[Status of outcome measures in randomized controlled trials of kidney-tonifying and blood-activating method in treatment of knee osteoarthritis].

This study assesses the status of outcome measures in the randomized controlled trial(RCT) involving the kidney-tonif-ying and blood-activating method for treating knee osteoarthritis(KOA), aiming to establish a theoretical foundation for the development of a core set of outcome measures in traditional Chinese medicine(TCM) treatment of KOA. The relevant articles were retrieved from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, and Web of Science, in addition to ClinicalTrials.gov and the China Clinical Trial Registration Center, with the time interval from inception to August 2023. The RCT of treating KOA with the kidney-tonifying and blood-activating method was included. Two assessors independently conducted literature screening, data collection, and qualitative analysis to compile the outcome measure results. A total of 350 RCTs were included, involving 165 outcome measures with the total frequency of 1 462. These outcome measures were categorized into six domains: symptom and sign measures(23) with the frequency of 718(49.1%), TCM symptom and syndrome measures(3) with the frequency of 53(3.6%), physical examination measures(130) with the frequency of 506(34.6%), quality of life measures(4) with the frequency of 20(1.3%), long-term efficacy measures(2) with the frequency of 6(0.4%), and safety measures(3) with the frequency of 159(10.9%). Additionally, 53 studies used TCM syndrome and symptom scores as indicators of efficacy, employing eight distinct measurement tools. The RCTs involving the kidney-tonifying and blood-activating method for treating KOA had a variety of problems, such as unclear prio-ritization of outcome measures, diversity in measurement tools, absence of standardized assessment criteria for specific measures, and non-standardized usage. These problems affected the research quality and reliability. Hence, it is advisable to draw upon international expertise, improve research design, and merge TCM efficacy characteristics with clinical research to establish a core set of KOA outcome measures aligned with TCM principles.

A critical overview of systematic reviews and meta-analyses of extracorporeal shockwave therapy for knee osteoarthritis.

Knee Osteoarthritis (KOA) has become a serious health issue for elderly patients. Several systematic reviews (SRs) and Meta-Analyses (MAs) have reported extracorporeal shockwave therapy (ESWT) has widely been used in the treatment of KOA. This overview aims to summarize and evaluate the available evidence for the efficacy of ESWT for KOA. Eight databases were searched from inception to December 4, 2022. The methodological quality of the included SRs/MAs was assessed by Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to assess the quality of the included studies in terms of outcome indicators. Eight SRs/MAs were finally included in this study. The results of the methodological quality of the included SRs/MAs were generally unsatisfactory. The limitations were a lack of explaining the reasons for selection, a list of excluded literature, reporting bias assessment, and reporting the potential sources of conflict of interest. A total of 49 outcome indicators were assessed by using the GRADE tool. Only 3 items were assessed as moderate quality and the remaining indicators were rated as low and very low. Limitations were the most common downgraded factors. ESWT is regarded as a safe and therapeutically effective non-pharmacological method for the treatment of KOA. However, the reliability of the results is affected by the generally low methodological and evidential quality of the included SRs/MAs. Future researchers should improve the quality of original studies and SRs/MAs to provide a higher level of evidence-based medical evidence.

Holographic generation of arbitrary ultrasonic fields by simultaneous modulation of amplitude and phase.

Acoustic holograms have been used widely to generate desired acoustic fields. Following the rapid development of 3D printing technology, the use of holographic lenses has become an efficient method to produce acoustic fields with high resolution and low cost. In this paper, we demonstrate a technique to modulate the amplitude and phase of ultrasonic waves simultaneously using a holographic method with high transmission efficiency and high accuracy. On this basis, we generate an Airy beam with high propagation invariance. We then discuss the advantages and disadvantages of the proposed method when compared with the conventional acoustic holographic method. Finally, we design a sinusoidal curve with a phase gradient and a constant pressure amplitude and realize transport of a particle on a water surface along a curve.

Flexible acoustic lens-based surface acoustic wave device for manipulation and directional transport of micro-particles.

Microfluidics is an emerging technology that is playing increasingly important roles in biomedical and pharmaceutical research and development. Surface acoustic waves (SAWs) have been combined with microfluidics technology to establish a SAW-based microfluidics technology that uses the unique interaction between the two techniques to manipulate substances effectively in fluids on the surface of a substrate. This paper reports a method to generate SAWs using conventional planar ultrasonic transducers and acoustic lenses. Additionally, this method is introduced to manipulate particles effectively on a substrate surface. It is demonstrated that the particle positions can be manipulated precisely in any direction on the substrate surface, thus enabling high-precision particle manipulation. We also proposed the generation of nonplanar SAWs via appropriate design of the acoustic lens and realized directional particle transport. In addition, structures to enhance forward-propagating acoustic beams are proposed. The proposed method has potential for use in microfluidics and biomedical applications, allowing tasks such as flexible cell manipulation on a chip to be performed without complex design or micromachining.

The Effectiveness of Duloxetine for Knee Osteoarthritis: An Overview of Systematic Reviews.

Background: Knee osteoarthritis (KOA) has become a public health problem. Several systematic reviews (SRs) have reported that duloxetine may be an effective treatment for improving pain and depressive symptoms in patients with KOA. Aim: To evaluate the available results and provide scientific evidence for the efficacy and safety of duloxetine for KOA. Methods: A comprehensive search strategy was conducted across eight databases from inception to 31 December 2021. Two researchers independently selected eligible studies, collected data and evaluated those included SRs' quality. For assessing methodological quality, the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) was employed. Risk of Bias in Systematic Reviews (ROBIS) was used to assess the risk of bias. Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) was utilized for assessing reporting quality. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine primary outcome indicators' evidence quality. Results: Totally 6 SRs were contained in this overview. After assessment based on AMSTAR 2, ROBIS, and PRISMA, unsatisfactory results in terms of methodological quality, risk of bias as well as reporting quality, were obtained. Limitations included a search of grey literature, the reasons for selecting the study type, an excluded study list and the specific reasons, reporting bias assessment, and reporting of potential sources of conflict of interest. According to the GRADE results, the evidence quality was high in 0, moderate in 5, low in 19, and very low in 36. Limitations were the most commonly downgraded factor, followed by publication bias and inconsistency. Conclusion: Duloxetine may be an effective treatment for improving pain and depressive symptoms in KOA patients with acceptable adverse events. However, due to the low quality of the available evidence, the original study design and the quality of evidence from SRs should be further improved, so as to provide strong scientific evidence for definitive conclusions. Systematic Review Registration: PROSPERO; (http://www.crd.york.ac.uk/PROSPERO/), identifier (CRD42021289823).

Acupuncture for the Treatment of Knee Osteoarthritis: An Overview of Systematic Reviews.

BACKGROUND: Acupuncture has been widely used in the clinical management of osteoarthritis of the knee (KOA). Many systematic reviews (SRs) and meta-analyses (MAs) have reported its effectiveness in relieving pain. This overview aimed to summarize SRs and MAs on the effectiveness and safety of acupuncture for KOA and evaluate their methodological and evidence quality of the included SRs and MAs. METHODS: We conducted a comprehensive literature search for SRs and MAs in four Chinese and four international databases from their inception until August 2021. Two researchers independently searched the reviews, extracted the data, and cross-checked the data. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool was used to evaluate the methodological quality of the included SRs and MAs. The Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence for the outcomes of the included SRs and MAs. RESULTS: A total of 14 SRs and MAs were included. The evaluation results of the AMSTAR 2 tool showed that the methodological quality of all the 14 SRs and MAs was critically low. The principal causes are the lack of a pre-registration proposal and a list of excluded studies and justify the exclusions, the report on the sources of funding, and the reasons for the study designs for inclusion. The results of the GRADE evaluation showed 25 of 46 outcomes were very low-level evidence. Seventeen were of low level, four were of moderate level and none were of high level. Most outcomes were downgraded in quality of evidence mainly because of publication bias and imprecision. CONCLUSION: The existing evidence suggests that acupuncture seems to be an effective and safe therapy for KOA. However, the deficiencies in the methodological quality and quality of evidence of the included SRs/MAs have limited the reliability of the conclusions. Therefore, further rigorous and comprehensive studies are warranted to verify the effectiveness and safety of acupuncture in KOA.

Precise micro-particle and bubble manipulation by tunable ultrasonic bottle beams.

This paper reports a method to generate tunable bottle beams using an ultrasonic lens, by which the bottle position can be precisely adjusted with the change of the acoustic frequency. Therefore, the position of a single particle or bubble in liquid can be manipulated without using phased array which is costly and huge with complex circuits. Furthermore, we introduced this method to multiple bubble manipulation using acoustic holography. The bottle properties against frequency are theoretically and experimentally analyzed. It is shown that the bottle position depends almost linearly on the operating frequency, which provides a basis for the precise manipulation of bubbles and particles. In addition, the relationship between the acoustic radiation force and the drag force under different incident acoustic pressures is considered, establishing a limit on the moving velocity of the trapped particles. The ultrasonic field observation is further demonstrated by Schlieren imaging system. The proposed method has potential biomedical applications, such as more flexible cell manipulation and targeted drug delivery in vivo, as well as potential applications in the study of chemical reactions between micro objects.

Intra-Articular Injection of Umbilical Cord Mesenchymal Stem Cells Loaded With Graphene Oxide Granular Lubrication Ameliorates Inflammatory Responses and Osteoporosis of the Subchondral Bone in Rabbits of Modified Papain-Induced Osteoarthritis.

Aim: This study is to investigate the effects of umbilical cord mesenchymal stem cells (UCMSCs) loaded with the graphene oxide (GO) granular lubrication on ameliorating inflammatory responses and osteoporosis of the subchondral bone in knee osteoarthritis (KOA) animal models. Methods: The KOA animal models were established using modified papain joint injection. 24 male New Zealand rabbits were classified into the blank control group, GO group, UCMSCs group, and GO + UCMSCs group, respectively. The concentration in serum and articular fluid nitric oxide (NO), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), type II collagen (COL-II), and glycosaminoglycan (GAG) was detected using ELISA, followed by the dissection of femoral condyles and staining of HE and Micro-CT for observation via the microscope. Results: GO granular lubrication and UCMSCs repaired the KOA animal models. NO, IL-6, TNF-α, GAG, and COL-II showed optimal improvement performance in the GO + UCMSCs group, with statistical significance in contrast to the blank group (P <0.01). Whereas, there was a great difference in levels of inflammatory factors in serum and joint fluid. Micro-CT scan results revealed the greatest efficacy of the GO + UCMSCs group in improving joint surface damage and subchondral bone osteoporosis. HE staining pathology for femoral condyles revealed that the cartilage repair effect in GO + UCMSCs, UCMSCs, GO, and blank groups were graded down. Conclusion: UCMSCs loaded with graphene oxide granular lubrication can promote the secretion of chondrocytes, reduce the level of joint inflammation, ameliorate osteoporosis of the subchondral bone, and facilitate cartilage repair.

Acoustic trapping of particles using a Chinese taiji lens.

Focused acoustic vortex (FAV) beams can trap particles in a contactless and non-destructive way and the method has thereby attracted much attention. In contrast to the traditional complex and expensive transducer array, we propose a fast and cheap method to generate FAV beams in water using an ultrasonic holographic lens engraved with the Chinese taiji pattern. This method can obtain high transmission efficiency, and hence the strong trapping force makes the particles trapped stably in a straight line. The formation of the FAV beams derives from a superposition of the spiral phase of a Laguerre Gaussian beam and the focusing phase. Because of the phase singularity of this beam, the intensity of the ultrasonic field on the beam axis is zero, thereby forming a strong gradient surround the beam axis. The trapping and manipulation of polystyrene particles with a radius of 150 µm is realized in the gradient field of the FAV beam. The proposed single beam acoustic trapping method does not depend on the reflector, making it more suitable for the manipulation of cells in vivo.

Expression of human peroxisome proliferator-activated receptors ligand binding domain-maltose binding protein fusion protein in Escherichia coli: a convenient and reliable method for preparing receptor for screening ligands.

Human peroxisome proliferator-activated receptors (hPPARs) are ligand-activated transcription factors and are the target for the treatment of many diseases. Screening of their ligands is mainly based on assays of ligand binding to the ligand binding domain (LBD) of hPPARs.However, such assays are difficult because of the preparation of hPPARs LBD. In order to yield functional hPPARs LBD for screening ligands, hPPARs LBD was fused with maltose-binding protein(MBP) using the pMAL-p2x expression system through the gene engineering technique. The radioligand binding assay showed that MBP did not affect ligand binding with hPPARs LBD in the fusion proteins, which means that MBP-hPPARs LBD can be used instead of hPPARs LBD in ligand screening work. The results show that the new strategy using MBP as a fusion tag for preparing hPPARs LBD for screening ligands is a convenient and reliable method. It may be used to easily obtain the other nuclear receptors.