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Liang H, Chen K, Xie J, Yao L, Liu Y, Hu F, Li H, Lei Y, Wang Y, Lv L, Chen Z, Liu S, Liu Q, Wang Z, Li J, Chang YN, Li J, Yuan H, Xing G, Xing G. A Bone-Penetrating Precise Controllable Drug Release System Enables Localized Treatment of Osteoporotic Fracture Prevention via Modulating Osteoblast-Osteoclast Communication. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023:e2207195. [PMID: 36971278 DOI: 10.1002/smll.202207195] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Improving local bone mineral density (BMD) at fracture-prone sites of bone is a clinical concern for osteoporotic fracture prevention. In this study, a featured radial extracorporeal shock wave (rESW) responsive nano-drug delivery system (NDDS) is developed for local treatment. Based on a mechanic simulation, a sequence of hollow zoledronic acid (ZOL)-contained nanoparticles (HZNs) with controllable shell thickness that predicts various mechanical responsive properties is constructed by controlling the deposition time of ZOL and Ca2+ on liposome templates. Attributed to the controllable shell thickness, the fragmentation of HZNs and the release of ZOL and Ca2+ can be precisely controlled with the intervention of rESW. Furthermore, the distinct effect of HZNs with different shell thicknesses on bone metabolism after fragmentation is verified. In vitro co-culture experiments demonstrate that although HZN2 does not have the strongest osteoclasts inhibitory effect, the best pro-osteoblasts mineralization results are achieved via maintaining osteoblast-osteoclast (OB-OC) communication. In vivo, the HZN2 group also shows the strongest local BMD enhancement after rESW intervention and significantly improves bone-related parameters and mechanical properties in the ovariectomy (OVX)-induced osteoporosis (OP) rats. These findings suggest that an adjustable and precise rESW-responsive NDDS can effectively improve local BMD in OP therapy.
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Affiliation(s)
- Haojun Liang
- Department of Orthopedic, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, 100039, P. R. China
| | - Kui Chen
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Jing Xie
- State Key Laboratory of Explosion Science and Technology, Beijing Institute of Technology, Beijing, 100081, P. R. China
| | - Lei Yao
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Yunpeng Liu
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Fan Hu
- Department of Orthopedic, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, 100039, P. R. China
| | - Hao Li
- Department of Orthopedic, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, 100039, P. R. China
| | - Yinze Lei
- State Key Laboratory of Explosion Science and Technology, Beijing Institute of Technology, Beijing, 100081, P. R. China
| | - Yujiao Wang
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Linwen Lv
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Ziteng Chen
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Sen Liu
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Qiuyang Liu
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Zhijie Wang
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Jiacheng Li
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Ya-Nan Chang
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Juan Li
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Hui Yuan
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Gengyan Xing
- Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, 100043, P. R. China
| | - Gengmei Xing
- Department of Orthopedic, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, 100039, P. R. China
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Zhao F, Wu J, Wang D, Li P, Tian W, Li W, Chai B, Zhang Y. The effect of subacromial decompression on the curative effect of arthroscopic treatment of shoulder calcific tendinitis. Front Surg 2023; 9:1043794. [PMID: 36684344 PMCID: PMC9852624 DOI: 10.3389/fsurg.2022.1043794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To observe and analyze the surgical efficacy of arthroscopic debridement of calcified deposits and arthroscopic debridement combined with subacromial decompression in patients with supraspinatus tendon calcific myositis. To observe the effect of Subacromial decompression on the efficacy of arthroscopic treatment of shoulder calcific tendinitis. Patients and methods From 2016 to 2021, 48 cases of shoulder arthroscopic debridement due to supraspinatus calcific tendinitis met the inclusion criteria and were included, with 24 cases assigned to the arthroscopic debridement group and 24 cases to the arthroscopic debridement combined with subacromial decompression group. Changes between preoperative and postoperative shoulder pain and shoulder function were statistically analyzed. Results The 24 patients in the arthroscopic debridement group were better than the arthroscopic debridement combined with subacromial decompression group in terms of short-term postoperative shoulder pain and shoulder joint function recovery (P < 0.05). There was no significant difference in the postoperative long-term shoulder pain and shoulder function recovery between the two groups (P > 0.05). Conclusions Compared with arthroscopic debridement combined with subacromial decompression, arthroscopic debridement alone is a better surgical option for the treatment of calcific tendinitis.
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Topalović I, Nešić D. Application of shock wave therapy in the treatment of calcific tendinopathies. MEDICINSKI PODMLADAK 2022. [DOI: 10.5937/mp73-35808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Tendons are the soft tissue that connects muscles to bones. They are made of collagen and elastin, they are strong and solid, and have no possibility of contraction. Their strength helps us to move. Recovery of tendon injuries is long-lasting and can take more than six months. If a tendon is shed during a time injury, calcification occurs at the site of the injury and the disease is called calcifying tendinopathy. The very existence of calcifications is an indication for treatment with a mechanical shock wave (Shock wave). Mechanical shock waves can act in focus or radially. The difference between focused and radial waves is primarily in their physical basis. Focused shock waves differ from radial shock waves in terms of therapeutic depth of penetration into the tissue. The basic biological effect of a mechanical shock wave is stimulating. The energy of the mechanical shock wave acts at the cellular level by stimulating the reduction of inflammation and pain in the tissue. Using mechanical shock wave in the treatment of calcified tendinopathies, a safe method for breaking calcifications was obtained. Shock wave can be applied to using: different frequency, different number of strokes, as well as different strength of strokes in their studies. The choice of parameters for the application depends on whether it is calcified or non-calcified tendinopathy. Indications for the use are: painful shoulder, heel spur, plantar fasciitis, tennis elbow, Achilles tendon tendinopathy, jumping knee, patellar tendinitis, myalgia, myogelosis and muscular tendon overstrain syndrome. Contraindications for the use are: the existence of prostheses, knees and hips, as well as various orthopedic material, pacemaker, as well as the presence of chronic diseases such as multiple sclerosis, amyotrophic lateral sclerosis or tumors. The application of a mechanical shock wave is new, non-invasive method, easy to apply, always reduces pain and practically without side effects. This method has a special role in the treatment of chronic inflammation of diseased tendons, with or without calcification. The only dilemma in the application of a mechanical shock wave can be in the number of applications as well as the time break between the applications of two consecutive mechanical shock waves therapy.
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Robinson DM, Schowalter S, McInnis KC. Update on Evaluation and Management of Calcific Tendinopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00317-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ramon S, Russo S, Santoboni F, Lucenteforte G, Di Luise C, de Unzurrunzaga R, Vetrano M, Albano M, Baldini R, Cugat R, Stella G, Balato G, Seijas R, Nusca SM, Servodidio V, Vulpiani MC. Focused Shockwave Treatment for Greater Trochanteric Pain Syndrome: A Multicenter, Randomized, Controlled Clinical Trial. J Bone Joint Surg Am 2020; 102:1305-1311. [PMID: 32769596 DOI: 10.2106/jbjs.20.00093] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a condition of lateral hip pain. Its physiopathology remains unknown, and there is no consensus on optimal management. The aim of this study was to assess the effectiveness of electromagnetic-focused extracorporeal shockwave treatment (F-ESWT) in patients with GTPS. METHODS This multicenter clinical trial included 103 patients with chronic GTPS randomly assigned to the treatment group, consisting of electromagnetic F-ESWT and a specific exercise protocol, or the control group, receiving sham F-ESWT and the same exercise protocol. Both groups were treated with 3 weekly sessions; the F-ESWT group received an energy flux density of 0.20 mJ/mm, whereas the control group received 0.01 mJ/mm. Patients were assessed at baseline and 1, 2, 3, and 6 months after treatment. A visual analogue scale (VAS) score for pain at 2 months was the primary outcome. The Harris hip score (HHS), Lower Extremity Functional Scale (LEFS), EuroQoL-5 Dimensions Questionnaire (EQ-5D), and Roles and Maudsley score were used as secondary outcomes. Complications were recorded. RESULTS The mean VAS score decreased from 6.3 at baseline in both groups to 2.0 in the F-ESWT group versus 4.7 in the control group at 2 months; the 2-month score differed significantly between groups (p < 0.001). All secondary outcomes at all follow-up intervals were significantly better in the F-ESWT group, except for the LEFS score at 1 month after treatment (p = 0.25). No complications were observed. CONCLUSIONS F-ESWT in association with a specific exercise program is safe and effective for GTPS, with a success rate of 86.8% at 2 months after treatment, which was maintained until the end of follow-up. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Silvia Ramon
- Department of Physical Medicine and Rehabilitation (PMR) (S. Ramon and R.d.U.) and Department of Orthopedic Surgery, Instituto Cugat (R.C. and R.S.), Quirónsalud Hospital, Barcelona, Spain
- Garcia Cugat Foundation-CEU, Barcelona, Spain
- School of Medicine, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Sergio Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Flavia Santoboni
- Physical Medicine and Rehabilitation (F.S., M.V., R.B., G.S., S.-M.N., and M.-C.V.), and Department of Statistics (R.B.), Sapienza University School of Medicine, Rome, Italy
| | - Giacomo Lucenteforte
- Policlinico Vittorio Emanuele, Università degli Studi di Catania, Catania. Italy
- Education & Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Carla Di Luise
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Rocio de Unzurrunzaga
- Department of Physical Medicine and Rehabilitation (PMR) (S. Ramon and R.d.U.) and Department of Orthopedic Surgery, Instituto Cugat (R.C. and R.S.), Quirónsalud Hospital, Barcelona, Spain
- Garcia Cugat Foundation-CEU, Barcelona, Spain
| | - Mario Vetrano
- Physical Medicine and Rehabilitation (F.S., M.V., R.B., G.S., S.-M.N., and M.-C.V.), and Department of Statistics (R.B.), Sapienza University School of Medicine, Rome, Italy
| | - Mariantonia Albano
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Rosella Baldini
- Physical Medicine and Rehabilitation (F.S., M.V., R.B., G.S., S.-M.N., and M.-C.V.), and Department of Statistics (R.B.), Sapienza University School of Medicine, Rome, Italy
| | - Ramon Cugat
- Department of Physical Medicine and Rehabilitation (PMR) (S. Ramon and R.d.U.) and Department of Orthopedic Surgery, Instituto Cugat (R.C. and R.S.), Quirónsalud Hospital, Barcelona, Spain
- Garcia Cugat Foundation-CEU, Barcelona, Spain
- School of Medicine, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
- Mutualitat Catalana de Futbolistes, Barcelona, Spain
| | - Giulia Stella
- Physical Medicine and Rehabilitation (F.S., M.V., R.B., G.S., S.-M.N., and M.-C.V.), and Department of Statistics (R.B.), Sapienza University School of Medicine, Rome, Italy
| | - Giovanni Balato
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberto Seijas
- Department of Physical Medicine and Rehabilitation (PMR) (S. Ramon and R.d.U.) and Department of Orthopedic Surgery, Instituto Cugat (R.C. and R.S.), Quirónsalud Hospital, Barcelona, Spain
- Garcia Cugat Foundation-CEU, Barcelona, Spain
- School of Medicine, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Sveva-Maria Nusca
- Physical Medicine and Rehabilitation (F.S., M.V., R.B., G.S., S.-M.N., and M.-C.V.), and Department of Statistics (R.B.), Sapienza University School of Medicine, Rome, Italy
| | - Valeria Servodidio
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Maria-Chiara Vulpiani
- Physical Medicine and Rehabilitation (F.S., M.V., R.B., G.S., S.-M.N., and M.-C.V.), and Department of Statistics (R.B.), Sapienza University School of Medicine, Rome, Italy
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Simplicio CL, Purita J, Murrell W, Santos GS, dos Santos RG, Lana JFSD. Extracorporeal shock wave therapy mechanisms in musculoskeletal regenerative medicine. J Clin Orthop Trauma 2020; 11:S309-S318. [PMID: 32523286 PMCID: PMC7275282 DOI: 10.1016/j.jcot.2020.02.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/11/2022] Open
Abstract
Extracorporeal shockwave therapy (ESWT) is a popular non-invasive therapeutic modality in the medical field for the treatment of numerous musculoskeletal disorders. This technique first emerged around the 1980s as extracorporeal shockwave lithotripsy and has been studied since then for its application towards orthopedics and traumatology. ESWT works by the emission of acoustic waves (shockwaves) that carry energy and can propagate through tissues. Shockwaves can generate interstitial and extracellular responses, producing many beneficial effects such as: pain relief, vascularization, protein biosynthesis, cell proliferation, neuro and chondroprotection, and destruction of calcium deposits in musculoskeletal structures. The combination of these effects can lead to tissue regeneration and significant alleviation of pain, improving functional outcomes in injured tissue. Considering these facts, ESWT shows great potential as a useful regenerative medicine technique for the treatment of numerous musculoskeletal injuries.
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Affiliation(s)
| | - Joseph Purita
- Institute of Regenerative Medicine, 200 Glades Rd suite 1, Boca Raton, FL, United States
| | - William Murrell
- Emirates Integra Medical & Surgery Centre, Al Razi Bldg #64, Block F, Ground and 1st Floors, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Gabriel Silva Santos
- IOC – Instituto do Osso e da Cartilagem / The Bone and Cartilage Institute, Avenida Presidente Kennedy, 1386 – 2nd Floor, Room #29 – Cidade Nova I, Indaiatuba, SP, Brazil,Corresponding author. IOC – Instituto do Osso e da Cartilagem / The Bone and Cartilage Institute, Avenida Presidente Kennedy, 1386 – 2nd floor, Room #29 – Cidade Nova I, Indaiatuba, SP, 13334-170, Brazil.
| | - Rafael Gonzales dos Santos
- IOC – Instituto do Osso e da Cartilagem / The Bone and Cartilage Institute, Avenida Presidente Kennedy, 1386 – 2nd Floor, Room #29 – Cidade Nova I, Indaiatuba, SP, Brazil
| | - José Fábio Santos Duarte Lana
- IOC – Instituto do Osso e da Cartilagem / The Bone and Cartilage Institute, Avenida Presidente Kennedy, 1386 – 2nd Floor, Room #29 – Cidade Nova I, Indaiatuba, SP, Brazil
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