECTIVES

The effectiveness of sustained acoustic medicine to alleviate pain and improve function in subjects with elbow or Achilles tendinopathy was evaluated through a level IV case series study. Subjects were trained to self-apply the wearable, long-duration, low-intensity ultrasonic device on their affected body part at home for 4 hours a day, at least 5 times per week over 6 weeks. Twenty-five subjects with clinician-diagnosed tendinopathy of the elbow (medial or lateral epicondyle) or Achilles tendon were enrolled.

METHODS

Pain measurements were recorded before, during, and after daily intervention using an 11-point numeric rating scale (NRS). Function of the injured limb was assessed biweekly using dynamometry. Repeated measures ANOVAs and paired-samples t-tests were used to examine the effect of treatment over time.

RESULTS

Among subjects with elbow tendinopathy (n = 20), a 3.94 ± 2.15 point reduction in pain (p = 0.002) was observed over the 6-week study and a 2.83 ± 5.52 kg improvement in grip strength (p = 0.04) was observed over the first two weeks. In addition, a significant reduction in pain was observed within the 4-h treatment sessions (p < 0.001). Among 5 subjects with Achilles tendinopathy, a reduction in pain and improvement in strength was also observed.

CONCLUSIONS

Daily multi-hour ultrasonic therapy was associated with improved pain and increased function in subjects with chronic tendon injuries. This trial showed the safety and feasibility of self-administration of sustained acoustic medicine, and suggests that this therapy may be clinically beneficial in the treatment of tendinopathies of the elbow and Achilles tendon. A randomized controlled trial appears warranted to more definitively investigate the therapeutic potential of this treatment modality. Registered at www.ClinicalTrials.gov, NCT02466308.

Assessing the biochemical changes of tendons of rats in an experimental model of tenotomy under therapeutic ultrasound and LEDs (625 and 945 nm) by near-infrared Raman spectroscopy

Given the complexity of the tendon repair process, where the neoformed scar tissue tends to prevent or hamper the tendon from performing its normal functions, ultrasound (US) and light-emitting diode (LED) devices have been applied to modulate the tendon repair process. This study aimed to compare the anti-inflammatory and healing effects of therapeutic US and LED in an experimental model of tenotomy using histomorphometry and Raman spectroscopy. Forty Wistar rats (235 ± 8.3 g) were separated into four groups: tenotomy (TC; control), tenotomy associated with ultrasound (US; 1 MHz, 0.5 W/cm(2)), tenotomy associated with LED at 625 nm (LR; 4 J/cm(2)), and tenotomy associated with LED at 945 nm (LIR; 4 J/cm(2)), in two experimental periods of 7 and 14 days. Histomorphometry showed a decrease of inflammatory cells (macrophages and polymorphonuclear leukocytes) for the group treated with US compared to the TC group (ANOVA, p < 0.0001) and the LIR group compared to the TC group (p < 0.05) at the seventh day, indicating an anti-inflammatory effect. In relation to the LR and TC groups, there was no significant difference. Raman spectroscopy revealed that the LR group presented an increased synthesis of collagen I compared to the other treatments and the TC groups on the 14th day (p < 0.01). US therapy showed an adjuvant effect with anti-inflammatory action, and the LED therapy at 625 nm showed an increase in collagen synthesis, contributing to the process of tendon healing.

De Quervain's Tenosynovitis and Phonophoresis: A Randomised Controlled Trial in Pregnant Females

Background

De Quervain's tenosynovitis is a common cause of wrist pain in pregnant and postpartum females. This study provides objective evidence regarding the therapeutic efficacy of phonophoresis in treating de Quervain's disease during pregnancy.

Methods

In a single blind, randomised, controlled trial (n = 50), ketoprofen phonophoresis was given to the intervention group and conventional ultrasound (US) was given to controls, coupled with thumb splint immobilisation, and supervised strengthening and stretching exercises for 1 month. Symptomatic and functional improvement was assessed by visual pain analogue, grip, tip, key, and palmer pinch scales.

Results

There was a statistically significant improvement in the intervention group compared to the control group in grip and pinch strength, and pain reduction.

Conclusion

Ketoprofen phonophoresis as an adjunct to supervised exercise and splint immobilisation is a safe and effective therapy for de Quervain's tenosynovitis during pregnancy. Phonophoresis augments the benefits of US in terms of reducing pain and inflammation, and improving functional strength.

The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon

OBJECTIVE

Our primary objective was to summarise the known effects of locally administered glucocorticoid on tendon tissue and tendon cells.

METHODS

We conducted a systematic review of the scientific literature using the PRISMA and Cochrane guidelines of the Medline database using specific search criteria. The search yielded 50 articles, which consisted of 13 human studies, 36 animal studies and one combined human/animal study.

RESULTS

Histologically, there was a loss of collagen organisation (6 studies) and an increase in collagen necrosis (3 studies). The proliferation (8 studies) and viability (9 studies) of fibroblasts was reduced. Collagen synthesis was decreased in 17 studies. An increased inflammatory cell infiltrate was shown in 4 studies. Increased cellular toxicity was demonstrated by 3 studies. The mechanical properties of tendon were investigated by 18 studies. Descriptively, 6 of these studies showed a decrease in mechanical properties, 3 showed an increase, while the remaining 9 showed no significant change. A meta-analysis of the mechanical data revealed a significant deterioration in mechanical properties, with an overall effect size of -0.67 (95% CI = 0.01 to -1.33) (data from 9 studies).

CONCLUSIONS

Overall it is clear that the local administration of glucocorticoid has significant negative effects on tendon cells in vitro, including reduced cell viability, cell proliferation and collagen synthesis. There is increased collagen disorganisation and necrosis as shown by in vivo studies. The mechanical properties of tendon are also significantly reduced. This review supports the emerging clinical evidence that shows significant long-term harms to tendon tissue and cells associated with glucocorticoid injections.

Effect of phonophoresis on skin permeation of commercial anti-inflammatory gels: sodium diclofenac and ketoprofen

This study evaluated the use of ultrasound in combination with the commercial anti-inflammatory drugs ketoprofen and sodium diclofenac, according to the parameters used in physiotherapy. Ketoprofen and sodium diclofenac were used in the Franz diffusion cell model adapted to an ultrasound transducer in three conditions: no ultrasound, one application of ultrasound and two applications of ultrasound. High-performance liquid chromatography was used to quantify the total amount of drug permeating skin per unit area, as well as flux and latency. The results showed that for ketoprofen, the amount of drug permeating skin and flux increased with two ultrasound applications. Permeation of sodium diclofenac decreased in the presence of ultrasound. Ultrasound parameters and drug properties must be considered in the use of phonophoresis.

Effects of low-power LED and therapeutic ultrasound in the tissue healing and inflammation in a tendinitis experimental model in rats

This work evaluated the anti-inflammatory response of low-power light-emitting diode (LED) and ultrasound (US) therapies and the quality and rapidness of tendon repair in an experimental model of tendinitis, employing histomorphometry and Raman spectroscopy. Tendinitis was induced by collagenase into the right tendon of 35 male Wistar rats with an average weight of 230 g. The animals were randomly separated into seven groups of five animals each: tendinitis without treatment-control (TD7 and TD14, where 1 and 2 indicated sacrifice on the 7th and 14th day, respectively), tendinitis submitted to US therapy (US7 and US14) and tendinitis submitted to LED therapy (LED7 and LED14). Contralateral tendons of the TD group at the 14th day were used as the healthy group (H). US treatment was applied in pulsed mode at 10 %, 1 MHz frequency, 0.5 W/cm(2), 120 s. LED therapy parameters were 4 J/cm(2), 120 s, daily dose at the same time and same point. Sacrifice was performed on the 7th or 14th day. Histomorphometric analysis showed lower number of fibroblasts on the 14th day of therapy for the US-treated group, compared to the TD and LED, indicating lower tissue inflammation. Raman showed that the LED group had an increase in the amount of collagen I and III from the 7th to the 14th day, which would indicate more organized fibers and a better quality of the healing, and US showed lower collagen I synthesis in the 14th day compared to H, indicating a lower tissue reorganization.

Comparação do ultrassom pulsado e contínuo no reparo tendíneo de ratos

No tratamento de lesões tendíneas, o uso do ultrassom surge como possibilidade terapêutica, apesar de lacunas sobre seus efeitos clínicos. O objetivo foi avaliar dois protocolos de ultrassom terapêutico sobre dor e edema após trauma tendíneo. Vinte e um ratos Wistar foram submetidos a trauma no tendão calcâneo e divididos em três grupos: sham (GS); ultrassom contínuo (GUC); e ultrassom pulsado (GUP). O trauma ocorreu sobre a face lateral do tendão calcâneo direito, com energia de 0,40 J. A dor foi avaliada pelo teste de incapacidade funcional e o edema, pelo diâmetro laterolateral. Foram realizadas avaliações previamente à lesão; após 1 hora da indução da lesão; após o 1º tratamento; 2, 8 e 24 horas após lesão; e após o 5º dia. O tratamento ocorreu em 5 dias, com transdutor de 1 MHz, durante 3 minutos, sobre o local do trauma, com dose de 0,4 W/cm² SATA. Os resultados da incapacidade funcional para GS mostraram aumento da nocicepção. Para GUC houve aumento ao comparar a avaliação 1 (AV1) com as avaliações 2 (AV2), 3 (AV3) e 4 (AV4); ao comparar AV2 com as avaliações 5 (AV5) e 6 (AV6) houve diminuição de valores. Para GUP houve aumento ao comparar AV1 com AV2 e AV3, mas ao comparar AV2 com as seguintes, houve diminuição significativa a partir de AV4. Para o edema, os grupos tratados produziram aumento inicial, com redução nas últimas avaliações. O ultrassom terapêutico produziu diminuição de dor e edema, mais precocemente para a forma pulsada.

Absorption of hydrocortisone acetate in human connective tissue using phonophoresis

Background:

Therapeutic ultrasound to drive medication (phonophoresis) has been a mainstay in physical therapy. The most common drug used in phonophoresis is hydrocortisone acetate (HA). A number of studies have been done examining phonophoresis in the delivery of HA through the skin to underlying tissues; however, a study has never been done examining the absorption of HA using phonophoresis on human connective tissue.

Hypothesis:

Phonophoresis will facilitate the transmission of HA in human connective tissue.

Study Design:

Randomized controlled study.

Methods:

Twenty-one patients undergoing anterior cruciate ligament reconstruction surgery were randomly assigned to either a sham or true phonophoresis treatment group. The latter group received 6 minutes of 10% HA ultrasound at a point consistent with the gastrocnemius slip of the semitendinosis tendon (treatment site). The sham group received 6 minutes of 10% HA ultrasound to the same area, but the ultrasound was not turned on. The slip and a sample of the distal attachment of the tendon (control) were removed. Samples were analyzed for HA levels.

Results:

Although the mean and median levels of HA found at the treatment site were greater than those of the control site (means, 34.1 vs 22.9 parts per billion; medians, 7 vs 0 parts per billion), the levels of HA found at the treatment site were not significantly greater than those at the control site (P = 0.15). There were no statistically significant differences between the true and sham phonophoresis groups in HA levels (P = 0.80) nor in age, sex, or skin thickness.

Conclusion:

Phonophoresis does not appear to facilitate the absorption of HA in connective tissue when compared with simple absorption (sham).

Clinical Relevance:

Phonophoresis does not appear to enhance the transmission of HA in human connective tissue; therefore, use of phonophoresis should be reconsidered in inflammatory conditions.

Ultrasound-mediated transdermal drug delivery: mechanisms, scope, and emerging trends

The use of ultrasound for the delivery of drugs to, or through, the skin is commonly known as sonophoresis or phonophoresis. The use of therapeutic and high frequencies of ultrasound (≥0.7MHz) for sonophoresis (HFS) dates back to as early as the 1950s, while low-frequency sonophoresis (LFS, 20-100kHz) has only been investigated significantly during the past two decades. Although HFS and LFS are similar because they both utilize ultrasound to increase the skin penetration of permeants, the mechanisms associated with each physical enhancer are different. Specifically, the location of cavitation and the extent to which each process can increase skin permeability are quite dissimilar. Although the applications of both technologies are different, they each have strengths that could allow them to improve current methods of local, regional, and systemic drug delivery. In this review, we will discuss the mechanisms associated with both HFS and LFS, specifically concentrating on the key mechanistic differences between these two skin treatment methods. Background on the relevant physics associated with ultrasound transmitted through aqueous media will also be discussed, along with implications of these phenomena on sonophoresis. Finally, a thorough review of the literature is included, dating back to the first published reports of sonophoresis, including a discussion of emerging trends in the field.

Collagen changes and realignment induced by low-level laser therapy and low-intensity ultrasound in the calcaneal tendon

BACKGROUND AND OBJECTIVE

The treatment of calcaneal tendon injuries requires long-term rehabilitation. Ultrasound (US) and low-level laser therapy (LLLT) are the most used and studied physical agents in the treatment of tendon injuries; however, only a few studies examined the effects of the combination of US and LLLT. Therefore, the purpose of this study was to investigate which treatment (the exclusive or combined use of US and LLLT) most effectively contribute to tendon healing.

STUDY DESIGN/MATERIALS AND METHODS

This was a controlled laboratory study with 50 rats whose Achilles tendon was injured by direct trauma. The rats were randomly divided into five groups and treated for 5 consecutive days, as follows: group 1 (control) received no treatment; group 2 was treated with US alone; group 3 was treated with LLLT alone; group 4 was treated first with US followed by LLLT; and group 5 was treated first with LLLT followed by US. On the sixth post-injury day, the tendons were removed and examined by polarized light microscopy. The organization of collagen fibers was assessed by birefringence measurements. Picrosirius-stained sections were examined for the presence of types I and III collagen.

RESULTS

There was a significantly higher organization of collagen fibers in group 2 (US) than in the control group (P = 0.03). The amount of type I collagen found in groups 2 (US), 3 (LLLT), and 5 (LLLT + US) was significantly higher than that in the control group (P <or= 0.01), but no significant differences were found between treatment groups. There were no differences in the amount of type III collagen between groups.

CONCLUSION

Ultrasound, LLLT, and the combined use of LLLT and US resulted in greater synthesis of type I collagen; US was also effective in increasing collagen organization in the early stages of the healing process.

Comparative study of the topical application of Aloe vera gel, therapeutic ultrasound and phonophoresis on the tissue repair in collagenase-induced rat tendinitis

The aim of our study was to compare topical use of Aloe vera gel, pulsed mode ultrasound (US) and Aloe vera phonophoresis on rat paw with collagenase-induced tendinitis. Edema size, tensile tendon strength, tendon elasticity, number of inflammatory cells and tissue histology were studied at 7 and 14 days after tendinitis induction. Pulse mode US parameters were: 1 MHz frequency, 100 Hz repetition rate, 10% duty cycle, and 0.5 W/cm(2) intensity, applied for 2 min each session. A 0.5 mL of Aloe vera gel at 2% concentration was applied for 2 min per session, topically and by phonophoresis. Topical application of Aloe vera gel did not show any statistically significant improvement in the inflammatory process, whereas phonophoresis enhanced the gel action reducing edema and number of inflammatory cells, promoting the rearrangement of collagen fibers and promoting also the recovery of the tensile strength and elasticity of the inflamed tendon to recover their normal pre-injury status. Results seem to indicate that Aloe vera phonophoresis is a promising technique for tendinitis treatment, without the adverse effect provoked by systemic anti-inflammatory drugs.

Low-level laser therapy (LLLT; 780 nm) acts differently on mRNA expression of anti- and pro-inflammatory mediators in an experimental model of collagenase-induced tendinitis in rat

Low-level laser therapy (LLLT) has been found to produce anti-inflammatory effects in a variety of disorders. Tendinopathies are directly related to unbalance in expression of pro- and anti-inflammatory cytokines which are responsible by degeneration process of tendinocytes. In the current study, we decided to investigate if LLLT could reduce mRNA expression for TNF-α, IL-1β, IL-6, TGF-β cytokines, and COX-2 enzyme. Forty-two male Wistar rats were divided randomly in seven groups, and tendinitis was induced with a collagenase intratendinea injection. The mRNA expression was evaluated by real-time PCR in 7th and 14th days after tendinitis. LLLT irradiation with wavelength of 780 nm required for 75 s with a dose of 7.7 J/cm(2) was administered in distinct moments: 12 h and 7 days post tendinitis. At the 12 h after tendinitis, the animals were irradiated once in intercalate days until the 7th or 14th day in and them the animals were killed, respectively. In other series, 7 days after tendinitis, the animals were irradiated once in intercalated days until the 14th day and then the animals were killed. LLLT in both acute and chronic phases decreased IL-6, COX-2, and TGF-β expression after tendinitis, respectively, when compared to tendinitis groups: IL-6, COX-2, and TGF-β. The LLLT not altered IL-1β expression in any time, but reduced the TNF-α expression; however, only at chronic phase. We conclude that LLLT administered with this protocol reduces one of features of tendinopathies that is mRNA expression for pro-inflammatory mediators.

Análise nanoestrutural da ação do ultra-som terapêutico sobre o processo de regeneração do tendão de ratos

O ultra-som terapêutico pulsado (USTP) é uma das modalidades terapêuticas utilizadas para promover a aceleração do reparo tendíneo. Este estudo avaliou a microestrutura do tendão calcâneo sob o efeito do USTP em duas intensidades diferentes. Foram utilizados 24 ratos Wistar machos, divididos em quatro grupos, submetidos à tenotomia radical transversal do tendão calcâneo direito, sem posterior tenorrafia. Os animais do grupo controle (GC) não receberam tratamento; o grupo 1 (G1) foi submetido ao USTP de 1 MHz a 20%, com área de radiação efetiva de 1,0 cm² e intensidade média instantânea de 0,3 W/cm²; o grupo 2 (G2) recebeu USTP nos mesmos parãmetros, mas com intensidade de 1,5 W/cm²; no grupo 3 (G3), placebo, foi aplicado tratamento simulado (ultra-som desligado). Nos três grupos, o tratamento consistiu em uma sessão diária de 5 minutos, por 10 dias. No 11º dia pós-operatório os tendões foram removidos para análise qualitativa e quantitativa, por meio de microscopia de luz polarizada (MLP), de luz (ML) e de força atômica (MFA). As análises qualitativas de MLP e MFA foram coincidentes, mostrando melhor organização, agregação e orientação das fibras de colágeno no grupo G1. A análise quantitativa apresentou contagens médias de 400,7 fibroblastos e 2,22 capilares sangüíneos por campo de análise, não se encontrando diferença significativa entre os grupos (p>0,05). Conclui-se que o processo de regeneração tendínea em ratos pode ser beneficiado pelo tratamento com USTP em baixa intensidade.

Applications of ultrasonic skin permeation in transdermal drug delivery

Transdermal ultrasound-mediated drug delivery has been studied as a method for needle-less, non-invasive drug administration. Potential obstacles include the stratum corneum, which is not sufficiently passively permeable to allow effective transfer of many medications into the bloodstream without active methods. A general review of the transdermal ultrasound drug delivery literature has shown that this technology offers promising potential for non-invasive drug administration. Included in this review are the reported acoustic parameters used for achieving delivery, along with the known intensities and exposure times. Ultrasound mechanisms are discussed as well as spatial field characteristics. Accurate and precise quantification of the acoustic field used in drug delivery experiments is essential to ensure safety versus efficacy and to avoid potentially harmful bioeffects.

Ultrasound phonophoresis of panax notoginseng improves the strength of repairing ligament: a rat model

This study examined the phonophoretic effect of a therapeutic ultrasound coupled with a Panax notoginseng (PN) gel and compared it with a therapeutic ultrasound alone for medial collateral ligament repair in rats. Twenty mature male Sprague-Dawley rats receiving surgical transection to the left medial collateral ligament (MCL) were divided randomly into three groups: ultrasound (US, n = 7), ultrasound with PN coupling gel (PNUS, n = 7) and control (n = 6). The treatments started on day 3 after surgery for six days per week over a two-week period. The US group received 4 min of pulsed ultrasound (1 MHz) at the intensity of 0.5W/cm(2) with a normal ultrasonic coupling gel. The PNUS group received the same ultrasound treatment, but with a coupling gel that contained PN extract. The control group received a placebo ultrasound treatment similar to the other two groups. On day 17, the ligaments were mechanically tested for load-relaxation, stiffness and ultimate tensile strength (UTS). Values of the left side were normalized against that of the right side of each animal for analysis. Results revealed significantly higher normalized stiffness (p = 0.009) and UTS (p = 0.022) in the PNUS group than the other two groups, but insignificant difference in load-relaxation among all groups. This study reveals a positive ultrasonic phonophoretic effect of Panax notoginseng extract for improving the strength of ligament repair than ultrasound therapy alone.

Análise qualitativa dos efeitos da sonoforese com Arnica montana sobre o processo inflamatório agudo do músculo esquelético de ratos

Este estudo visou verificar o efeito da sonoforese com Arnica montana sobre a fase inflamatória aguda de uma lesão muscular. Para isso, 40 ratos Wistar machos, lesados cirurgicamente, foram divididos em 4 grupos: controle (C), 10 ratos lesados e não tratados; grupo ultra-som (US), 10 lesados, tratados com US; grupo ultra-som com arnica (US+A), 10 ratos lesados, tratados com sonoforese de gel de arnica; grupo arnica (A), 10 ratos lesados, tratados com massagem de gel de arnica. O tratamento dos três grupos foi iniciado 24h após a lesão, sendo aplicado uma vez ao dia durante 3 minutos, por três dias. Quatro dias após a lesão, os animais foram sacrificados e o terço médio do músculo tibial anterior lesado foi removido e tratado histologicamente. Os resultados da análise qualitativa mostram que, no grupo C, formou-se um intenso infiltrado de células inflamatórias no espaço intersticial e um processo de regeneração apenas iniciado. Nos grupos US e US+A foi detectado um avançado processo inflamatório, com tecido conjuntivo mais organizado e consistente. No grupo A foi detectada diminuição no número de células inflamatórias e uma desorganização em sua disposição, o que poderia levar a um atraso no processo de regeneração. Conclui-se que os grupos que receberam a aplicação do ultra-som e ultra-som com arnica apresentaram semelhante aceleração do processo inflamatório agudo, sugerindo ineficácia da sonoforese quando comparada à aplicação de apenas ultra-som.

Low-intensity pulsed ultrasound on tendon healing: a study of the effect of treatment duration and treatment initiation

BACKGROUND

Low-intensity pulsed ultrasound has been reported to be effective in promoting tendon healing. However, its optimal time and duration has not yet been determined.

HYPOTHESIS

Tendons at different stages of healing may respond differently to low-intensity pulsed ultrasound. In the present study, the timing effects of low-intensity pulsed ultrasound on tendon healing were investigated in a rat model with a patellar tendon graft harvest lesion.

STUDY DESIGN

Controlled laboratory study.

METHODS

Sixty Sprague-Dawley rats underwent central third patellar tendon donor site harvest. Low-intensity pulsed ultrasound sonication was then delivered to the injured knees at day 1, 14, or 28 after harvest for 2, 4, or 6 weeks. Tendon samples were harvested at day 14, 28, and 42 after lesion for histological examination and mechanical testing.

RESULTS

A 2-week session of low-intensity pulsed ultrasound applied from day 1 postlesion (D1-2W) significantly improved the ultimate mechanical strength of the healing tendons from 23.1 +/- 8.5 MPa to 36.6 +/- 9.0 MPa. Low-intensity pulsed ultrasound did not improve healing when it was given at later stages in D15-2W and D29-2W. When low-intensity pulsed ultrasound treatment was extended from 2 weeks (D1-2W) to 4 weeks (D1-4W) or 6 weeks (D1-6W), the beneficial effects on tendon healing became insignificant. Histological examination showed that low-intensity pulsed ultrasound sonication at late healing stages may disturb remodeling with a poor collagen fiber alignment.

CONCLUSION

Low-intensity pulsed ultrasound promoted restoration of mechanical strength and collagen alignment in healing tendons only when applied at early healing stages.

CLINICAL RELEVANCE

The present findings indicate that low-intensity pulsed ultrasound may be an effective treatment to reduce tendon donor site morbidity.

Enhancement of ultraweak photon emission with 3 MHz ultrasonic irradiation on transplanted tumor tissues of mice

We investigated photon emissions of various bio-samples which were induced by ultrasonic stimulation. It has been reported that ultrasonic stimulations induced the thermal excitation of the bio-tissues. After ultrasonic stimulation, any measurement of photon radiation in the visible spectral range has not been carried out yet. The instruments consisted of electronic devices for an ultrasonic generator of the frequency 3 MHz and a photomultiplier tube (PMT) system counting photons from bio-tissues. The transplanted tumor tissues of mice were prepared for the experiments and their liver and spleen tissues were also used for the controls. It was found that the continuous ultrasonic stimulations with the electrical power 2300 mW induced ultraweak photon emissions from the tumor tissues. The number of induced photon was dependent of the type of the tissues and the stimulation time intervals. The level of photon emission was increased from the mouse tumor exposed to the ultrasonic stimulations, and the changes were discriminated from those of the spleens and livers.

Effects of low-intensity focused ultrasound on the mouse submandibular gland

Ultrasound is expected to make a considerable contribution to drug delivery systems (DDSs). We tested the hypothesis that low-intensity focused ultrasound (LIFU) increases vessel permeability in the mouse submandibular gland without causing parenchymal damage. In a preliminary study, LIFU at 3 W/cm2 with a 50% duty cycle for 2 minutes did not cause histologic damage. We therefore applied LIFU to mouse submandibular gland at these conditions before and after injecting horseradish peroxidase. Single labeling laser scanning confocal microscopy revealed positive horseradish peroxidase staining around the excretory ducts in the mucous-producing part of the gland, but absence of staining in control glands. Immunostaining for fibrinogen was positive in the same region. Fibrinogen is an intravascular protein that does not pass through intact vessels. These findings suggest that LIFU increases vessel permeability and disruption without destruction. It is anticipated that this process will be useful in establishing a DDS that uses LIFU.