Image1_Effects of single and repeated shock wave application on the osteogenic differentiation potential of human primary mesenchymal stromal cells and the osteoblastic cell line MG63 in vitro.jpg

Introduction: Extracorporeal shock wave therapy is a non-invasive and effective option for treating various musculoskeletal disorders. Recent literature indicates that the parameters for extracorporeal shock wave therapy, such as the optimal intensity, treatment frequency, and localization, are yet to be determined. Studies reporting on the effects of shock wave application on primary mesenchymal stromal cells (MSCs) as well as osteoblastic cell lines in vitro are barely available and not standardized.Methods: In this study, we designed a special setup to precisely expose primary MSCs and the osteoblastic cell line MG63 to shock waves and subsequently analyzed the resulting cellular responses using standardized protocols to investigate their viability, proliferation behavior, cytokine secretion, and osteogenic differentiation potential in vitro. The shock wave transducer was coupled to a specifically designed water bath containing a 5 mL tube holder. Primary human MSCs and MG63 cells were trypsinated and centrifuged in a 5 mL tube and exposed to single and repeated shock wave application using different intensities and numbers of pulses.Results: Single treatment of MSCs using intensities 5, 10, 15, and 20 and pulse numbers 100, 250, 500, 750, and 1,000 at a constant pulse repetition frequency of 1 Hz resulted in a decreased viability and proliferation of both cell types with an increase in the intensity and number of pulses compared to controls. No significant difference in the osteogenic differentiation was observed at different time intervals in both cell types when a single shock wave application was performed. However, repeated shock wave sessions over three consecutive days of primary MSCs using low intensity levels 0.1 and 1 showed significant osteogenic differentiation 4-fold higher than that of the extracted Alizarin Red S at day 14, whereas MG63 cells showed no significant osteogenic differentiation compared to their corresponding controls. More specifically, repeated shock wave application triggered a significant downregulation of COL1A1, upregulation of RUNX2, and sustained increase of OCN in primary MSCs but not in the cell line MG63 when induced toward the osteogenic differentiation.Discussion: The effects of shock wave application on MSCs make it an effective therapy in regenerative medicine. We established a protocol to analyze a standardized shock wave application on MSCs and were able to determine conditions that enhance the osteogenic differentiation of MSCs in vitro.</p

Image and Diagnosis Quality of X-Ray Image Transmission via Cell Phone Camera: A Project Study Evaluating Quality and Reliability

<div><h3>Introduction</h3><p>Developments in telemedicine have not produced any relevant benefits for orthopedics and trauma surgery to date. For the present project study, several parameters were examined during assessment of x-ray images, which had been photographed and transmitted via cell phone.</p> <h3>Materials and Methods</h3><p>A total of 100 x-ray images of various body regions were photographed with a Nokia cell phone and transmitted via email or MMS. Next, the transmitted photographs were reviewed on a laptop computer by five medical specialists and assessed regarding quality and diagnosis.</p> <h3>Results</h3><p>Due to their poor quality, the transmitted MMS images could not be evaluated and this path of transmission was therefore excluded. Mean size of transmitted x-ray email images was 394 kB (range: 265–590 kB, SD ±59), average transmission time was 3.29 min ±8 (CI 95%: 1.7–4.9). Applying a score from 1–10 (very poor - excellent), mean image quality was 5.8. In 83.2±4% (mean value ± SD) of cases (median 82; 80–89%), there was agreement between final diagnosis and assessment by the five medical experts who had received the images. However, there was a markedly low concurrence ratio in the thoracic area and in pediatric injuries.</p> <h3>Discussion</h3><p>While the rate of accurate diagnosis and indication for surgery was high with a concurrence ratio of 83%, considerable differences existed between the assessed regions, with lowest values for thoracic images. Teleradiology is a cost-effective, rapid method which can be applied wherever wireless cell phone reception is available. In our opinion, this method is in principle suitable for clinical use, enabling the physician on duty to agree on appropriate measures with colleagues located elsewhere via x-ray image transmission on a cell phone.</p> </div

Distribution of diagnoses based on clinical and radiological findings.

<p>Distribution of diagnoses based on clinical and radiological findings.</p

Assessment of image quality (score 1–10) by four specialists in orthopedics/surgery/trauma surgery and one specialists in radiology.

<p>Left column: all reviewers; middle column: orthopedics/surgery/trauma surgery specialists; right column: radiology specialist; median of difference: reviewers 1 to 4 vs. reviewer 5 = 2.75 (p<0.01).</p

Comparison of diagnosis concurrence ratio based on individual reviewers.

<p>On average, a 76% total agreement of accurate diagnosis occurred.</p

Tally of accurate confirmations of final diagnoses after assessment of transmitted images by 5 specialists.

<p>No significant differences were found regarding the specifications “no pathological findings“ and “with diagnoses”.</p

Assessment of image quality (score: 1–10) after transmission.

<p>Mean values (MV), standard deviations (SD) and confidence intervals (CI: 95%) from statements of individuals reviewers.</p><p>Significant differences were found between values from specialists 1–4 and values from specialist 5 (radiology).</p

Uses of teleradiology.

<p>Uses of teleradiology.</p

Teleradiology requirements.

<p>Teleradiology requirements.</p

Diagram of correlation between sum of confirmed diagnoses by the five specialists (ordinate: 0 = false, 1 = accurate) and sum of assessments of image quality (abscissa: score 1–9).

<p>Correlation ratio: 0.204; exceeding probability: p = 0.04.</p