Nonsurgical Applications Research Articles

Evolution and Innovations in Bone Marrow Cellular Therapy for Musculoskeletal Disorders: Tracing the Historical Trajectory and Contemporary Advances.

Bone marrow cellular therapy has undergone a remarkable evolution, significantly impacting the treatment of musculoskeletal disorders. This review traces the historical trajectory from early mythological references to contemporary scientific advancements. The groundbreaking work of Friedenstein in 1968, identifying fibroblast colony-forming cells in bone marrow, laid the foundation for future studies. Caplan's subsequent identification of mesenchymal stem cells (MSCs) in 1991 highlighted their differentiation potential and immunomodulatory properties, establishing them as key players in regenerative medicine. Contemporary research has focused on refining techniques for isolating and applying bone marrow-derived MSCs. These cells have shown promise in treating conditions like osteonecrosis, osteoarthritis, and tendon injuries thanks to their ability to promote tissue repair, modulate immune responses, and enhance angiogenesis. Clinical studies have demonstrated significant improvements in pain relief, functional recovery, and tissue regeneration. Innovations such as the ACH classification system and advancements in bone marrow aspiration methods have standardized practices, improving the consistency and efficacy of these therapies. Recent clinical trials have validated the therapeutic potential of bone marrow-derived products, highlighting their advantages in both surgical and non-surgical applications. Studies have shown that MSCs can reduce inflammation, support bone healing, and enhance cartilage repair. However, challenges remain, including the need for rigorous characterization of cell populations and standardized reporting in clinical trials. Addressing these issues is crucial for advancing the field and ensuring the reliable application of these therapies. Looking ahead, future research should focus on integrating bone marrow-derived products with other regenerative techniques and exploring non-surgical interventions. The continued innovation and refinement of these therapies hold promise for revolutionizing the treatment of musculoskeletal disorders, offering improved patient outcomes, and advancing the boundaries of medical science.

The efficacy of non-surgical platelet-rich fibrin application on clinical periodontal parameters and periostin level in periodontitis: Clinical trial.

Platelet-rich fibrin (PRF) has been widely used in regenerative dentistry due to many growth factors produced. Periostin, a matricellular protein, is a reliable marker for tissue regeneration. Periostin is part of the cellular matrix and regulates bone homeostasis. This study aims to explore the efficacy of PRF in improvement of the clinical periodontal parameters as an adjunct to the scaling and root planing and to evaluate periostin level in gingival crevicular fluid (GCF) at baseline, 1- and 3-month recall visits. Fourteen periodontitis patients who met the inclusion criteria were recruited in this study. Two contralateral periodontal pockets with 4-6 mm in depth in each patient were selected. The sites in every participant were randomly allocated into control sites or test sites. In control sites, only conventional scaling and root planing was carried out. In test sites, however, scaling and root planing method and PRF were applied. Periostin level in GCF and clinical periodontal parameters were measured. The test sites revealed greater relative attachment gain (2.614 ± 0.606 mm and 3.321 ± 0.668 mm) than control sites (1.285 ± 0.671 mm and 1.839 ± 0.632 mm) and a significant pocket reduction (2.535 ± 0.664 mm and 3.321 ± 0.668 mm) than the control sites (1.21 ± 0.508 mm and 1.892 ± 0.655 mm) at 1- and 3-month recall visits respectively. In the test sites, level of periostin (48.83 ± 9.3ng/μl and 98.90 ± 24.94 ng/μl) were greater than periostin levels in the control sites (42.65 ± 7.03 ng/μl and 49.29 ± 15.14 ng/μl) at 1- and 3-month recall visits respectively. In conclusion, the non-surgical application of PRF as an adjunct to scaling and root planing significantly improved the clinical periodontal parameters through raising periostin level in GCF.

Augmented Reality in Spinal Surgery: Highlights From Augmented Reality Lectures at the Emerging Technologies Annual Meetings.

IntroductionAugmented reality (AR) is an advanced technology and emerging field that has been adopted into spine surgery to enhance care and outcomes. AR superimposes a three-dimensional computer-generated image over the normal anatomy of interest in order to facilitate visualization of deep structures without the ability to directly see them.ObjectiveTo summarize the latest literature and highlight AR from the annual “Spinal Navigation, Emerging Technologies and Systems Integration” meeting lectures presented by the Seattle Science Foundation (SSF) on the development and use of augmented reality in spinal surgery. Methods We performed a comprehensive literature review from 2016 to 2020 on PubMed to correlate with lectures given at the annual “Emerging Technologies” conferences. After the exclusion of papers that concerned non-spine surgery specialties, a total of 54 papers concerning AR in spinal applications were found. The articles were then categorized by content and focus.ResultsThe 54 papers were divided into six major focused topics: training, proof of concept, feasibility and usability, clinical evaluation, state of technology, and nonsurgical applications. The greatest number of papers were published during 2020. Each paper discussed varied topics such as patient rehabilitation, proof of concept, workflow, applications in neurological and orthopedic spine surgery, and outcomes data.ConclusionsThe recent literature and SSF lectures on AR provide a solid base and demonstrate the emergence of an advanced technology that offers a platform for an advantageous technique that is superior, in that it allows the operating surgeon to focus directly on the patient rather than a guidance screen.

The protective effects of resveratrol pretreatment in cyclophosphamide-induced rat ovarian injury: an vivo study

Objectives To explore whether resveratrol (Res) pretreatment could exert a protective effect on cyclophosphamide (Cy) induced ovarian toxicity in a rat model. Methods Twenty-four female 7-week old Sprague-Dawley rats were randomly divided into four groups: Con, administered with vehicle solutions; Cy, treated with Cy; Res + Cy, treated with Cy + Res combined; Res, treated with Res. After 21 d of treatments, the rats were euthanized and blood samples were collected to evaluate the levels of anti-Müllerian hormone (AMH). The Ovaries were processed for immunohistochemical and western blotting. Results Cy-treat caused the decrease of body weights and ovarian weight. AMH was lower in Cy group, whereas AMH levels were similar among other groups. Histomorphology showed a large number of primordial follicles were activated in Cy groups, whereas the primordial follicles were inhibited in the Res and Res + Cy groups. The expressions of Sirt1, Foxo3a were up-regulated and p53, Caspase-3, and Bax were down-regulated in Res + Cy and Res groups (p < .05). Conclusions Res can prevent the primordial follicle activation and decrease apoptosis induced by Cy. Res may be an effective protection for ovarian function during chemotherapy, which means a new nonsurgical application for protection of ovarian reserve.

In vitro surgical and non-surgical air-polishing efficacy for implant surface decontamination in three different defect configurations

ObjectivesEvaluation of surgical and non-surgical air-polishing in vitro efficacy for implant surface decontamination.Material and methodsOne hundred eighty implants were distributed to three differently angulated bone defect models (30°, 60°, 90°). Biofilm was imitated using indelible red color. Sixty implants were used for each defect, 20 of which were air-polished with three different types of glycine air powder abrasion (GAPA1–3) combinations. Within 20 equally air-polished implants, a surgical and non-surgical (with/without mucosa mask) procedure were simulated. All implants were photographed to determine the uncleaned surface. Changes in surface morphology were assessed using scanning electron micrographs (SEM).ResultsCleaning efficacy did not show any significant differences between GAPA1–3 for surgical and non-surgical application. Within a cleaning method significant (p < 0.001) differences for GAPA2 between 30° (11.77 ± 2.73%) and 90° (7.25 ± 1.42%) in the non-surgical and 30° (8.26 ± 1.02%) and 60° (5.02 ± 0.84%) in the surgical simulation occurred. The surgical use of air-polishing (6.68 ± 1.66%) was significantly superior (p < 0.001) to the non-surgical (10.13 ± 2.75%). SEM micrographs showed no surface damages after use of GAPA.ConclusionsAir-polishing is an efficient, surface protective method for surgical and non-surgical implant surface decontamination in this in vitro model. No method resulted in a complete cleaning of the implant surface.Clinical relevanceAir-polishing appears to be promising for implant surface decontamination regardless of the device.

Effect of Flap Design for Enamel Matrix Derivative Application in Intraosseous Defects.

To systematically review the literature addressing the focused question: What is the effectiveness of different surgical and nonsurgical procedures combined with enamel matrix derivative (EMD) on clinical, radiographic, and patient-centered outcomes in intraosseous defects? Electronic (Medline, Scopus, and Cochrane databases) and hand literature searches were performed for studies including at least 1 treatment arm where EMD had been applied according to 1 of the following procedures: modified Widman flap; papilla preservation variants (PPVs), including papilla preservation technique, modified papilla preservation technique, and simplified papilla preservation technique; minimally invasive variants, including minimally invasive surgical approach and minimally invasive surgical technique; single-flap variants (SFVs), including single-flap approach and modified minimally invasive surgical technique; or nonsurgical application (flapless approach). Data from 42 selected articles were used to perform a network meta-analysis, and a hierarchy of surgical and nonsurgical applications of EMD was built separately for EMD and EMD + graft based on 6- to 12-mo clinical and radiographic outcomes. Among surgical approaches, EMD was associated with best regenerative outcomes when applied through SFVs, with a mean clinical attachment level gain of 3.93 mm and a reduction in the intrabony component of the defect of 3.35 mm. For EMD + graft, limited differences in regenerative outcomes were observed among surgical procedures. PPVs were associated with the highest residual probing depth for EMD (4.08 mm) and EMD + graft (4.32 mm). In the treatment of periodontal intraosseous defects, 1) SFVs appear to optimize the regenerative outcomes of EMD; 2) substantial regenerative outcomes can be obtained with SFVs and conservative double flaps (i.e., PPVs and minimally invasive variants) when EMD is combined with a graft; and 3) residual probing depth was higher following PPVs for EMD and EMD + graft. The results of the present systematic review and meta-analysis can be used by clinicians to identify the most effective surgical or nonsurgical procedure to treat an intraosseous defect with EMD or EMD + graft. The main findings indicate that when EMD application is indicated, surgical access based on a single flap seems the most appropriate to optimize clinical outcomes. The application of EMD + graft can be effectively combined with single flaps and conservative double flaps.

Design of a non-invasive pulse rate controlled deep vein thrombosis prophylaxis lower limb device.

Patients with lower limb dysfunctions have a risk of developing deep vein thrombosis (DVT) symptoms if they are in a sitting posture for a long duration. In addition, unconscious patients undergoing a long hour surgery are also prone to DVT problems which further complicates the health of the patient under treatment. A prototype design in the form of an assistive and portable device to overcome deep vein thrombosis (DVT) is developed for surgical and non-surgical applications. The portable device facilitates the movement of the lower limb around the ankle to promote blood flow and overcome DVT problem. The device is designed using a pair of actuators that translates the linear motion to axial flexion and extension movement of the ankle. The ankle movement is synchronized with the patient's heartbeats to promote blood flow and complete the venous movement. In addition, an electrically driven intermittent pneumatic compression layer is wrapped around the calf muscle to further enhance the blood flow in the lower limb. The integrated device is lightweight and portable which can be issued by the hospital centers to the patients for domestic utilization.

Optical coherence tomography for dynamic axial correction of an optical end-effector for robot-guided surgical laser ablation

Robot-guided laser ablation for surgical applications potentially offers many advantages compared to by-hand mechanical tissue cutting. However, given that tissue can be rough and/or uneven, ablation quality can be compromised if the beam waist deviates significantly from the target tissue surface. Therefore, we present a method that uses optical coherence tomography (OCT) for dynamic refocusing of robot-guided surgical laser ablation. A 7-DOF robotic manipulator with an OCT-equipped optical payload was used to simulate robotic guided laser osteotomy. M-mode OCT feedback is used for continuous surface detection to correct for axial deviations along the ablation path due to surface nonuniformity. We were able to show that such a correction scheme could maintain the beam waist within the depth of focus for surface variation as aggressive as 45 deg with feed rates up to 1 mm / s. Strategies for implementation in surgical and nonsurgical applications are examined.

Rapamycin Prevents cyclophosphamide-induced Over-activation of Primordial Follicle pool through PI3K/Akt/mTOR Signaling Pathway in vivo

BackgroundPrimordial follicular depletion has thought to be a common adverse effect of chemotherapy especially for female of reproductive age. The study aimed to evaluate the protective effect of rapamycin on the primordial follicles and its potential mechanism for patients receiving chemotherapy.Methods8-week old BALB/c female mice were randomly assigned into four groups (control; rapamycin; cyclophosphamide; and rapamycin combined with cyclophosphamide). Hematoxylin staining, immunohistochemical, TUNEL, western blotting and ELISA were employed to assess inter-group differences using Student’s t-test and Mann-Whitney test.ResultsCyclophosphamide depleted the follicular reserve and induced the phosphorylation of the key proteins of PI3K/Akt/mTOR pathway in mice in a dose-dependent manner. Co-treatment with rapamycin significantly reduced primordial follicle loss at all cyclophosphamide dose groups and prevent the follicle growth wave caused by cyclophosphamide treatment (P < 0.05). TUNEL staining showed that no apoptosis occured in the primordial follicles in all groups and fewer apoptosis in large growing follicles were observed in ovaries from rapamycin + cyclophosphamide group compared to that received cyclophosphamide alone. Serum anti-Müllerian hormone (AMH) was significantly reduced in cyclophosphamide alone group, in contrast to the normal level in rapamycin + cyclophosphamide group. Compared to p-Akt/Akt and p-mtor/mtor, p-rps6/rps6 was significantly decreased in rapamycin + cyclophosphamide group (P < 0.05), indicating that rapamycin attenuated the increased level of phosphorylation of rpS6 after cyclophosphamide treatment.ConclusionsRapamycin can prevent the primordial follicle activation induced by cyclophosphamide through PI3K/Akt/mTOR signaling pathway and thus plays a role in preserving the follicle pool. These results suggest that rapamycin may be an effective protection for ovarian function during chemotherapy, which means a new nonsurgical application for protection of ovarian reserve and prevention of POF.

Non-thermal atmospheric pressure plasma increased mRNA expression of growth factors in human gingival fibroblasts.

The aim of this in vitro study was to investigate the effects of a non-thermal atmospheric pressure plasma jet (NTAPPJ) on the cellular activity of human gingival fibroblasts (HGF) for possible non-surgical application of it during gingival wound healing. HGF cells were exposed with NTAPPJ for 1, 2, and 4min and were investigated for cellular attachment, cell viability, morphology of attached cells, proliferation rate, and messenger ribonucleic acid (mRNA) expression of various growth factors. Also, scavengers for chemicals produced by NTAPPJ were used to identify the chemical species responsible for the effects. There was no significant change in the number of HGF cells attached or their proliferation following NTAPPJ exposure. Also, high cell viability resulted from exposure of all of HGF cells to NTAPPJ for 1, 2, and 4min. However, cells were more stretched while the mRNA expressions of transforming growth factor and vascular endothelial growth factor were significantly increased following NTAPPJ exposure. Additionally, the scavenger test showed that nitric oxide is likely to be the chemical responsible for an increase of cellular activity. The results demonstrated that the NTAPPJ increased mRNA expressions of growth factors in human gingival fibroblasts. Application of NTAPPJ would be useful in gingival wound healing in clinics though additional studies confirming the effects would be needed.

Automatic SWI Venography Segmentation Using Conditional Random Fields.

Susceptibility-weighted imaging (SWI) venography can produce detailed venous contrast and complement arterial dominated MR angiography (MRA) techniques. However, these dense reversed-contrast SWI venograms pose new segmentation challenges. We present an automatic method for whole-brain venous blood segmentation in SWI using Conditional Random Fields (CRF). The CRF model combines different first and second order potentials. First-order association potentials are modeled as the composite of an appearance potential, a Hessian-based shape potential and a non-linear location potential. Second-order interaction potentials are modeled using an auto-logistic (smoothing) potential and a data-dependent (edge) potential. Minimal post-processing is used for excluding voxels outside the brain parenchyma and visualizing the surface vessels. The CRF model is trained and validated using 30 SWI venograms acquired within a population of deep brain stimulation (DBS) patients (age range [Formula: see text] years). Results demonstrate robust and consistent segmentation in deep and sub-cortical regions (median kappa = 0.84 and 0.82), as well as in challenging mid-sagittal and surface regions (median kappa = 0.81 and 0.83) regions. Overall, this CRF model produces high-quality segmentation of SWI venous vasculature that finds applications in DBS for minimizing hemorrhagic risks and other surgical and non-surgical applications.

Effects of different setting of diode laser on the mRNA expression of growth factors and type I collagen of human gingival fibroblasts

The aim of this study was to analyze the influence of non-surgical applications of diode laser (940 nm) on the cell proliferation and mRNA expressions of type I collagen and growth factors in human gingival fibroblasts (GF). Gingival fibroblasts were isolated from human gingival connective tissue of systemically healthy individuals. Cells were treated with different laser parameters as follows; (1) Infected pocket setting (power: 2 W, pulse interval: 1 ms, pulse length: 1 ms, 20 s/cm(2)); (2) Perio-pocket setting (power: 1.5 W, pulse interval: 20 ms, pulse length: 20 ms, 20 s/cm(2)); and (3) Biostimulation setting (power: 0.3 W in continuous wave, 20 s/cm(2)). Proliferation of GF was evaluated after different laser applications using a real-time cell analyzer. Total RNA was isolated on day 2 and cDNA synthesis was performed. Type I collagen, insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF) and transforming growth factor-beta (TGF-β) mRNA expressions were determined with quantitative RT-PCR. In a proliferation experiment, no significant differences were observed in the different laser applications when compared to the control group. Statistically significant increases in IGF, VEGF, and TGF-β mRNA expressions were noted in the laser groups when compared to the untreated control group (p < 0.05). A significant increase in collagen type I mRNA expression was noted in only biostimulation set-up of diode laser (p < 0.05). The results of this study demonstrate that non-surgical laser applications modulate behavior of gingival fibroblasts inducing growth factors mRNA expressions and these applications can be used to improve periodontal wound healing.

Viscoelastic response of the rat loading model: implications for studies of strain-adaptive bone formation

Studies of the adaptive skeletal response to mechanical loading require appropriate animal models. Two new approaches involve the nonsurgical application of loads to either the ulna or tibia of rats. Both of these approaches require the loading of bone through adjacent soft tissues, and thus the tissue viscoelasticity might affect the way load is transferred to the bone. The objective of this study was to characterize the mechanical strain in the rat tibia or ulna during applied loading at different frequencies. For the rat ulna model, loading was applied to the ulnae of four adult, female rats as a haversine waveform at frequencies of 1, 2, 5, 10, and 20 Hz and peak loads of 5, 10, 15, and 20 N. Mechanical strain was measured on the medial and lateral ulnar surfaces using single element strain gauges. For the rat tibia model, four-point bending loads were applied to the right tibiae of seven rats at frequencies of 0.5, 1, 2, 5, 10, and 20 Hz and peak loads of 30, 40, 50, and 60 N. Mechanical strain was measured on the lateral tibial surface at 5 mm proximal to the tibiofibular junction. We found that peak strains were linearly proportional to applied load, but decreased logarithmically as loading frequency was increased, indicating a significant viscoelastic effect in the soft tissues surrounding the ulnocarpal joint and in the soft tissues surrounding the tibia shaft. The viscoelastic response of the ulna and tibia tends to “filter out” high-frequency loading components and, as a result, the rat loading systems act as a low-pass filter. Consequently, any experiment designed to test the effect of loading frequency on bone formation in the rat ulna and tibia should employ progressively larger loads at higher loading frequencies to guarantee a consistent peak strain magnitude in the bone. The filtering effect of the ulna loading system is illustrated by an analysis of the strain waveforms from the recent study by Mosley and Lanyon ( Bone 23:313–318; 1998) that was designed to evaluate the effect of strain rate on bone formation.

Heparin-enhanced plasma phospholipase A2 activity and prostacyclin synthesis in patients undergoing cardiac surgery.

Although eicosanoid production contributes to physiological and pathophysiological consequences of cardiopulmonary bypass (CPB), the mechanisms accounting for the enhanced eicosanoid production have not been defined. Plasma phospholipase A2 (PLA2) activity, 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), and thromboxane B2 (TXB2) levels were measured at various times during cardiac surgery. Plasma PLA2 activity increased after systemic heparinization, before CPB. This was highly correlated with concurrent increases in plasma 6-keto-PGF1 alpha, TXB2 concentrations did not increase with heparin administration but did increase significantly after initiation of CPB. High plasma PLA2 activity, 6-keto-PGF1 alpha, and TXB2 concentrations were measured throughout the CPB period. Protamine, administered to neutralize the heparin, caused an acute reduction of both plasma PLA2 activity and plasma 6-keto-PGF1 alpha, but no change in plasma TXB2 concentrations. Thus the ratio of TXB2 to 6-keto-PGF1 alpha increased significantly after protamine administration. Enhanced plasma PLA2 activity was also measured in patients with lower doses of heparin used clinically for nonsurgical applications. Human plasma PLA2 was identified as group II PLA2 by its sensitivity to deoxycholate and dithiothreitol, its substrate specificity, and its elution characteristics on heparin affinity chromatography. Heparin addition to PMNs in vitro resulted in dose-dependent increases in cellular PLA2 activity and release of PLA2. The PLA2 released from the PMN had characteristics similar to those of post-heparin plasma PLA2. In conclusion, plasma PLA2 activity and 6-keto-PGF1 alpha concentrations are markedly enhanced with systemic heparinization. Part of the anticoagulant and vasodilating effects of heparin may be due to increased plasma prostacyclin (PGI2) levels. In addition the pulmonary vasoconstriction sometimes associated with protamine infusion during cardiac surgery might be due to decreased plasma PLA2 activity, with an associated increased TXB2/6-keto-PGF1 alpha ratio.