Disorders of the musculoskeletal system are the major contributors to the global burden of disease and current treatments show limited efficacy.Patients often suffer chronic pain and might eventually have to undergo e...Disorders of the musculoskeletal system are the major contributors to the global burden of disease and current treatments show limited efficacy.Patients often suffer chronic pain and might eventually have to undergo end-stage surgery.Therefore,future treatments should focus on early detection and intervention of regional lesions.Microrobots have been gradually used in organisms due to their advantages of intelligent,precise and minimally invasive targeted delivery.Through the combination of control and imaging systems,microrobots with good biosafety can be delivered to the desired area for treatment.In the musculoskeletal system,microrobots are mainly utilized to transport stem cells/drugs or to remove hazardous substances from the body.Compared to traditional biomaterial and tissue engineering strategies,active motion improves the efficiency and penetration of local targeting of cells/drugs.This review discusses the frontier applications of microrobotic systems in different tissues of the musculoskeletal system.We summarize the challenges and barriers that hinder clinical translation by evaluating the characteristics of different microrobots and finally point out the future direction of microrobots in the musculoskeletal system.展开更多
Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging a...Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging and the flow properties used within Doppler imaging, hence elastography provides a different form of tissue assessment. The current role of ultrasound elastography in the musculoskeletal system will be reviewed, in particular with reference to muscles, tendons, ligaments, joints and soft tissue tumours. The different ultrasound elastography methods currently available will be described, in particular strain elastography and shear wave elastography. Future directions of ultrasound elastography in the musculoskeletal system will also be discussed.展开更多
Chronic pain and general physical discomfort are common symptoms among those seeking medical or physiotherapy treatment, as it relates to disorders found in the Human Musculoskeletal System (HMS). Since this system is...Chronic pain and general physical discomfort are common symptoms among those seeking medical or physiotherapy treatment, as it relates to disorders found in the Human Musculoskeletal System (HMS). Since this system is highly complex and large in scale, clinical pain research has been confounded by many complex factors. The goal of our research is to overcome these obstacles by applying multidisciplinary approaches including systems engineering, traditional oriental techniques, conventional medicine and related sciences. To pursue such an integrated approach this paper examines the therapist-guided exercise for restoring human musculoskeletal balance called the Somatic Balance Restoration Therapy (SBRT). The SBRT is a simple but effective self-exercise therapy with minimal assistance by a trained therapist. This therapy is analyzed by a mechanical engineering method by modeling the human body as a multi-body subject to a static equilibrium condition. In addition, the wording has been rewritten in functional anatomical terms, enabling smooth communication between specialists of three different disciplines: therapy, conventional medicine and systems engineering. Examples will be given to demonstrate an integrated and systematic approach for identifying and remedying malfunctions within the HMS.展开更多
The intricate hierarchical structure of musculoskeletal tissues,including bone and interface tissues,necessitates the use of complex scaffold designs and material structures to serve as tissue-engineered substitutes.T...The intricate hierarchical structure of musculoskeletal tissues,including bone and interface tissues,necessitates the use of complex scaffold designs and material structures to serve as tissue-engineered substitutes.This has led to growing interest in the development of gradient bone scaffolds with hierarchical structures mimicking the extracellular matrix of native tissues to achieve improved therapeutic outcomes.Building on the anatomical characteristics of bone and interfacial tissues,this review provides a summary of current strategies used to design and fabricate biomimetic gradient scaffolds for repairing musculoskeletal tissues,specifically focusing on methods used to construct compositional and structural gradients within the scaffolds.The latest applications of gradient scaffolds for the regeneration of bone,osteochondral,and tendon-to-bone interfaces are presented.Furthermore,the current progress of testing gradient scaffolds in physiologically relevant animal models of skeletal repair is discussed,as well as the challenges and prospects of moving these scaffolds into clinical application for treating musculoskeletal injuries.展开更多
Nursing staff provides patient care in an occupational environment that often imposes challenges that affect significantly the musculoskeletal system.Work-related musculoskeletal disorders are common in nursing stuff ...Nursing staff provides patient care in an occupational environment that often imposes challenges that affect significantly the musculoskeletal system.Work-related musculoskeletal disorders are common in nursing stuff and have a negative impact in their professional and daily activities.In the current editorial,the duties of nursing staff,the types of musculoskeletal disorders,the predis-posing factors(including factors related to professional tasks/ergonomics and to working schedules,psychological,social and individual factors)and their impact on working ability and quality of life nursing staff are summarized and pre-ventive measures are proposed.展开更多
Biological musculoskeletal system （MSK）, composed of numerous bones, cartilages, skeletal muscles, tendons, ligaments etc., provides form, support, movement and stability for human or animal body. As the result of m...Biological musculoskeletal system （MSK）, composed of numerous bones, cartilages, skeletal muscles, tendons, ligaments etc., provides form, support, movement and stability for human or animal body. As the result of million years of selection and evolution, the biological MSK evolves to be a nearly perfect mechanical mechanism to support and transport the human or animal body, and would provide enormously rich resources to inspire engineers to innovate new technology and methodology to develop robots and mechanisms as effective and economical as the biological systems. This paper provides a general review of the current status of musculoskeletal biomechanics studies using both experimental and computational methods. This includes the use of the latest three-dimensional motion analysis systems, various medical imaging modalities, and also the advanced rigid-body and continuum mechanics musculoskeletal modelling techniques. Afterwards, several representative biomimetic studies based on ideas and concepts inspired from the structures and biomechanical functions of the biological MSK are dis- cussed. Finally, the major challenges and also the future research directions in musculoskeletal biomechanics and its biomimetic studies are proposed.展开更多
Musculoskeletal disorders are common in clinical practice.Repairing critical-sized defects in musculoskeletal systems remains a challenge for researchers and surgeons,requiring the application of tissue engineering bi...Musculoskeletal disorders are common in clinical practice.Repairing critical-sized defects in musculoskeletal systems remains a challenge for researchers and surgeons,requiring the application of tissue engineering biomaterials.Successful application depends on the response of the host tissue to the biomaterial and specific healing process of each anatomical structure.The commonly-held view is that biomaterials should be biocompatible to minimize local host immune response.However,a growing number of studies have shown that active modulation of the immune cells,particularly macrophages,via biomaterials is an effective way to control immune response and promote tissue regeneration as well as biomaterial integration.Therefore,we critically review the role of macrophages in the repair of injured musculoskeletal system soft tissues,which have relatively poor regenerative capacities,as well as discuss further enhancement of target tissue regeneration via modulation of macrophage polarization by biomaterial-mediated immunomodulation(biomaterial properties and delivery systems).This active regulation approach rather than passive-evade strategy maximizes the potential of biomaterials to promote musculoskeletal system soft tissue regeneration and provides alternative therapeutic options for repairing critical-sized defects.展开更多
Importance:There are a variety of musculoskeletal malformations and injuries that can occur in newborns.These can be a significant cause of perinatal death or a reason for miscarriage and can lead to long-term functio...Importance:There are a variety of musculoskeletal malformations and injuries that can occur in newborns.These can be a significant cause of perinatal death or a reason for miscarriage and can lead to long-term functional issues if not managed appropriately.There is no systematic and well-established screening program for neonatal musculoskeletal malformations and injuries in China now.Objective:To report the incidence and types of congenital musculoskeletal malformations in two hospitals in Shenzhen City,to explore and discuss the details of the screening procedure and improve future prevention and treatment.Methods:From October 2013 to May 2014,2564 one-day-old newborns were screened by a pediatric orthopedic physical examination,in combination with ultrasonography when required,and the incidence and variety of diseases were recorded statistically.Results:Among 2564 screened newborns,the following musculoskeletal conditions were identified:congenital muscular torticollis(CMT)(seven cases,0.27%),hip subluxation(four cases,0.16%),hip dysplasia(47 cases,1.83%),congenital talipes equinovarus(CTEV)(two cases,0.08%),congenital talipes calcaneovalgus(15 cases,0.58%),polydactyly(nine cases,0.35%),syndactyly(one case,0.04%),and spinal hemivertebra(one case,0.04%).Additionally,there were five(0.19%)neonates with birth injuries.Interpretation:It is feasible to carry out neonatal screening and identification of musculoskeletal malformations and birth injuries in China.This is helpful as timely detection and early intervention for many of these conditions can avoid permanent functional impairment in these children.展开更多
Infection and rejection in musculoskeletal trauma often pose challenges for natural healing,prompting the exploration of biomimetic organ and tissue transplantation as a common alternative solution.Polyhydroxyalkanoat...Infection and rejection in musculoskeletal trauma often pose challenges for natural healing,prompting the exploration of biomimetic organ and tissue transplantation as a common alternative solution.Polyhydroxyalkanoates(PHAs)are a large family of biopolyesters synthesised in microorganism,demonstrating excellent biocompatibility and controllable biodegradability for tissue remodelling and drug delivery.With different monomer-combination and polymer-types,multi-mechanical properties of PHAs making them have great application prospects in medical devices with stretching,compression,twist in long time,especially in musculoskeletal tissue engineering.This review systematically summarises the applications of PHAs in multiple tissues repair and drug release,encompassing areas such as bone,cartilage,joint,skin,tendons,ligament,cardiovascular tissue,and nervous tissue.It also discusses challenges encountered in their application,including high production costs,potential cytotoxicity,and uncontrollable particle size distribution.In conclusion,PHAs offer a compelling avenue for musculoskeletal system applications,striking a balance between biocompatibility and mechanical performance.However,addressing challenges in their production and application requires further research to unleash their full potential in tackling the complexities of musculoskeletal regeneration.展开更多
Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during...Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training,operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.Methods: A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed(using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.Results: In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/nonmodifiable, as well as extrinsic/intrinsic risk factors.Conclusions: This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.展开更多
Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran ...Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.展开更多
Background:Musculoskeletal(MSK)conditions,MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability,yet global guidance to arrest the rising disability burden is lacking.We aimed t...Background:Musculoskeletal(MSK)conditions,MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability,yet global guidance to arrest the rising disability burden is lacking.We aimed to explore contemporary context,challenges and opportunities at a global level and relevant to health systems strengthening for MSK health,as identified by international key informants(KIs)to inform a global MSK health strategic response.Methods:An in-depth qualitative study was undertaken with international KIs,purposively sampled across highincome and low and middle-income countries(LMICs).KIs identified as representatives of peak global and international organisations(clinical/professional,advocacy,national government and the World Health Organization),thought leaders,and people with lived experience in advocacy roles.Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method.Data were organised into categories describing 1)contemporary context;2)goals;3)guiding principles;4)accelerators for action;and 5)strategic priority areas(pillars),to build a data-driven logic model.Here,we report on categories 1–4 of the logic model.Results:Thirty-one KIs from 20 countries(40%LMICs)affiliated with 25 organisations participated.Six themes described contemporary context(category 1):1)MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised;2)improving MSK health is more than just healthcare;3)global guidance for country-level system strengthening is needed;4)impact of COVID-19 on MSK health;5)multiple inequities associated with MSK health;and 6)complexity in health service delivery for MSK health.Five guiding principles(category 3)focussed on adaptability;inclusiveness through co-design;prevention and reducing disability;a lifecourse approach;and equity and value-based care.Goals(category 2)and seven accelerators for action(category 4)were also derived.Conclusion:KIs strongly supported the creation of an adaptable global strategy to catalyse and steward countrylevel health systems strengthening responses for MSK health.The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health.Contextual considerations about MSK health and accelerators for action should be considered in reform activities.展开更多
A variety of indications have been published regarding the use of percutaneous thermal ablation for treating tumors of the musculoskeletal system,including bone and soft tissue lesions,benign and malignant lesions,and...A variety of indications have been published regarding the use of percutaneous thermal ablation for treating tumors of the musculoskeletal system,including bone and soft tissue lesions,benign and malignant lesions,and primary and metastatic tumors.In the appropriately selected patient,the advantages of percutaneous thermal ablation include decreased morbidity,decreased cost,and shorter hospitalization stays compared to surgery.The number of different thermal ablation modalities is increasing,and each modality has its advantages and disadvantages.Studies directly comparing the effectiveness of the various thermal ablation modalities are sparse,however,so the choice of ablation modality often depends on availability,user preference,and local expertise.Although the list of uses for percutaneous thermal ablation is ever-expanding,in this article,we will discuss the two most well-established indications,which are palliation of pain attributed to bone and soft tissue metastases and local control of oligometastatic disease.Numerous clinical trials have shown percutaneous thermal ablation to be an effective method of palliating pain due to bone and soft tissue metastases and of achieving local control in the setting of oligometastatic disease with low rates of complication.展开更多
BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few years.AIM The systematic review question...BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few years.AIM The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:CRD42021279639.Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in pain.RESULTS After full-text screening,we included 14 studies in the qualitative synthesis.Of these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients enrolled.There was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome explored.The MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an outcome.In 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not well-specified.The included studies were found to have a low-moderate risk of bias.CONCLUSION Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury.Intravenous ketamine may cause more adverse events than other routes of administration.展开更多
A severe injury can trigger an inflammation response and excessive response can cause multiple organ failure. HMGB1 is an early inflammation mediator in sterile injury and a late inflammation mediator in infection. It...A severe injury can trigger an inflammation response and excessive response can cause multiple organ failure. HMGB1 is an early inflammation mediator in sterile injury and a late inflammation mediator in infection. It is an important mediator in severe sepsis and always associated with the severity of organ failure. Previous studies showed that the administration of systemic lidocaine could inhibit the expression of HMGB1 on septic mice with musculoskeletal injury. Nine male adult Balb/c mice were grouped by simple random sampling method into three groups of intravenous lidocaine injection dosages: 2 mg/kg, 3 mg/kg, 4 mg/kg. Musculoskeletal injury was done by breaking the left femoral bone in a close manner. Peripheral blood sampling was done 4 hours after injury and 2 hours after lidocaine therap. To evaluate the expression level of HMGB1 mRNA, RT-PCR was used. The result of our study showed that intravenous lidoaine administration on the 3 groups could decrease the level of HMGB1. In conclusion, lidocaine hold an important role in clinical diseases by inhibiting HMGB1.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)has crippled humanity since early 2020.Various sequelae of COVID-19 have been reported in different body systems.Musculoskeletal symptoms are widely reported during COVID-1...BACKGROUND Coronavirus disease 2019(COVID-19)has crippled humanity since early 2020.Various sequelae of COVID-19 have been reported in different body systems.Musculoskeletal symptoms are widely reported during COVID-19 infection,but musculoskeletal complications in long COVID-19 are underreported.However,post-COVID-19 survivors have reported complaints of persisting or new-onset fatigue,myalgia,arthralgia,arthritis,muscle weakness,etc in clinical practice.The well-known detrimental effects of steroids on the musculoskeletal system coupled with their over-the-counter availability can also be anticipated since they were the cornerstone of life-saving management in this pandemic.AIM To determine the musculoskeletal complications in long COVID.METHODS We performed a systematic review of‘systematic reviews and meta-analyses’.RESULTS Of the 63 articles screened,24 articles were included.Two articles specifically discussed children and adolescents.One article discussed rehabilitation intervention.No article addressed rehabilitation of musculoskeletal issues in long COVID-19 in particular.Fatigue was the most common musculoskeletal complication.CONCLUSION Fatigue is found to be very common along with myalgia and arthralgia.There were no studies on rehabilitation intervention in musculoskeletal complications specifically.Considering the lacuna in literature and the needs of the current situation,further studies are warranted to standardize effective rehabilitation interventions in musculoskeletal complications.More homogenous studies are needed.Studies on functional impairment due to musculoskeletal involvement are essential.展开更多
BACKGROUND:The widespread use of recreational drugs has raised concerns regarding their eff ects on various organ systems.The use of cannabis and opioids in chronic pain management increases their prevalence among pat...BACKGROUND:The widespread use of recreational drugs has raised concerns regarding their eff ects on various organ systems.The use of cannabis and opioids in chronic pain management increases their prevalence among patients with musculoskeletal conditions whose bone health may already be compromised.This article aims to review the pathophysiology and toxic eff ects of recreational drug use on musculoskeletal health to establish appropriate pain regimens for patients with substance use.METHODS:Medical literature published from 1970 until 2022 was identifi ed utilizing MEDLINE/PubMed and the Cochrane Library.In addition to the databases,references were obtained through the use of reference lists of published articles identifi ed by the aforementioned databases.The initial search terms included opioids,inhalants,hallucinogens,cannabis,stimulants,and bone health.There were no methodological limitations in relation to the initial acquisition and analysis of data.RESULTS:A total of 55 research articles were included in this review.Cannabis,stimulants,opioids,and inhalants impact bone maintenance,specifically osteoblast and osteoclast activity,as well as impede hormone production.These substances inhibit bone remodeling and development,manifesting as lower bone mineral density and increased fracture risk in chronic users.CONCLUSION:Although the current literature suggests a deleterious effect of recreational drugs on bone health and musculoskeletal disease,further research is warranted to evaluate the clinical effects of long-term substance use.The evaluation of such effects will aid in establishing appropriate pain regimens,as well as appropriate screening and treatment plans for recreational drug users.展开更多
Urine-derived stem cells(USCs)are derived from urine and harbor the potential of proliferation and multidirectional differentiation.Moreover,USCs could be reprogrammed into pluripotent stem cells[namely urine-derived ...Urine-derived stem cells(USCs)are derived from urine and harbor the potential of proliferation and multidirectional differentiation.Moreover,USCs could be reprogrammed into pluripotent stem cells[namely urine-derived induced pluripotent stem cells(UiPSCs)]through transcription factors,such as octamer binding transcription factor 4,sex determining region Y-box 2,kruppel-like factor 4,myelocytomatosis oncogene,and Nanog homeobox and protein lin-28,in which the first four are known as Yamanaka factors.Mounting evidence supports that USCs and UiPSCs possess high potential of neurogenic,myogenic,and osteogenic differentiation,indicating that they may play a crucial role in the treatment of neurological and musculoskeletal diseases.Therefore,we summarized the origin and physiological characteristics of USCs and UiPSCs and their therapeutic application in neurological and musculoskeletal disorders in this review,which not only contributes to deepen our understanding of hallmarks of USCs and UiPSCs but also provides the theoretical basis for the treatment of neurological and musculoskeletal disorders with USCs and UiPSCs.展开更多
Degenerative musculoskeletal diseases are structural and functional failures of the musculoskeletal system,including osteoarthritis,osteoporosis,intervertebral disc degeneration(IVDD),and sarcopenia.As the global popu...Degenerative musculoskeletal diseases are structural and functional failures of the musculoskeletal system,including osteoarthritis,osteoporosis,intervertebral disc degeneration(IVDD),and sarcopenia.As the global population ages,degenerative musculoskeletal diseases are becoming more prevalent.However,the pathogenesis of degenerative musculoskeletal diseases is not fully understood.Previous studies have revealed that endoplasmic reticulum(ER)stress is a stress response that occurs when impairment of the protein folding capacity of the ER leads to the accumulation of misfolded or unfolded proteins in the ER,contributing to degenerative musculoskeletal diseases.By affecting cartilage degeneration,synovitis,meniscal lesion,subchondral bone remodeling of osteoarthritis,bone remodeling and angiogenesis of osteoporosis,nucleus pulposus degeneration,annulus fibrosus rupture,cartilaginous endplate degeneration of IVDD,and sarcopenia,ER stress is involved in the pathogenesis of degenerative musculoskeletal diseases.Preclinical studies have found that regulation of ER stress can delay the progression of multiple degenerative musculoskeletal diseases.These pilot studies provide foundations for further evaluation of the feasibility,efficacy,and safety of ER stress modulators in the treatment of musculoskeletal degenerative diseases in clinical trials.In this review,we have integrated up-to-date research findings of ER stress into the pathogenesis of degenerative musculoskeletal diseases.In a future perspective,we have also discussed possible directions of ER stress in the investigation of degenerative musculoskeletal disease,potential therapeutic strategies for degenerative musculoskeletal diseases using ER stress modulators,as well as underlying challenges and obstacles in bench-to-beside research.展开更多
Background: Acute lymphoblastic leukemia (ALL), the most common paediatric malignancy, is a heterogeneous hematologic disease. ALL patients may present with isolated and persistent osteo-articular complaints, lower in...Background: Acute lymphoblastic leukemia (ALL), the most common paediatric malignancy, is a heterogeneous hematologic disease. ALL patients may present with isolated and persistent osteo-articular complaints, lower incidence of hepatomegaly, splenomegaly or lymphadenopathy without clear laboratory features, and misdiagnosed as systemic juvenile idiopathic arthritis (sJIA). Methods: This was a single center cross sectional study over a period of 4 years. Clinic laboratory profiles of 39 ALL children were compared with 39 age and sex-matched sJIA cases. Result: Among 39 ALL patients 89.7% were initially misdiagnosed as sJIA upon clinical presentation. Majority (66.7%) of ALL patients had oligo-articular joint involvement. In sJIA, small joints of the hands were most commonly involved. The total WBC count was significantly higher in ALL patients (p-value 0.0065). CRP and LDH values between the two groups showed significant differences (p-value 0.00006 and 0.00001 respectively). Conclusion: The presentation of leukemia with arthralgia or arthritis makes the diagnosis difficult for the physicians. The diagnosis of sJIA must be made with caution keeping the possibility of haematological malignancy in mind.展开更多
基金supported by the National Natural Science Foundation of China(No.81572187,No.81871812 and No.52205590)the Natural Science Foundation of Jiangsu Province(No.BK20220834)+1 种基金project supported by Ruihua Charity Foundation(YL20220525)the Start-up Research Fund of Southeast University(No.RF1028623098).
文摘Disorders of the musculoskeletal system are the major contributors to the global burden of disease and current treatments show limited efficacy.Patients often suffer chronic pain and might eventually have to undergo end-stage surgery.Therefore,future treatments should focus on early detection and intervention of regional lesions.Microrobots have been gradually used in organisms due to their advantages of intelligent,precise and minimally invasive targeted delivery.Through the combination of control and imaging systems,microrobots with good biosafety can be delivered to the desired area for treatment.In the musculoskeletal system,microrobots are mainly utilized to transport stem cells/drugs or to remove hazardous substances from the body.Compared to traditional biomaterial and tissue engineering strategies,active motion improves the efficiency and penetration of local targeting of cells/drugs.This review discusses the frontier applications of microrobotic systems in different tissues of the musculoskeletal system.We summarize the challenges and barriers that hinder clinical translation by evaluating the characteristics of different microrobots and finally point out the future direction of microrobots in the musculoskeletal system.
文摘Ultrasound is an essential modality within musculoskeletal imaging, with the recent addition of elastography. The elastic properties of tissues are different from the acoustic impedance used to create B mode imaging and the flow properties used within Doppler imaging, hence elastography provides a different form of tissue assessment. The current role of ultrasound elastography in the musculoskeletal system will be reviewed, in particular with reference to muscles, tendons, ligaments, joints and soft tissue tumours. The different ultrasound elastography methods currently available will be described, in particular strain elastography and shear wave elastography. Future directions of ultrasound elastography in the musculoskeletal system will also be discussed.
文摘Chronic pain and general physical discomfort are common symptoms among those seeking medical or physiotherapy treatment, as it relates to disorders found in the Human Musculoskeletal System (HMS). Since this system is highly complex and large in scale, clinical pain research has been confounded by many complex factors. The goal of our research is to overcome these obstacles by applying multidisciplinary approaches including systems engineering, traditional oriental techniques, conventional medicine and related sciences. To pursue such an integrated approach this paper examines the therapist-guided exercise for restoring human musculoskeletal balance called the Somatic Balance Restoration Therapy (SBRT). The SBRT is a simple but effective self-exercise therapy with minimal assistance by a trained therapist. This therapy is analyzed by a mechanical engineering method by modeling the human body as a multi-body subject to a static equilibrium condition. In addition, the wording has been rewritten in functional anatomical terms, enabling smooth communication between specialists of three different disciplines: therapy, conventional medicine and systems engineering. Examples will be given to demonstrate an integrated and systematic approach for identifying and remedying malfunctions within the HMS.
基金supported by the National Natural Science Foundation of China(Grant No.52473121,52403370 and 52221006)Fundamental Research Funds for the Central Universities(buctrc202020,buctrc202312).
文摘The intricate hierarchical structure of musculoskeletal tissues,including bone and interface tissues,necessitates the use of complex scaffold designs and material structures to serve as tissue-engineered substitutes.This has led to growing interest in the development of gradient bone scaffolds with hierarchical structures mimicking the extracellular matrix of native tissues to achieve improved therapeutic outcomes.Building on the anatomical characteristics of bone and interfacial tissues,this review provides a summary of current strategies used to design and fabricate biomimetic gradient scaffolds for repairing musculoskeletal tissues,specifically focusing on methods used to construct compositional and structural gradients within the scaffolds.The latest applications of gradient scaffolds for the regeneration of bone,osteochondral,and tendon-to-bone interfaces are presented.Furthermore,the current progress of testing gradient scaffolds in physiologically relevant animal models of skeletal repair is discussed,as well as the challenges and prospects of moving these scaffolds into clinical application for treating musculoskeletal injuries.
文摘Nursing staff provides patient care in an occupational environment that often imposes challenges that affect significantly the musculoskeletal system.Work-related musculoskeletal disorders are common in nursing stuff and have a negative impact in their professional and daily activities.In the current editorial,the duties of nursing staff,the types of musculoskeletal disorders,the predis-posing factors(including factors related to professional tasks/ergonomics and to working schedules,psychological,social and individual factors)and their impact on working ability and quality of life nursing staff are summarized and pre-ventive measures are proposed.
基金Acknowledgements This work was supported by the Intemational Cooperation Project of National Natural Science Foundation of China （No. 50920105504）, the UK En- gineering and Physical Sciences Research Council Grant （No. EP/I033602/1）, the Project of National Natural Science Foundation of China （No. 51105167） and the scientific and technological development planning project of Jilin Province, China （No. 20130522187JH）.
文摘Biological musculoskeletal system （MSK）, composed of numerous bones, cartilages, skeletal muscles, tendons, ligaments etc., provides form, support, movement and stability for human or animal body. As the result of million years of selection and evolution, the biological MSK evolves to be a nearly perfect mechanical mechanism to support and transport the human or animal body, and would provide enormously rich resources to inspire engineers to innovate new technology and methodology to develop robots and mechanisms as effective and economical as the biological systems. This paper provides a general review of the current status of musculoskeletal biomechanics studies using both experimental and computational methods. This includes the use of the latest three-dimensional motion analysis systems, various medical imaging modalities, and also the advanced rigid-body and continuum mechanics musculoskeletal modelling techniques. Afterwards, several representative biomimetic studies based on ideas and concepts inspired from the structures and biomechanical functions of the biological MSK are dis- cussed. Finally, the major challenges and also the future research directions in musculoskeletal biomechanics and its biomimetic studies are proposed.
基金National key R&D program of China(2017YFA0104900)NSFC grants(81874019,81572115,81572157)325 Health High Level Talent project of Zhejiang province,Clinical top young talents cultivation project of Zhejiang university,the Fundamental Research Funds for the Central Universities.
文摘Musculoskeletal disorders are common in clinical practice.Repairing critical-sized defects in musculoskeletal systems remains a challenge for researchers and surgeons,requiring the application of tissue engineering biomaterials.Successful application depends on the response of the host tissue to the biomaterial and specific healing process of each anatomical structure.The commonly-held view is that biomaterials should be biocompatible to minimize local host immune response.However,a growing number of studies have shown that active modulation of the immune cells,particularly macrophages,via biomaterials is an effective way to control immune response and promote tissue regeneration as well as biomaterial integration.Therefore,we critically review the role of macrophages in the repair of injured musculoskeletal system soft tissues,which have relatively poor regenerative capacities,as well as discuss further enhancement of target tissue regeneration via modulation of macrophage polarization by biomaterial-mediated immunomodulation(biomaterial properties and delivery systems).This active regulation approach rather than passive-evade strategy maximizes the potential of biomaterials to promote musculoskeletal system soft tissue regeneration and provides alternative therapeutic options for repairing critical-sized defects.
基金Sanming Project of Medicine in Shenzhen(Grant/Award Number:SZSM202011012)Shenzhen Fund for Guangdong Provincial High-level Clinical Key specialties(Grant/Award Number:No.SZXK035)Shenzhen Innovation Science and Technology Committee(Grant/Award Number:JCYJ20180228175358223)。
文摘Importance:There are a variety of musculoskeletal malformations and injuries that can occur in newborns.These can be a significant cause of perinatal death or a reason for miscarriage and can lead to long-term functional issues if not managed appropriately.There is no systematic and well-established screening program for neonatal musculoskeletal malformations and injuries in China now.Objective:To report the incidence and types of congenital musculoskeletal malformations in two hospitals in Shenzhen City,to explore and discuss the details of the screening procedure and improve future prevention and treatment.Methods:From October 2013 to May 2014,2564 one-day-old newborns were screened by a pediatric orthopedic physical examination,in combination with ultrasonography when required,and the incidence and variety of diseases were recorded statistically.Results:Among 2564 screened newborns,the following musculoskeletal conditions were identified:congenital muscular torticollis(CMT)(seven cases,0.27%),hip subluxation(four cases,0.16%),hip dysplasia(47 cases,1.83%),congenital talipes equinovarus(CTEV)(two cases,0.08%),congenital talipes calcaneovalgus(15 cases,0.58%),polydactyly(nine cases,0.35%),syndactyly(one case,0.04%),and spinal hemivertebra(one case,0.04%).Additionally,there were five(0.19%)neonates with birth injuries.Interpretation:It is feasible to carry out neonatal screening and identification of musculoskeletal malformations and birth injuries in China.This is helpful as timely detection and early intervention for many of these conditions can avoid permanent functional impairment in these children.
基金the National Natural Science Foundation of China,Nos.31900950 and 32000944 and Key Science and Technology Plan Projects in Zigong,No.2022ZCNKY07.
文摘Infection and rejection in musculoskeletal trauma often pose challenges for natural healing,prompting the exploration of biomimetic organ and tissue transplantation as a common alternative solution.Polyhydroxyalkanoates(PHAs)are a large family of biopolyesters synthesised in microorganism,demonstrating excellent biocompatibility and controllable biodegradability for tissue remodelling and drug delivery.With different monomer-combination and polymer-types,multi-mechanical properties of PHAs making them have great application prospects in medical devices with stretching,compression,twist in long time,especially in musculoskeletal tissue engineering.This review systematically summarises the applications of PHAs in multiple tissues repair and drug release,encompassing areas such as bone,cartilage,joint,skin,tendons,ligament,cardiovascular tissue,and nervous tissue.It also discusses challenges encountered in their application,including high production costs,potential cytotoxicity,and uncontrollable particle size distribution.In conclusion,PHAs offer a compelling avenue for musculoskeletal system applications,striking a balance between biocompatibility and mechanical performance.However,addressing challenges in their production and application requires further research to unleash their full potential in tackling the complexities of musculoskeletal regeneration.
文摘Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training,operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.Methods: A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed(using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.Results: In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/nonmodifiable, as well as extrinsic/intrinsic risk factors.Conclusions: This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.
基金the Veterans and Martyrs Affair Foundation (VMAF)Janbazan Medical and Engineering Research Center (JMERC)
文摘Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.
基金Grant funding from the Bone and Joint Decade Foundationadditional funding from Curtin University is acknowledged.
文摘Background:Musculoskeletal(MSK)conditions,MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability,yet global guidance to arrest the rising disability burden is lacking.We aimed to explore contemporary context,challenges and opportunities at a global level and relevant to health systems strengthening for MSK health,as identified by international key informants(KIs)to inform a global MSK health strategic response.Methods:An in-depth qualitative study was undertaken with international KIs,purposively sampled across highincome and low and middle-income countries(LMICs).KIs identified as representatives of peak global and international organisations(clinical/professional,advocacy,national government and the World Health Organization),thought leaders,and people with lived experience in advocacy roles.Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method.Data were organised into categories describing 1)contemporary context;2)goals;3)guiding principles;4)accelerators for action;and 5)strategic priority areas(pillars),to build a data-driven logic model.Here,we report on categories 1–4 of the logic model.Results:Thirty-one KIs from 20 countries(40%LMICs)affiliated with 25 organisations participated.Six themes described contemporary context(category 1):1)MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised;2)improving MSK health is more than just healthcare;3)global guidance for country-level system strengthening is needed;4)impact of COVID-19 on MSK health;5)multiple inequities associated with MSK health;and 6)complexity in health service delivery for MSK health.Five guiding principles(category 3)focussed on adaptability;inclusiveness through co-design;prevention and reducing disability;a lifecourse approach;and equity and value-based care.Goals(category 2)and seven accelerators for action(category 4)were also derived.Conclusion:KIs strongly supported the creation of an adaptable global strategy to catalyse and steward countrylevel health systems strengthening responses for MSK health.The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health.Contextual considerations about MSK health and accelerators for action should be considered in reform activities.
文摘A variety of indications have been published regarding the use of percutaneous thermal ablation for treating tumors of the musculoskeletal system,including bone and soft tissue lesions,benign and malignant lesions,and primary and metastatic tumors.In the appropriately selected patient,the advantages of percutaneous thermal ablation include decreased morbidity,decreased cost,and shorter hospitalization stays compared to surgery.The number of different thermal ablation modalities is increasing,and each modality has its advantages and disadvantages.Studies directly comparing the effectiveness of the various thermal ablation modalities are sparse,however,so the choice of ablation modality often depends on availability,user preference,and local expertise.Although the list of uses for percutaneous thermal ablation is ever-expanding,in this article,we will discuss the two most well-established indications,which are palliation of pain attributed to bone and soft tissue metastases and local control of oligometastatic disease.Numerous clinical trials have shown percutaneous thermal ablation to be an effective method of palliating pain due to bone and soft tissue metastases and of achieving local control in the setting of oligometastatic disease with low rates of complication.
文摘BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few years.AIM The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:CRD42021279639.Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in pain.RESULTS After full-text screening,we included 14 studies in the qualitative synthesis.Of these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients enrolled.There was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome explored.The MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an outcome.In 11 cases,the setting of care was the Emergency Department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not well-specified.The included studies were found to have a low-moderate risk of bias.CONCLUSION Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury.Intravenous ketamine may cause more adverse events than other routes of administration.
文摘A severe injury can trigger an inflammation response and excessive response can cause multiple organ failure. HMGB1 is an early inflammation mediator in sterile injury and a late inflammation mediator in infection. It is an important mediator in severe sepsis and always associated with the severity of organ failure. Previous studies showed that the administration of systemic lidocaine could inhibit the expression of HMGB1 on septic mice with musculoskeletal injury. Nine male adult Balb/c mice were grouped by simple random sampling method into three groups of intravenous lidocaine injection dosages: 2 mg/kg, 3 mg/kg, 4 mg/kg. Musculoskeletal injury was done by breaking the left femoral bone in a close manner. Peripheral blood sampling was done 4 hours after injury and 2 hours after lidocaine therap. To evaluate the expression level of HMGB1 mRNA, RT-PCR was used. The result of our study showed that intravenous lidoaine administration on the 3 groups could decrease the level of HMGB1. In conclusion, lidocaine hold an important role in clinical diseases by inhibiting HMGB1.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)has crippled humanity since early 2020.Various sequelae of COVID-19 have been reported in different body systems.Musculoskeletal symptoms are widely reported during COVID-19 infection,but musculoskeletal complications in long COVID-19 are underreported.However,post-COVID-19 survivors have reported complaints of persisting or new-onset fatigue,myalgia,arthralgia,arthritis,muscle weakness,etc in clinical practice.The well-known detrimental effects of steroids on the musculoskeletal system coupled with their over-the-counter availability can also be anticipated since they were the cornerstone of life-saving management in this pandemic.AIM To determine the musculoskeletal complications in long COVID.METHODS We performed a systematic review of‘systematic reviews and meta-analyses’.RESULTS Of the 63 articles screened,24 articles were included.Two articles specifically discussed children and adolescents.One article discussed rehabilitation intervention.No article addressed rehabilitation of musculoskeletal issues in long COVID-19 in particular.Fatigue was the most common musculoskeletal complication.CONCLUSION Fatigue is found to be very common along with myalgia and arthralgia.There were no studies on rehabilitation intervention in musculoskeletal complications specifically.Considering the lacuna in literature and the needs of the current situation,further studies are warranted to standardize effective rehabilitation interventions in musculoskeletal complications.More homogenous studies are needed.Studies on functional impairment due to musculoskeletal involvement are essential.
文摘BACKGROUND:The widespread use of recreational drugs has raised concerns regarding their eff ects on various organ systems.The use of cannabis and opioids in chronic pain management increases their prevalence among patients with musculoskeletal conditions whose bone health may already be compromised.This article aims to review the pathophysiology and toxic eff ects of recreational drug use on musculoskeletal health to establish appropriate pain regimens for patients with substance use.METHODS:Medical literature published from 1970 until 2022 was identifi ed utilizing MEDLINE/PubMed and the Cochrane Library.In addition to the databases,references were obtained through the use of reference lists of published articles identifi ed by the aforementioned databases.The initial search terms included opioids,inhalants,hallucinogens,cannabis,stimulants,and bone health.There were no methodological limitations in relation to the initial acquisition and analysis of data.RESULTS:A total of 55 research articles were included in this review.Cannabis,stimulants,opioids,and inhalants impact bone maintenance,specifically osteoblast and osteoclast activity,as well as impede hormone production.These substances inhibit bone remodeling and development,manifesting as lower bone mineral density and increased fracture risk in chronic users.CONCLUSION:Although the current literature suggests a deleterious effect of recreational drugs on bone health and musculoskeletal disease,further research is warranted to evaluate the clinical effects of long-term substance use.The evaluation of such effects will aid in establishing appropriate pain regimens,as well as appropriate screening and treatment plans for recreational drug users.
基金Supported by the Key Research and Development Program of Sichuan Science and Technology Agency,No.2020YFS0043Natural Science Foundation of Sichuan Province of China,No.2023NSFSC1567+1 种基金Sichuan University Innovation Research Project,No.2023SCUH0033Innovation Team at the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,No.2022-CXTD-05.
文摘Urine-derived stem cells(USCs)are derived from urine and harbor the potential of proliferation and multidirectional differentiation.Moreover,USCs could be reprogrammed into pluripotent stem cells[namely urine-derived induced pluripotent stem cells(UiPSCs)]through transcription factors,such as octamer binding transcription factor 4,sex determining region Y-box 2,kruppel-like factor 4,myelocytomatosis oncogene,and Nanog homeobox and protein lin-28,in which the first four are known as Yamanaka factors.Mounting evidence supports that USCs and UiPSCs possess high potential of neurogenic,myogenic,and osteogenic differentiation,indicating that they may play a crucial role in the treatment of neurological and musculoskeletal diseases.Therefore,we summarized the origin and physiological characteristics of USCs and UiPSCs and their therapeutic application in neurological and musculoskeletal disorders in this review,which not only contributes to deepen our understanding of hallmarks of USCs and UiPSCs but also provides the theoretical basis for the treatment of neurological and musculoskeletal disorders with USCs and UiPSCs.
基金supported by the National Natural Science Foundation of China(92268115,82072506,81874030,82172387,82372371,82371989)the Science and Technology Innovation Program of Hunan Province(2021RC3025)+3 种基金the Natural Science Foundation of Jiangsu Province(BK20230066)the Suzhou Science and Technology Development Plan(SKY2023035,SZM2023008)the Gusu Health Talents Program(GSWS2020023)the Innovation Project for Postgraduate Students of Central South University(1053320221391,1053320231273).
文摘Degenerative musculoskeletal diseases are structural and functional failures of the musculoskeletal system,including osteoarthritis,osteoporosis,intervertebral disc degeneration(IVDD),and sarcopenia.As the global population ages,degenerative musculoskeletal diseases are becoming more prevalent.However,the pathogenesis of degenerative musculoskeletal diseases is not fully understood.Previous studies have revealed that endoplasmic reticulum(ER)stress is a stress response that occurs when impairment of the protein folding capacity of the ER leads to the accumulation of misfolded or unfolded proteins in the ER,contributing to degenerative musculoskeletal diseases.By affecting cartilage degeneration,synovitis,meniscal lesion,subchondral bone remodeling of osteoarthritis,bone remodeling and angiogenesis of osteoporosis,nucleus pulposus degeneration,annulus fibrosus rupture,cartilaginous endplate degeneration of IVDD,and sarcopenia,ER stress is involved in the pathogenesis of degenerative musculoskeletal diseases.Preclinical studies have found that regulation of ER stress can delay the progression of multiple degenerative musculoskeletal diseases.These pilot studies provide foundations for further evaluation of the feasibility,efficacy,and safety of ER stress modulators in the treatment of musculoskeletal degenerative diseases in clinical trials.In this review,we have integrated up-to-date research findings of ER stress into the pathogenesis of degenerative musculoskeletal diseases.In a future perspective,we have also discussed possible directions of ER stress in the investigation of degenerative musculoskeletal disease,potential therapeutic strategies for degenerative musculoskeletal diseases using ER stress modulators,as well as underlying challenges and obstacles in bench-to-beside research.
文摘Background: Acute lymphoblastic leukemia (ALL), the most common paediatric malignancy, is a heterogeneous hematologic disease. ALL patients may present with isolated and persistent osteo-articular complaints, lower incidence of hepatomegaly, splenomegaly or lymphadenopathy without clear laboratory features, and misdiagnosed as systemic juvenile idiopathic arthritis (sJIA). Methods: This was a single center cross sectional study over a period of 4 years. Clinic laboratory profiles of 39 ALL children were compared with 39 age and sex-matched sJIA cases. Result: Among 39 ALL patients 89.7% were initially misdiagnosed as sJIA upon clinical presentation. Majority (66.7%) of ALL patients had oligo-articular joint involvement. In sJIA, small joints of the hands were most commonly involved. The total WBC count was significantly higher in ALL patients (p-value 0.0065). CRP and LDH values between the two groups showed significant differences (p-value 0.00006 and 0.00001 respectively). Conclusion: The presentation of leukemia with arthralgia or arthritis makes the diagnosis difficult for the physicians. The diagnosis of sJIA must be made with caution keeping the possibility of haematological malignancy in mind.
