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BACKGROUND: The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP). OBJECTIVE: The purpose of this meta-analysis was to evaluate the effectiveness and safety of thoracic manipulation (TM) in patients with neck pain (NP). METHODS: Seven electronic databases were searched from their inception through October 2023 by two authors. The methodological quality assessments were performed with the Physiotherapy Evidence Database (PEDro) scale. Pain, cervical range of motion (ROM), disability, and quality of life (QOL) were estimated for TM treatment in patients with NP. RESULTS: Eighteen randomized controlled trials (RCTs) with 914 patients were included with a PEDro score of 6.923 ± 3.120. Pooled effect sizes of pain (SMD = - 0.481, 95% CI - 0.653 to - 0.309, P = 0.000), disability (SMD = - 1.435, 95% CI - 2.480 to - 0.390, P = 0.007), QOL-physical component score (PCS) (SMD = 0.658, 95% CI 0.290 to 1.025, P = 0.000), ROM of flexion (SMD = 0.921, 95% CI 0.287 to 1.555, P = 0.000), ROM of extension (SMD = 0.572, 95% CI 0.321 to 0.822, P = 0.000), ROM of left lateral flexion (SMD = 0.593, 95% CI 0.075 to 1.112, P = 0.025) and ROM of left rotation (SMD = 0.230, 95% CI 0.010 to 0.450, P = 0.04) were favored by the TM group. CONCLUSIONS: TM provides short-term effect on relieving neck pain, increasing cervical ROM, and disability in patients with NP without serious side effects. Continuous therapy and distraction therapy are recommended as optimal choice on reducing pain and improving cervical ROM, especially in patients with chronic NP (> 3 months). The TM-induced improvements in the QOL of patients with NP should be verified by more further high-quality RCTs. [ABSTRACT FROM AUTHOR]

Background: Concerns have been raised regarding the impact of preoperative intravenous dexamethasone on postoperative glycemic control in diabetic patients undergoing total joint arthroplasty (TJA). This study aimed to determine relationships between preoperative different dexamethasone regimens and postoperative fasting blood glucose (FBG), as well as to identify risk factors for postoperative FBG ≥ 200 mg/dl in diabetic patients undergoing TJA. Methods: This retrospective study included 1216 diabetic patients undergoing TJA and categorized into group A (dexamethasone = 0 mg), group B (dexamethasone = 5 mg), and group C (dexamethasone = 10 mg). All dexamethasone was administered before skin incision. FBG levels were monitored until postoperative day (POD) 3. Analyses were conducted for periprosthetic joint infection (PJI) and wound complications during 90 days postoperatively. And the risk factors for postoperative FBG ≥ 200 mg/dl were identified. Results: Preoperative dexamethasone administration resulted in a transiently higher FBG on POD 0 and POD 1 (all P < 0.001). However, no differences were observed on POD 2 (P = 0.583) and POD 3 (P = 0.131) among three groups. While preoperative dexamethasone led to an increase in postoperative mean FBG and postoperative maximum FBG (all P < 0.001), no differences were found in wound complications (P = 0.548) and PJI (P = 1.000). Increased HbA1c and preoperative high FBG, but not preoperative dexamethasone, were identified as risk factors for postoperative FBG ≥ 200 mg/dl. Preoperative HbA1c level of ≥ 7.15% was associated with an elevated risk of postoperative FBG ≥ 200 mg/dl. Conclusions: Although preoperative intravenous administration of 5 mg or 10 mg dexamethasone in diabetic patients showed transient effects on postoperative FBG after TJA, no differences were found in the rates of PJI and wound complications during 90 days postoperatively. Notably, patients with a preoperative HbA1c level of ≥ 7.15% and elevated preoperative FBG may encountered postoperative FBG ≥ 200 mg/dl. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (KOA) is a chronic musculoskeletal disease that can cause joint pain and dysfunction, affecting the quality of life of patients. Nonsurgical treatment is the conventional treatment of KOA, among which physical therapy is widely used because of its simplicity, convenience and effectiveness. The functional biomarker will add to the clinical fidelity and diagnostic accuracy. Therefore, our study chose a more objective evaluation indicator, functional near-infrared spectroscopy (fNIRS), to identify between healthy people and KOA patients, and to detect the pain change before and after treatment of KOA patients. Methods: The study will be conducted in the Rehabilitation Medical Center of West China Hospital of Sichuan University and divided into 2 stages. In the first stage, we will compare and determine the differences in baseline data between healthy volunteers and KOA patients. In the second stage, 72 KOA patients will be randomly divided into two groups: the drug therapy group (DT) and the combination therapy group (CT) for 10 treatments. Outcome measures will be measured at baseline and on the 5th and 10th days after the intervention, including the numerical rating scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain catastrophizing scale (PCS), the association of pain severity with task-state functional connectivity fNIRS and association of pain severity with task-activated fNIRS. Discussion: By analyzing the fNIRS data of healthy volunteers and KOA patients, our study will be determined whether fNIRS can be used as a new indicator to reflect the severity of pain in KOA patients. Subsequently, the same fNIRS data for KOA patients before and after the intervention will be collected to provide an accurate evaluation criterion for the effect of physical therapy on KOA. Trial registration: The study was registered on the Chinese Registry website (registered in ChiCTR.org with the identifiers ChiCTR2200064175 and 29/09/2022). [ABSTRACT FROM AUTHOR]

Objective: To determine whether exoskeleton-assisted walking (EAW) improves pulmonary ventilation function, motor function and related body structure, and activities equivalently as the conventional exercise program for people with spinal cord injury (SCI). Methods: Forty participants (7 females and 33 males; age 37.1±12.0 years) with thoracic SCI were randomized into two groups and undertook 16 sessions of 50–60 min training (4 days/week). Participants in the EAW group received EAW trainings, such as assisted standing, walking, and climbing the stairs. The control group received a conventional exercise program. Outcomes were measured at baseline and upon completion of treatment. Results: After trainings, the EAW group improved more than the control group in the forced vital capacity (FVC, 0.53 L [0.01–1.06 L]), predicted FVC% (19.59 [6.63–32.54]) and forced expiratory volume in 1s (0.61 L [0.15–1.07 L]), basic activities of daily living (BADL) (19.75 [10.88–28.62]), and distal femoral cartilage. Participants in the EAW group completed 6-minute walk test with median 17.3 meters while wearing the exoskeleton. There was no difference in trunk and lower extremity motor function, bone mineral density, and adverse events (${P}$ > 0.05). Conclusion: In people with lower thoracic neurological level of SCI, EAW training has potential benefits to facilitate pulmonary ventilation function, walking, BADL and thickness of cartilage comparing to a conventional excise program. Significance: This study provided more evidence for using EAW in clinic, and partly proved EAW had equivalent effects as conventional exercise program, which may combine with conventional exercise program for reducing burden of therapists in the future. [ABSTRACT FROM AUTHOR]

Osteoarthritis, as a degenerative disease, is a common problem and results in high socioeconomic costs and rates of disability. The most commonly affected joint is the knee and characterized by progressive destruction of articular cartilage, loss of extracellular matrix, and progressive inflammation. Mesenchymal stromal cell (MSC)-based therapy has been explored as a new regenerative treatment for knee osteoarthritis in recent years. However, the detailed functions of MSC-based therapy and related mechanism, especially of cartilage regeneration, have not been explained. Hence, this review summarized how to choose, authenticate, and culture different origins of MSCs and derived exosomes. Moreover, clinical application and the latest mechanistical findings of MSC-based therapy in cartilage regeneration were also demonstrated. [ABSTRACT FROM AUTHOR]

Objective: Repetitive Transcranial Magnetic Stimulation (rTMS) has been used in cognition impairment due to various neuropsychiatric disorders. However, its optimum parameters and the neuroimaging mechanism are still of uncertainty. In order to simulate a study setting as close to real world as possible, the present study introduces a new orthogonally-designed protocol, consisting of the rTMS intervention with four key parameters (stimulating site, frequency, intensity and pulse number) and three different levels in each one, and aims to investigate the optimum parameters and the brain activity and connectivity in default mode network (DMN), dorsal attention network (DAN), central executive network (CEN) following rTMS intervention to post-stroke cognition impairment (PSCI). Methods: A single-center, orthogonally-designed, triple-blind randomized controlled trial will be conducted and forty-five PSCI patients will be recruited and randomly assigned to one of nine active rTMS groups based on four rTMS paraments: stimulating site, frequency, intensity and pulse number. Neuropsychological, activities of daily living, quality of life and functional magnetic resonance imaging (fMRI) evaluations were be performed pre-, post- and 3 months after rTMS. Discussion: This study evaluates the optimum parameters of rTMS for patients with post-stroke cognition impairment and explores the alteration of neural function in DMN, DAN, CEN brain network. These results would facilitate the standardized application of rTMS in cognition impairment rehabilitation. [ABSTRACT FROM AUTHOR]

Osteoarthritis, as a degenerative disease, is a common problem and results in high socioeconomic costs and rates of disability. The most commonly affected joint is the knee and characterized by progressive destruction of articular cartilage, loss of extracellular matrix, and progressive inflammation. Mesenchymal stromal cell (MSC)-based therapy has been explored as a new regenerative treatment for knee osteoarthritis in recent years. However, the detailed functions of MSC-based therapy and related mechanism, especially of cartilage regeneration, have not been explained. Hence, this review summarized how to choose, authenticate, and culture different origins of MSCs and derived exosomes. Moreover, clinical application and the latest mechanistical findings of MSC-based therapy in cartilage regeneration were also demonstrated. [ABSTRACT FROM AUTHOR]

Background Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders. Purpose The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD). Data Sources Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019. Study Selection All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included. Data Extraction Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies. Data Synthesis Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score (mean difference = 1.23; 95% CI = 0.15 to 2.31; I2 = 56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference = 0.69; 95% CI = 0.12 to 1.26; I2 = 0%). Both provided moderate statistical evidence. However, the Timed "Up & Go" Test and the Activities-Specific Balance Confidence Scale did not differ significantly. Limitations Publication bias and diversity in the interventions were the main limitations. Conclusions Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD. [ABSTRACT FROM AUTHOR]

Background An evaluation of cardiopulmonary exercise testing ( CPET) screening and pre-operative pulmonary rehabilitation in reducing postoperative complications and improving fast-track recovery in high-risk patients who undergo resection for lung cancer. Methods Of 342 potential lung cancer cases, 142 high-risk patients were finally divided into two groups: group R (n = 71) underwent an intensive pre-operative pulmonary rehabilitation program ( PRP), followed by lobectomy; group S (n = 71) underwent only lobectomy with conventional management. Postoperative complications, average days in hospital, postoperative days in hospital, and cost were analyzed. Results The 142 high-risk patients were screened by smoking history and CPET. Sixty-eight patients had bronchial hyperresponsiveness ( BHR) and 47 patients had peak expiratory flow <250 L/minute by CPET. The rate of postoperative total complications in group R (16.90%) was significantly lower than in group S (83.31%) ( P = 0.00), as was the rate of postoperative pulmonary complications PPC: group R (12.81%) versus S (13.55%) ( P = 0.009); the PPC in the left lung (17.9%) was higher than in the right lung (2.3%) ( P = 0.00). The average days in hospital in group S was significantly higher than in group R ( P = 0.03). There was no difference between groups in average hospital cost ( P = 0.304). Conclusion Pre-operative screening using CPET is conducive to identifying high-risk patients for lung resection. Pre-operative pulmonary rehabilitation is helpful to reduce postoperative complications and improve fast-track recovery. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis (OP) and osteoarthritis (OA) are prevalent skeletal disorders among postmenopausal women. Coexistence is common especially that of postmenopausal osteoporosis (PMO) and lumbar OA. An hypothesis has been raised that OP and OA might share the same pathogenic mechanism, and pulsed electromagnetic fields (PEMFs) were reported to have anti-osteoporosis and anti-osteoarthritis properties, but this suggestion was based primarily on biomarker data. Therefore, whether these two effects could take place simultaneously has not yet been investigated. This randomized controlled trial (RCT) is designed to explore the effect of PEMFs for PMO and concomitant lumbar OA.Methods/design: The study will include PMO patients (postmenopausal women; aged between 50 and 70 years; have been postmenopausal for at least 5 years and diagnosed with OP using proximal femur T-score) with concomitant lumbar OA (patients with confounding disorders like diabetes, hypertension, hyperlipidemia, and previous fracture history, etcetera, will be excluded) will be randomly assigned to two arms: PEMFs group and sham PEMFs group. There will be 25 participants in each arm (50 in total) and the outcome assessment, including the primary endpoint (proximal femur bone mineral density), will be performed at 5 weeks, 3 months and 6 months after enrollment.Discussion: PMO and lumbar OA are prominent public health problem, especially for postmenopausal women. We hope this RCT will provide scientific evidence to primary care of the postmenopausal women regarding the use of these nonpharmaceutical, noninvasive modalities, PEMFs, in managing PMO and lumbar OA.Trial Registration: Chinese Clinical Trial Registry: ChiCTR-TRC-14005156 (28 August 2014). [ABSTRACT FROM AUTHOR]

The aim of this study is to observe the effect of different treatment time of millimeter wave (MMW) on chondrocyte apoptosis, caspase-3, caspase-8, and matrix metalloproteinase-13 (MMP-13) in rabbit knee osteoarthritis induced by anterior cruciate ligament transection (ACLT). Thirty-two New Zealand White rabbits were randomly assigned into 4 groups: millimeter wave treatment for 20-min group (MWT20); millimeter wave treatment for 40-min group (MWT40); model control group (MC) and normal control group (NC). All groups received anterior cruciate ligament transection in the right knee except NC group. Six weeks after transection, the MWT20 group and MWT40 group were given millimeter wave (MMW) at 37.5 GHz frequency, 8 mm wavelength, and 10 mW/cm power for 20 and 40 min, respectively, for 10 days. Eight weeks after transection, all animals were killed. Modified Mankin Score was assessed for histological assessment. Chondrocytes apoptosis was tested by the TUNEL assessment, and the expressions of related proteins were tested by the immunohistochemistry observation and Western blot. The modified Mankin Score, the chondrocyte apoptosis, and the expression of caspase-3 and MMP-13 in MWT40 group were significantly lower than those in MC group. Only a decreasing trend of modified Mankin Score and caspase-3 and MMP-13 expression was found in MWT20 group. The caspase-8 expression of the treatment groups was lower than model control group and higher than normal control group, but no significant difference was found. This study revealed MWT40 had a better therapeutic benefit to osteoarthritis cartilage structure, decreased the apoptosis of chondrocyte, and caspase-3 and MMP-13 expression compared to MWT20. But only a decreasing trend of caspase-8 expression was found. [ABSTRACT FROM AUTHOR]

The present study was designed to determine the effects of pulsed electromagnetic fields (PEMFs) on the mRNA expression of the carbonic anhydrase II (CAII) and receptor activator of NF-κB (RANK) in ovariectomized rats. A total of 48 SD rats were randomly divided into four groups [Sham, OVX, PEMFs, and E (premarin)], 12 rats in each group. Rats in the Sham group received sham ovariectomy, while rats in OVX, PEMFs, and E groups received ovariectomy. Twelve weeks following the surgery, rats (whole body) in the PEMFs group were exposed to PEMFs for 30 days with 3.8 mT, 8 Hz, and 40 min per day; rats in the E group were administered premarin (0.0625 mg/kg/d; intragastric administration 1-2 ml/100 g). Rats in the Sham and OVX groups housed in the same conditions. At the end of intervention, the level of serum estradiol of rats was measured. The gene expression of CAII and RANK in the left ilium of rats was determined with real-time fluorescent-nested quantitative polymerase chain reaction. Compared with the Sham group, the level of serum estradiol in the ovariectomized group was significantly decreased ( P < 0.05); compared with the OVX group, CAIImRNA expression was significantly decreased in the PEMFs group and E group ( P < 0.05, 0.01, respectively). Compared with the E group, RANKmRNA expression was significantly higher in the PEMFs group ( P < 0.05); although RANKmRNA expression decreased in PEMFs group, no statistically significant difference was found between PEMF group and OVX group ( P = 0.82). These data suggest that PEMFs could regulate the expression of CAIImRNA in ovariectomized rats. [ABSTRACT FROM AUTHOR]

The purpose of this study was to observe the effect of 810-nm low-level laser to apoptosis of chondrocyte and related proteins, including caspase-3 and caspase-8, in rabbit surgery-induced model of knee osteoarthritis. A total of 24 New Zealand White rabbits were randomly assigned into 3 groups: test group, model group, and normal group. The rabbits in test group and model group received anterior cruciate ligament transection in the right knee. Six weeks after transection, the rabbits in test group were given 10-session 810-nm laser illumination. Eight weeks after transection, all animal were killed. Modified Mankin Score was made for histological assessment. The caspases expressions and chondrocytes apoptosis were tested using the immunohistochemistry and TUNEL assessment, respectively. The modified Mankin Score of test group was significantly lower than model group ( P < 0.01) and higher than normal group ( P < 0.01). The caspase-8 expression of test group was lower than model group and higher than normal group, but no significant difference was found ( P > 0.05). This study revealed that the 810-nm low-level laser can improve cartilage structure, prevent articular cartilage degradation and significantly decrease the expression of caspase-3 in this surgery-induced OA model. Further studies are needed. [ABSTRACT FROM AUTHOR]

This study was designed to determine the effects of pulsed electromagnetic fields (PEMF) on the mRNA expression of the receptor activator of NF-κ-B (RANK) and carbonic anhydrase II (CA II) in ovariectomized rat osteoclast-like cells. Marrow cells were harvested from femora and tibiae of rats, from which the ovaries had been totally excised, and cultured in 6-well chamber slides. After 1 day of incubation, the marrow cells were exposed to PEMF for 3 days with 3.8 mT, 8 Hz, and 40 min per day. Osteoclast-like cells were confirmed by both tartrate resistant acid phosphatase (TRAP) stain and bone resorption assay. The expression of RANK and CA II mRNA was determined with real-time fluorescent-nested quantitative polymerase chain reaction. Compared with the sham group, the level of serum estradiol in the ovariectomized group was significantly decreased ( p < 0.05). The numbers of multinucleated, TRAP-positive osteoclast-like cells and resorption pits formed were observed. In invitro study, the expression of RANK and CA II were measured in sham, ovariectomized without PEMF, and ovariectomized with PEMF treatment. Compared with the ovariectomized (PEMF) experimental group and sham group, CA II mRNA expression was significantly increased in the ovariectomized control group ( p < 0.05, 0.01, respectively). Compared with the sham group, RANK mRNA expression was significantly increased in the ovariectomized control group ( p < 0.05). These data suggest that PEMF could regulate the expression of RANK and CA II mRNA in the marrow culture system. [ABSTRACT FROM AUTHOR]