Pamela E. Houghton

Effects of low power laser irradiation on bone healing in animals: a meta-analysis

PurposeThe meta-analysis was performed to identify animal research defining the effects of low power laser irradiation on biomechanical indicators of bone regeneration and the impact of dosage.MethodsWe searched five electronic databases (MEDLINE, EMBASE, PubMed, CINAHL, and Cochrane Database of Randomised Clinical Trials) for studies in the area of laser and bone healing published from 1966 to October 2008. Included studies had to investigate fracture healing in any animal model, using any type of low power laser irradiation, and use at least one quantitative biomechanical measures of bone strength. There were 880 abstracts related to the laser irradiation and bone issues (healing, surgery and assessment). Five studies met our inclusion criteria and were critically appraised by two raters independently using a structured tool designed for rating the quality of animal research studies. After full text review, two articles were deemed ineligible for meta-analysis because of the type of injury method and biomechanical variables used, leaving three studies for meta-analysis. Maximum bone tolerance force before the point of fracture during the biomechanical test, 4 weeks after bone deficiency was our main biomechanical bone properties for the Meta analysis.ResultsStudies indicate that low power laser irradiation can enhance biomechanical properties of bone during fracture healing in animal models. Maximum bone tolerance was statistically improved following low level laser irradiation (average random effect size 0.726, 95% CI 0.08 - 1.37, p 0.028). While conclusions are limited by the low number of studies, there is concordance across limited evidence that laser improves the strength of bone tissue during the healing process in animal models.

Involvement of neuronal cell bodies of the mesencephalic locomotor region in the initiation of locomotor activity of freely behaving rats

The locomotor activity of freely-moving rats was increased substantially by injections of L-sodium glutamate or of picrotoxin, a GABA antagonist, into the region of the tegmental pedunculopontine nucleus. The onset of hyper-motility was more rapid with L-glutamate than with picrotoxin and the duration shorter. Locomotor activity from injecting amphetamine unilaterally into the nucleus accumbens was reduced by injections of GABA into the ipsilateral pedunculopontine nucleus. These observations provide additional evidence implicating neurons of the MLR and possibly GABA synaptic inputs to these neurons in locomotor activity and suggest that they may mediate indirect inputs from the nucleus accumbens.

Effects of low-intensity pulsed ultrasound therapy on fracture healing: a systematic review and meta-analysis.

Objective This systematic review and meta-analysis was performed to identify the clinical trials relevant to the effects of low-intensity pulsed ultrasound (LIPUS) on bone regeneration. Design We searched five international electronic databases including MEDLINE (1966–June 2010), and PubMed, EMBase, Cumulative Index to Nursing and Allied Health, and Cochrane (1980–June 2010) to identify the relevant studies on the effects of LIPUS on bone healing. The inclusion criteria were human clinical trial, all types of bones, fractures, and outcome measurements, LIPUS application, and English language. Overall, 260 potentially eligible abstracts were identified, and 65 articles were retrieved in full text. Of the 65 studies, 23 met the inclusion criteria and were critically appraised by two raters independently using the PEDro quality measurement method. The results of all eligible studies were categorized in three groups: fresh fractures, delayed or nonunions, and distraction osteogenesis. Seven trials among fresh fracture trials were identified eligible for meta-analysis because of the varieties of outcome measurements and clinical situations. The time of the third cortical bridging (increase in density or size of initial periosteal reaction) in radiographic healing was our common criteria for the meta-analysis. Results The time of third cortical bridging was statistically earlier following LIPUS therapy in fresh fractures (mean random effect, 2.263; 95% CI, 0.183–4.343, P = 0.033). Conclusions LIPUS can stimulate radiographic bone healing in fresh fractures. Although there is weak evidence that LIPUS also supports radiographic healing in delayed unions and nonunions, it was not possible to pool the data because of a paucity of sufficient studies with similar outcome measures.

Development, validity, reliability, and responsiveness of a new leg ulcer measurement tool.

OBJECTIVE:To develop and validate an assessment tool—the Leg Ulcer Measurement Tool (LUMT)—that would be able to detect changes in the appearance of lower extremity ulcers. SUBJECTS:Twenty-two subjects with chronic leg ulcers of various etiologies (arterial, venous, diabetes) participated in the validation study. DESIGN:An interdisciplinary panel consisting of 9 local wound care specialists confirmed content validity. Concurrent criterion validity was determined by correlation of the size domain (1 of 14 clinician-rated domains in the LUMT) with acetate tracing measurement of wound surface area. Reliability was determined using repeated assessments by 4 wound care specialist and 2 inexperienced evaluators; responsiveness was determined using monthly reassessments by a single rater for 4 months. RESULTS:Concurrent criterion validity was r = 0.82. Excellent values of intrarater and interrater reliability (ICC > 0.75) were obtained for total LUMT scores and for many of the 14 individual domains; however, several domains were found to be less reproducible. The LUMT detected change in wound status over time (responsiveness coefficient = 0.84). CONCLUSION:The LUMT can be used by 1 or more assessors, with relatively little previous training, to make reproducible evaluations of lower extremity ulcer appearance and to document change in appearance over time. The LUMT represents a novel assessment tool specifically designed and validated for clinical or research use on chronic leg ulcers.

EFFECTS OF ELECTRICAL STIMULATION ON THE HISTOLOGICAL PROPERTIES OF WOUNDS IN DIABETIC MICE

The purpose of this study was to identify mechanisms underlying electrically stimulated wound closure in diabetic mice. Adult male mice (n= 58) with full‐thickness excisional wounds were treated five times using negative polarity over the wound site for 15 minutes each over a 16‐day period with sham (0 Volts) or 5.0, 10.0, 12.5 Volts. In addition, animals (diabetic [n= 33] and nondiabetic [n= 22]) received treatments of electrical stimulation (12.5 V), or sham treatment (0 V) at wound sites which were then harvested and prepared for histological analysis at 2, 8, and 16 days postwounding. Using computerized image analysis of sections stained with a picro sirus red‐fast green staining technique, we found that increasing doses of electrical stimulation reduced collagen/noncollagenous protein ratios measured in the superficial scar of nondiabetic animals, with no effect in diabetic animals. In the deep scar, lower doses of electrical stimulation (5.0 V) produced significantly (p < 0.01) increased collagen deposition in wounds of nondiabetic animals compared with sham controls. Higher doses of electrical stimulation (12.5 V) were required to produce changes in diabetic animals than were observed in nondiabetic animals. These results suggest that electrical stimulation altered collagen deposition in excisional wounds of diabetic and nondiabetic animals. Electrical stimulation had a differential effect on wound healing in diabetic compared with nondiabetic animals. These data speak to the need to study the effects of electrical stimulation on healing in disease‐specific models.

Implementation of best practice in the prevention of heel pressure ulcers in the acute orthopedic population

To implement and evaluate a heel pressure ulcer prevention program (HPUPP) for orthopaedic patients. Program development of HPUPP involved input from administrators, staff and adult patients on an orthopaedic service in an academic tertiary care facility, located in a small urban centre in Canada. Prospective evaluation was conducted. Consensus exercises with clinical staff and administrators (Delphi and Nominal group) were used to, evaluate current practices, select a heel protective device, and develop key aspects of the HPUPP. HPUPP involved an individualised, bedside, staff education program, a team approach to improve patient mobility and use of a heel protective device. A 2‐inch foam wedge covered in washable vinyl was placed at the foot of all beds on the orthopedic service. After the program was implemented, the incidence of heel pressure ulcers was 0%, which was a significant reduction compared with pre‐implementation levels [13·8% (95% confidence interval 8–18%)]. Key components of the program success were initial and ongoing support from administration and surgeons, incorporation of feedback from clinical staff and patients, and keeping the program simple. Heel PU can be prevented in most orthopaedic patients using a universal heel PU prevention program.

ONTOGENY OF THE DISTRIBUTION AND COLOCALIZATION OF CALBINDIN-D28K WITHIN NEURAL AND ENDOCRINE-CELLS OF THE GASTROINTESTINAL-TRACT OF FETAL AND NEONATAL SHEEP

Using immunocytochemical techniques we have demonstrated that Calbindin D28K (CaBP) is present in the gastrointestinal tract of ovine fetuses early in development (by day 45). At day 45, CaBP was limited to neuronal elements in the developing intestine. By day 100, CaBP immunoreactivity was abundant in both epithelial endocrine cells and nerves of the submucous and myenteric ganglia. The location of CaBP containing cells and fibers was similar in duodenal sections taken from day 100 and term (145 days), as well as those taken from 24-48 h postnatal lambs. CaBP is colocalized in endocrine cells containing gastrin, glucagon, somatostatin and neurotensin, but not glucose dependent insulinotrophic peptide (GIP). Furthermore, it is extensively colocalized in nerve fibers and cells containing neurotensin but not somatostatin or vasoactive intestinal peptide. The colocalization of CaBP within various endocrine and nerve cells does not change in fetal sheep over the last one-third of gestation and there is no difference between fetal and neonatal sheep.

Effect of Laser irradiation on the growth and development of fetal mouse limbs in an in vitro model

The purpose of the present study was to examine the effects of laser irradiation on the growth and development of fetal limb tissue.

Evaluation of the Cost-Effectiveness of Electrical Stimulation Therapy for Pressure Ulcers in Spinal Cord Injury

OBJECTIVE To evaluate the incremental cost-effectiveness of electrical stimulation (ES) plus standard wound care (SWC) as compared with SWC only in a spinal cord injury (SCI) population with grade III/IV pressure ulcers (PUs) from the public payer perspective. DESIGN A decision analytic model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness of ES plus SWC to SWC in a cohort of participants with SCI and grade III/IV PUs. Model inputs for clinical probabilities were based on published literature. Model inputs, namely clinical probabilities and direct health system and medical resources were based on a randomized controlled trial of ES plus SWC versus SWC. Costs (Can

A simple method to assess the relative amount of collagen deposition in wounded fetal mouse limbs.

) included outpatient (clinic, home care, health professional) and inpatient management (surgery, complications). One way and probabilistic sensitivity (1000 Monte Carlo iterations) analyses were conducted. SETTING The perspective of this analysis is from a Canadian public health system payer. PARTICIPANTS Model target population was an SCI cohort with grade III/IV PUs. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Incremental cost per PU healed. RESULTS ES plus SWC were associated with better outcomes and lower costs. There was a 16.4% increase in the PUs healed and a cost savings of