Study Design Randomized clinical trial. Objectives To determine whether manipulation of the proximal or distal tibiofibular joint would change ankle dorsiflexion range of motion and functional outcomes over a 3-week period in individuals with chronic ankle instability. Background Altered joint arthrokinematics may play a role in chronic ankle instability dysfunction. Joint mobilization or manipulation may offer the ability to restore normal joint arthrokinematics and improve function. Methods Forty-three participants (mean ± SD age, 25.6 ± 7.6 years; height, 174.3 ± 10.2 cm; mass, 74.6 ± 16.7 kg) with chronic ankle instability were randomized to proximal tibiofibular joint manipulation, distal tibiofibular joint manipulation, or a control group. Outcome measures included ankle dorsiflexion range of motion, the single-limb stance on foam component of the Balance Error Scoring System, the step-down test, and the Foot and Ankle Ability Measure sports subscale. Measurements were obtained prior to the interven...

Effects of a Proximal or Distal Tibiofibular Joint Manipulation on Ankle Range of Motion and Functional Outcomes in Individuals With Chronic Ankle Instability

A significant problem that has an impact on community wellbeing is environmental pollution. Environmental pollution due to air, water, or soil pollutants might pose a severe risk to global health, necessitating intense scientific effort. Osteoporosis is a common chronic condition with substantial clinical implications on mortality, morbidity, and quality of life. It is closely linked to bone fractures. Worldwide, osteoporosis affects around 200 million people, and every year, there are almost 9 million fractures. There is evidence that certain environmental factors may increase the risk of osteoporosis in addition to traditional risk factors. It is crucial to understand the molecular mechanisms at play because there is a connection between osteoporosis and exposure to environmental pollutants such as heavy metals, air pollutants, endocrine disruptors, metal ions and trace elements. Hence, in this scoping review, we explore potential explanations for the link between pollutants and bone deterioration through deep insights into molecular pathways. Understanding and recognizing these pollutants as modifiable risk factors for osteoporosis would possibly help to enhance environmental policy thereby aiding in the improvement of bone health and improving patient quality of life. 

A comprehensive review on environmental pollutants and osteoporosis: Insights into molecular pathways

In contrast to cigarettes, electronic cigarette use (E-cigarettes) has grown substantially over the last decade. This is due to their promotion as both a safer alternative to cigarettes and as an aide to stop smoking. Critically, upon E-cigarette use, the user may be exposed to high doses of nicotine in addition to other compounds including flavouring chemicals, metal particulates and carbonyl compounds, particularly in highly vascularised tissues such as bone. However, there has been limited investigation into the impact of E-cigarette usage on bone physiology, particularly over extended time periods and there are no clinical recommendations regarding E-cigarette usage in relation to orthopaedic surgery. This literature review draws together data from studies that have investigated the impact of E-cigarette vapour and its major constituents on bone, detailing the models utilised and the relevant mechanistic and functional results. Currently there is a lack of studies both in vivo and in vitro that have utilised E-cigarette vapour, necessary to account for changes in chemical composition of E-cigarette liquids upon vaping. There is however evidence that human bone and bone cells express nicotine receptors and exposure of both osteoblasts and osteoclasts to nicotine, in high concentrations may reduce their viability and impair function. Similarly, it appears that aldehydes and flavouring chemicals may also negatively impact osteoblast viability and their ability to form bone. However, such functional findings are predominantly the result of studies utilising bone cell lines such as MG-63 or Saos-2 cells, with limited use of human osteoblasts or osteoclasts. Additionally, there is limited consideration for a possible impact on mesenchymal stem cells, which can also play an import role in bone repair. Understanding the function and mechanism of action of the various components of E-cigarette vapour in mediating human bone cell function, in addition to long term studies to determine the potential harm of chronic E-cigarette use on human bone will be important to inform users of potential risks, particularly regarding bone healing following orthopaedic surgery and injury.

/pdf/the-impact-of-e-cigarette-vaping-and-vapour-constituents-on-vp0lt0e1fg.pdf

The impact of E-cigarette vaping and vapour constituents on bone health

Almost 6 years ago, a Guest Editorial of Archives of Toxicology was published by Henkler and Luch (2014), pointing to toxicological problems associated with the use of e-cigarettes. From a regulatory point of view, the discussion was primarily focused on nicotine, as a proposal was just approved at the EU level to set an upper limit of 20 mg nicotine per ml vaping liquid. But at the same time, it was also known that vaping liquids contained a wide range of flavourings, additives and contaminants, a field that was insufficiently investigated (Hutzler et al. 2014). Since that, e-cigarettes have received rapidly increasing popularity. The dynamics of this development is evidenced by very recent publications from all over the world (e.g., Shiffman and Sembower 2020 [USA]; Al Rifai et al. 2020 [USA]; Cruz-Jiménez et al. 2020 [Mexico]; Sharan et al. 2020 [India]; Kapan et al. 2020 [Europe]; Wipfli et al. 2020 [East Asia], Briganto et al. 2020 [world-wide analysis]), and by the electronic social media as well (Ahmed et al. 2020). In first instance, the design of e-cigarettes as electronic nicotine delivery systems has focused the interest of toxicologists on nicotine and on local effects on the respiratory system, but other endpoints of toxicity are also being discussed (Tzortzi et al. 2020); current examples are atherosclerosis (Knura et al. 2018) and neuroinflammation (Heldt et al. 2020). The presence of a considerable number of toxic substances apart from nicotine in the liquid cartridges and in emissions of e-cigarettes has increasingly raised concern (Rehan et al. 2018). With regard to possible carcinogenicity, a systematic literature search has just appeared by Bjurlin et al. (2020), using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Relevant articles in peer-reviewed journals, published through January 2019 that investigated urinary biomarkers in e-cigarettes users were included. Parent compounds and urinary biomarkers were classified according to the International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans and cross-referenced using the Collaborative on Health and the Environment, Toxicant and Disease Database to determine a link to bladder cancer, grouped by strength of evidence. The search identified 22 articles that met the final inclusion criteria and were included in the analysis. It finally appeared that, compared with non-user controls, e-cigarette users showed higher concentrations of urinary biomarkers of several carcinogenic compounds linked to bladder cancer. This issue of Archives of Toxicology contains six contributions, which highlight the e-cigarette topic from very different angles: analytical chemistry, experimental toxicology, epidemiology and clinical aspects.

/pdf/electronic-cigarettes-and-vaping-toxicological-awareness-is-1y5bizmdh6.pdf

Electronic Cigarettes and Vaping: Toxicological Awareness Is Increasing

Oxidative stress which can be induced by cigarette smoke (CS) is associated with an altered osteoblast differentiation, and an inhibition of the mineralization process. Therefore, treatments focusing on reducing oxidative stress in osteoblasts could be a potential therapy supporting bone formation. Maqui berry extract (MBE) is the richest natural source of delphinidins with high antioxidant activity. In the present study, we pre-/ co-/ post-incubated MBE in cigarette smoke extract (CSE)-affected human osteoblasts (hOBs), to investigate the effects of MBE as an antioxidant on hOBs. Our results clearly showed that high concentrations of MBE are toxic for hOBs, while physiological concentrations of MBE have no negative effects in vitro. Physiological concentrations of MBE can reduce oxidative stress caused by CSE in hOBs by activating the antioxidative regulator Nrf2 and its regulated antioxidative enzymes. Moreover, the physiological concentration of MBE prevents the detrimental effects of CSE-induced oxidative damage on hOBs by increasing cell viability, differentiation capability and matrix mineralization. Pre-incubation with MBE showed a positive effect on the activation of the cellular antioxidant system in hOBs. Thus, we conclude that MBE at physiological concentrations can effectively protect osteoblasts from oxidative stress-induced damage by activating the cells' antioxidative defense system.

Maqui berry extract prevents cigarette smoke induced oxidative stress in human osteoblasts in vitro.

Cigarette smoke (CS) exposure is one of the leading risk factors for human health. Nicotine-containing inhalable products, such as e-cigarettes, can effectively support tobacco harm reduction approaches. However, there are limited comparative data on the effects of the aerosols generated from electronic vapor products (e-vapor) and CS on bone. Here, we report the effects of e-vapor aerosols and CS on bone morphology, structure, and strength in a 6-month inhalation study. Eight-week-old ApoE-/- mice were exposed to aerosols from three different e-vapor formulations-CARRIER (propylene glycol and vegetable glycerol), BASE (CARRIER and nicotine), TEST (BASE and flavor)-to CS from 3R4F reference cigarettes at matched nicotine concentrations (35 µg/L) or to fresh air (Sham) (N = 10 per group). Tibiae were analyzed for bone morphology by µCT imaging, biomechanics by three-point bending, and by histological analysis. CS inhalation caused a significant decrease in cortical and total bone volume fraction and bone density relative to e-vapor aerosols. Additionally, CS exposure caused a decrease in ultimate load and stiffness. In contrast, bone structural and biomechanical parameters were not significantly affected by e-vapor aerosol or Sham exposure. At the dissection time point, there was no significant difference in body weight or tibia bone weight or length among the groups. Histological findings revealed microcracks in cortical bone areas among all exposed groups compared to Sham control. In conclusion, because of the bone-preserving effect of e-vapor aerosols relative to CS exposure, e-vapor products could potentially constitute less harmful alternatives to cigarettes in situations in which bone health is of importance.

/pdf/e-vapor-aerosols-do-not-compromise-bone-integrity-relative-3k8idvj0t1.pdf

E-vapor aerosols do not compromise bone integrity relative to cigarette smoke after 6-month inhalation in an ApoE –/– mouse model

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E-vapor aerosols do not compromise bone integrity relative to cigarette smoke after 6-month inhalation in an ApoE –/– mouse model