RESUMEN
Tendons have limited reparative ability and perform a relatively simple mechanical function via the extracellular matrix. Thus, the injured tendon might be treated successfully by stem cell transplantation. We performed a randomized, controlled study to investigate the effects of mesenchymal stem cell injection for treating partial tears in the supraspinatus tendon. We enrolled 24 patients with shoulder pain lasting more than 3 months and partial tears in the supraspinatus tendon. Participants were assigned to three groups: stem cells in fibrin glue, normal saline/fibrin glue mixture, and normal saline only, with which intra-lesional injection was performed. Pain at activity and rest, shoulder function and tear size were evaluated. For safety measures, laboratory tests were taken and adverse events were recorded at every visit. Participants were followed up at 6, 12 weeks, 6, 12 months and 2 years after injection. The primary outcome measure was the improvement in pain at activity at 3 months after injection. Twenty-three patients were included in the final analysis. Primary outcome did not differ among groups (p = 0.35). A mixed effect model revealed no statistically significant interactions. Only time significantly predicted the outcome measure. All participants reported transient pain at the injection site. There were no differences in post-injection pain duration or severity. Safety measures did not differ between groups, and there were no persistent adverse events. Stem cell injection into supraspinatus partial tears in patients with shoulder pain lasting more than 3 months was not more effective than control injections.ClinicalTrials.gov Identifier: NCT02298023.
Asunto(s)
Trasplante de Células Madre Mesenquimatosas/métodos , Traumatismos de los Tendones/terapia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Manguito de los Rotadores , Dolor de Hombro/etiología , Dolor de Hombro/terapia , Traumatismos de los Tendones/complicaciones , Resultado del TratamientoRESUMEN
BACKGROUND CONTEXT: Clinicians regard lumbar lordotic curvature (LLC) with respect to low back pain (LBP) in a contradictory fashion. The time-honored point of view is that LLC itself, or its increment, causes LBP. On the other hand, recently, the biomechanical role of LLC has been emphasized, and loss of lordosis is considered a possible cause of LBP. The relationship between LLC and LBP has immense clinical significance, because it serves as the basis of therapeutic exercises for treating and preventing LBP. PURPOSE: This study aimed to (1) determine the difference in LLC in those with and without LBP and (2) investigate confounding factors that might affect the association between LLC and LBP. STUDY DESIGN: Systematic review and meta-analysis. PATIENT SAMPLE: The inclusion criteria consisted of observational studies that included information on lumbar lordotic angle (LLA) assessed by radiological image, in both patients with LBP and healthy controls. Studies solely involving pediatric populations, or addressing spinal conditions of nondegenerative causes, were excluded. METHODS: A systematic electronic search of Medline, Embase, Cochrane Library, CINAHL, Scopus, PEDro, and Web of Science using terms related to lumbar alignment and Boolean logic was performed: (lumbar lordo*) or (lumbar alignment) or (sagittal alignment) or (sagittal balance). Standardized mean differences (SMD) and 95% confidence intervals (CI) were estimated, and chi-square and I2 statistics were used to assess within-group heterogeneity by random effects model. Additionally, the age and gender of participants, spinal disease entity, and the severity and duration of LBP were evaluated as possible confounding factors. RESULTS: A total of 13 studies consisting of 796 patients with LBP and 927 healthy controls were identified. Overall, patients with LBP tended to have smaller LLA than healthy controls. However, the studies were heterogeneous. In the meta-regression analysis, the factors of age, severity of LBP, and spinal disease entity were revealed to contribute significantly to variance between studies. In the subgroup analysis of the five studies that compared patients with disc herniation or degeneration with healthy controls, patients with LBP had smaller LLA (SMD: -0.94, 95% CI: -1.19 to -0.69), with sufficient homogeneity based on significance level of .1 (I2=45.7%, p=.118). In the six age-matched studies, patients with LBP had smaller LLA than healthy controls (SMD: -0.33, 95% CI: -0.46 to -0.21), without statistical heterogeneity (I2=0%, p=.916). CONCLUSIONS: This meta-analysis demonstrates a strong relationship between LBP and decreased LLC, especially when compared with age-matched healthy controls. Among specific diseases, LBP by disc herniation or degeneration was shown to be substantially associated with the loss of LLC.
Asunto(s)
Desplazamiento del Disco Intervertebral/complicaciones , Lordosis/complicaciones , Dolor de la Región Lumbar/etiología , Adulto , Anciano , Femenino , Humanos , Dolor de la Región Lumbar/epidemiología , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
Direct current stimulation (DCS) has been known as a noninvasive method for modulating neural activity. We estimated the effects of noninvasive cutaneous DCS applied to the cervical region on corticospinal excitability and segmental sensorimotor excitability. The motor-evoked potential amplitudes and the parameters of the Hoffmann reflex were measured before, immediately after, 1 h after, and 2 h after DCS. In this study, we found that noninvasive cervical application of DCS could increase the motor-evoked potential amplitudes which reflected corticospinal tract excitability. This effect of DCS remained for 2 h after stimulation had ceased. These findings suggest DCS might be a noninvasive and effective tool for corticospinal tract excitation.