1
|
Fernandez SV, Kim JH, Sadat D, Marcus C, Suh E, Mclntosh R, Shah A, Dagdeviren C. A Dynamic Ultrasound Phantom with Tissue-Mimicking Mechanical and Acoustic Properties. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2400271. [PMID: 38647427 DOI: 10.1002/advs.202400271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/25/2024] [Indexed: 04/25/2024]
Abstract
Tissue-mimicking phantoms are valuable tools that aid in improving the equipment and training available to medical professionals. However, current phantoms possess limited utility due to their inability to precisely simulate multiple physical properties simultaneously, which is crucial for achieving a system understanding of dynamic human tissues. In this work, novel materials design and fabrication processes to produce various tissue-mimicking materials (TMMs) for skin, adipose, muscle, and soft tissue at a human scale are developed. Target properties (Young's modulus, density, speed of sound, and acoustic attenuation) are first defined for each TMM based on literature. Each TMM recipe is developed, associated mechanical and acoustic properties are characterized, and the TMMs are confirmed to have comparable mechanical and acoustic properties with the corresponding human tissues. Furthermore, a novel sacrificial core to fabricate a hollow, ellipsoid-shaped bladder phantom complete with inlet and outlet tubes, which allow liquids to flow through and expand this phantom, is adopted. This dynamic bladder phantom with realistic mechanical and acoustic properties to human tissues in combination with the developed skin, soft tissue, and subcutaneous adipose tissue TMMs, culminates in a human scale torso tank and electro-mechanical system that can be systematically utilized for characterizing various medical imaging devices.
Collapse
Affiliation(s)
- Sara V Fernandez
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Jin-Hoon Kim
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - David Sadat
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Colin Marcus
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Emma Suh
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Rachel Mclntosh
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Aastha Shah
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Canan Dagdeviren
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| |
Collapse
|
2
|
Li H, Tan P, Rao Y, Bhattacharya S, Wang Z, Kim S, Gangopadhyay S, Shi H, Jankovic M, Huh H, Li Z, Maharjan P, Wells J, Jeong H, Jia Y, Lu N. E-Tattoos: Toward Functional but Imperceptible Interfacing with Human Skin. Chem Rev 2024; 124:3220-3283. [PMID: 38465831 DOI: 10.1021/acs.chemrev.3c00626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
The human body continuously emits physiological and psychological information from head to toe. Wearable electronics capable of noninvasively and accurately digitizing this information without compromising user comfort or mobility have the potential to revolutionize telemedicine, mobile health, and both human-machine or human-metaverse interactions. However, state-of-the-art wearable electronics face limitations regarding wearability and functionality due to the mechanical incompatibility between conventional rigid, planar electronics and soft, curvy human skin surfaces. E-Tattoos, a unique type of wearable electronics, are defined by their ultrathin and skin-soft characteristics, which enable noninvasive and comfortable lamination on human skin surfaces without causing obstruction or even mechanical perception. This review article offers an exhaustive exploration of e-tattoos, accounting for their materials, structures, manufacturing processes, properties, functionalities, applications, and remaining challenges. We begin by summarizing the properties of human skin and their effects on signal transmission across the e-tattoo-skin interface. Following this is a discussion of the materials, structural designs, manufacturing, and skin attachment processes of e-tattoos. We classify e-tattoo functionalities into electrical, mechanical, optical, thermal, and chemical sensing, as well as wound healing and other treatments. After discussing energy harvesting and storage capabilities, we outline strategies for the system integration of wireless e-tattoos. In the end, we offer personal perspectives on the remaining challenges and future opportunities in the field.
Collapse
Affiliation(s)
- Hongbian Li
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Philip Tan
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Yifan Rao
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Sarnab Bhattacharya
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Zheliang Wang
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Sangjun Kim
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Susmita Gangopadhyay
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Hongyang Shi
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Matija Jankovic
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Heeyong Huh
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Zhengjie Li
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Pukar Maharjan
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Jonathan Wells
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Hyoyoung Jeong
- Department of Electrical and Computer Engineering, University of California Davis, Davis, California 95616, United States
| | - Yaoyao Jia
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Nanshu Lu
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas 78712, United States
- Department of Electrical and Computer Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas 78712, United States
- Texas Materials Institute, The University of Texas at Austin, Austin, Texas 78712, United States
| |
Collapse
|
3
|
Rennoll V, McLane I, Eisape A, Grant D, Hahn H, Elhilali M, West JE. Electrostatic Acoustic Sensor with an Impedance-Matched Diaphragm Characterized for Body Sound Monitoring. ACS APPLIED BIO MATERIALS 2023; 6:3241-3256. [PMID: 37470762 PMCID: PMC10804910 DOI: 10.1021/acsabm.3c00359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Acoustic sensors are able to capture more incident energy if their acoustic impedance closely matches the acoustic impedance of the medium being probed, such as skin or wood. Controlling the acoustic impedance of polymers can be achieved by selecting materials with appropriate densities and stiffnesses as well as adding ceramic nanoparticles. This study follows a statistical methodology to examine the impact of polymer type and nanoparticle addition on the fabrication of acoustic sensors with desired acoustic impedances in the range of 1-2.2 MRayls. The proposed method using a design of experiments approach measures sensors with diaphragms of varying impedances when excited with acoustic vibrations traveling through wood, gelatin, and plastic. The sensor diaphragm is subsequently optimized for body sound monitoring, and the sensor's improved body sound coherence and airborne noise rejection are evaluated on an acoustic phantom in simulated noise environments and compared to electronic stethoscopes with onboard noise cancellation. The impedance-matched sensor demonstrates high sensitivity to body sounds, low sensitivity to airborne sound, a frequency response comparable to two state-of-the-art electronic stethoscopes, and the ability to capture lung and heart sounds from a real subject. Due to its small size, use of flexible materials, and rejection of airborne noise, the sensor provides an improved solution for wearable body sound monitoring, as well as sensing from other mediums with acoustic impedances in the range of 1-2.2 MRayls, such as water and wood.
Collapse
Affiliation(s)
- Valerie Rennoll
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Ian McLane
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Adebayo Eisape
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Drew Grant
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Helena Hahn
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Mounya Elhilali
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - James E West
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| |
Collapse
|
4
|
Webb T, Cheeniyil R, Wilson M, Kubanek J. Remote targeted electrical stimulation. J Neural Eng 2023; 20:036030. [PMID: 37236172 PMCID: PMC10251736 DOI: 10.1088/1741-2552/acd95c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/26/2023] [Accepted: 05/26/2023] [Indexed: 05/28/2023]
Abstract
Objective:The ability to generate electric fields in specific targets remotely would transform manipulations of processes that rest on electrical signaling.Approach:This article shows that focal electric fields are generated from distance by combining two orthogonal, remotely applied energies-magnetic and focused ultrasonic fields. The effect derives from the Lorentz force equation applied to magnetic and ultrasonic fields.Main results:We elicited this effect using standard hardware and confirmed that the generated electric fields align with the Lorentz equation. The effect significantly and safely modulated human peripheral nerves and deep brain regions of non-human primates.Significance:This approach opens a new set of applications in which electric fields are generated at high spatiotemporal resolution within intact biological tissues or materials, thus circumventing the limitations of traditional electrode-based procedures.
Collapse
Affiliation(s)
- Taylor Webb
- University of Utah, 36 S Wasatch Dr, Salt Lake City, UT, 84112, United States of America
| | - Rahul Cheeniyil
- University of Utah, 36 S Wasatch Dr, Salt Lake City, UT, 84112, United States of America
| | - Matthew Wilson
- University of Utah, 36 S Wasatch Dr, Salt Lake City, UT, 84112, United States of America
| | - Jan Kubanek
- University of Utah, 36 S Wasatch Dr, Salt Lake City, UT, 84112, United States of America
| |
Collapse
|
5
|
Wigley CH, Janssen TJ, Mosahebi A. Shock Wave Therapy in Plastic Surgery: A Review of the Current Indications. Aesthet Surg J 2023; 43:370-386. [PMID: 36226364 DOI: 10.1093/asj/sjac262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) represents a promising, non-invasive management strategy supporting the treatment of a variety of conditions related to plastic surgery. OBJECTIVES This literature review aimed to give a systematic overview of current applications, its mechanism of action, and its potential to provide tangible therapies in plastic surgery. METHODS The databases PubMed (National Institute of Health, Bethesda, MD), Embase (via Ovid [Elsevier, Amsterdam, the Netherlands]), and the Cochrane Library (Cochrane, London, UK) were searched for articles published up to June 1, 2021. Clinical studies of any design including ESWT in the context of plastic surgery were included. Two reviewers extracted data, and 46 articles were analyzed after application of the inclusion and exclusion criteria. RESULTS Forty-six included studies (n = 1496) were categorized into the following broad themes: cellulite/body contouring/skin rejuvenation, burns/scar treatment, diabetic foot ulcers/chronic wound, and future perspectives of ESWT. Overall, applications of ESWT were heterogenous, and the majority of studies reported effectiveness of ESWT as an alternative treatment technique. Flawed methodology and differences in technical standards limit the outcome and conclusion of this review. CONCLUSIONS There is yet insufficient evidence to support the effectiveness of any specific intervention included in this review; however, all included studies reported improvements in key outcomes. Where reported, ESWT displayed a good safety profile with no serious adverse events. Further research is needed to provide more evidence to delineate the indications of ESWT in plastic surgery.
Collapse
Affiliation(s)
- Catrin H Wigley
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | - Tim J Janssen
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, UK
| | | |
Collapse
|
6
|
Cao HX, Jung D, Lee HS, Nguyen VD, Choi E, Kim CS, Park JO, Kang B. Fabrication, Acoustic Characterization and Phase Reference-Based Calibration Method for a Single-Sided Multi-Channel Ultrasonic Actuator. MICROMACHINES 2022; 13:2182. [PMID: 36557481 PMCID: PMC9782305 DOI: 10.3390/mi13122182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The ultrasonic actuator can be used in medical applications because it is label-free, biocompatible, and has a demonstrated history of safe operation. Therefore, there is an increasing interest in using an ultrasonic actuator in the non-contact manipulation of micromachines in various materials and sizes for therapeutic applications. This research aims to design, fabricate, and characterize a single-sided transducer array with 56 channels operating at 500 kHz, which provide benefits in the penetration of tissue. The fabricated transducer is calibrated using a phase reference calibration method to reduce position misalignment and phase discrepancies caused by acoustic interaction. The acoustic fields generated by the transducer array are measured in a 300 mm × 300 mm × 300 mm container filled with de-ionized water. A hydrophone is used to measure the far field in each transducer array element, and the 3D holographic pattern is analyzed based on the scanned acoustic pressure fields. Next, the phase reference calibration is applied to each transducer in the ultrasonic actuator. As a result, the homogeneity of the acoustic pressure fields surrounding the foci area is improved, and the maximum pressure is also increased in the twin trap. Finally, we demonstrate the capability to trap and manipulate micromachines with acoustic power by generating a twin trap using both optical camera and ultrasound imaging systems in a water medium. This work not only provides a comprehensive study on acoustic actuators but also inspires the next generation to use acoustics in medical applications.
Collapse
Affiliation(s)
- Hiep Xuan Cao
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
- Korea Institute of Medical Microrobotics, Gwangju 61011, Republic of Korea
| | - Daewon Jung
- Korea Institute of Medical Microrobotics, Gwangju 61011, Republic of Korea
| | - Han-Sol Lee
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Van Du Nguyen
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
- Korea Institute of Medical Microrobotics, Gwangju 61011, Republic of Korea
| | - Eunpyo Choi
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
- Korea Institute of Medical Microrobotics, Gwangju 61011, Republic of Korea
| | - Chang-Sei Kim
- School of Mechanical Engineering, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Jong-Oh Park
- Korea Institute of Medical Microrobotics, Gwangju 61011, Republic of Korea
| | - Byungjeon Kang
- Korea Institute of Medical Microrobotics, Gwangju 61011, Republic of Korea
- College of AI Convergence, Chonnam National University, Gwangju 61186, Republic of Korea
- Graduate School of Data Science, Chonnam National University, Gwangju 61186, Republic of Korea
| |
Collapse
|
7
|
Oliveira Modena DA, Soares CD, Candido EC, Chaim FM, Cazzo E, Chaim EA. Effect of Extracorporeal Shock Waves on Induced Neocollagenesis of Integumentary Tissue. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:52-57. [PMID: 36312825 PMCID: PMC9586529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Obesity became a worldwide public health problem and its treatment presents a strict relationship with skin flaccidity, for which the development of non-invasive therapies is an emerging field. OBJECTIVE This study aims to evaluate the physiological response of the skin tissue of individuals with obesity with flaccidity to the physiological stimulus of shockwave therapy (ESWT). METHODS This is a comparative intervention study based on histological and immunohistochemical analyses of a set of samples of skin tissue of women with Grade II obesity who achieved a 10 percent preoperative weight loss before bariatric surgery and complaints of skin flaccidity, subjected to the ESWT treatment. A total of seven sessions were carried out in the abdominal region on the left side, and the collateral side was used as control; the biological material was collected at the moment of the bariatric surgery. Hematoxylin and Eosin, Masson's trichrome, Picrosirius Red and the markers for immunohistochemical were used for the morphological evaluation. RESULTS Fourteen women were included in the research. The results demonstrated that the tissue which underwent the ESWT intervention presented significant increases of fibroblast cells (p<0.0001) and collagen fibers Type I and II (p<0.0002). In the significant expressions of the markers FGF1, FGF2, FGFR1 were identified in the exposed side (p<0.0002, 0.0017, <0.0001, respectively) as well as a significantly higher expression of Ki67 marker of cell proliferation (p<0.0002). CONCLUSION ESWT was associated with a significant increase of cell proliferation and collagen expression in flaccid skin of individuals who achieved weight loss before bariatric surgery.
Collapse
Affiliation(s)
- Débora Aparecida Oliveira Modena
- Drs. Oliveira Modena, Candido, Chaim, Cazzo, and Chaim are with the Department of Surgery, Medical Sciences Institute at the University of Campinas (UNICAMP) in São Paulo, Brazil
| | - Ciro Dantas Soares
- Dr. Soares is with the Oral Pathology Section, Department of Oral Diagnosis, and Piracicaba Dental School at the University of Campinas (UNICAMP) in Piracicaba, Brazil
| | - Elaine Cristina Candido
- Drs. Oliveira Modena, Candido, Chaim, Cazzo, and Chaim are with the Department of Surgery, Medical Sciences Institute at the University of Campinas (UNICAMP) in São Paulo, Brazil
| | - Felipe Mendonça Chaim
- Drs. Oliveira Modena, Candido, Chaim, Cazzo, and Chaim are with the Department of Surgery, Medical Sciences Institute at the University of Campinas (UNICAMP) in São Paulo, Brazil
| | - Everton Cazzo
- Drs. Oliveira Modena, Candido, Chaim, Cazzo, and Chaim are with the Department of Surgery, Medical Sciences Institute at the University of Campinas (UNICAMP) in São Paulo, Brazil
| | - Elinton Adami Chaim
- Drs. Oliveira Modena, Candido, Chaim, Cazzo, and Chaim are with the Department of Surgery, Medical Sciences Institute at the University of Campinas (UNICAMP) in São Paulo, Brazil
| |
Collapse
|
8
|
Holographic Acoustic Tweezers for 5-DoF Manipulation of Nanocarrier Clusters toward Targeted Drug Delivery. Pharmaceutics 2022; 14:pharmaceutics14071490. [PMID: 35890382 PMCID: PMC9317593 DOI: 10.3390/pharmaceutics14071490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022] Open
Abstract
Acoustic tweezers provide unique capabilities in medical applications, such as contactless manipulation of small objects (e.g., cells, compounds or living things), from nanometer-sized extracellular vesicles to centimeter-scale structures. Additionally, they are capable of being transmitted through the skin to trap and manipulate drug carriers in various media. However, these capabilities are hindered by the limitation of controllable degrees of freedom (DoFs) or are limited maneuverability. In this study, we explore the potential application of acoustical tweezers by presenting a five-DoF contactless manipulation acoustic system (AcoMan). The system has 30 ultrasound transducers (UTs) with single-side arrangement that generates active traveling waves to control the position and orientation of a fully untethered nanocarrier clusters (NCs) in a spherical workspace in water capable of three DoFs translation and two DoFs rotation. In this method, we use a phase modulation algorithm to independently control the phase signal for 30 UTs and manipulate the NCs’ positions. Phase modulation and switching power supply for each UT are employed to rotate the NCs in the horizontal plane and control the amplitude of power supply to each UT to rotate the NCs in the vertical plane. The feasibility of the method is demonstrated by in vitro and ex vivo experiments using porcine ribs. A significant portion of this study could advance the therapeutic application such a system as targeted drug delivery.
Collapse
|
9
|
Riis T, Kubanek J. Effective Ultrasonic Stimulation in Human Peripheral Nervous System. IEEE Trans Biomed Eng 2022; 69:15-22. [PMID: 34057888 PMCID: PMC9080060 DOI: 10.1109/tbme.2021.3085170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Low-intensity ultrasound can stimulate excitable cells in a noninvasive and targeted manner, but which parameters are effective has remained elusive. This question has been difficult to answer because differences in transducers and parameters-frequency in particular-lead to profound differences in the stimulated tissue volumes. The objective of this study is to control for these differences and evaluate which ultrasound parameters are effective in stimulating excitable cells. METHODS Here, we stimulated the human peripheral nervous system using a single transducer operating in a range of frequencies, and matched the stimulated volumes with an acoustic aperture. RESULTS We found that low frequencies (300 kHz) are substantially more effective in generating tactile and nociceptive responses in humans compared to high frequencies (900 kHz). The strong effect of ultrasound frequency was observed for all pressures tested, for continuous and pulsed stimuli, and for tactile and nociceptive responses. CONCLUSION This prominent effect may be explained by a mechanical force associated with ultrasound. The effect is not due to heating, which would be weaker at the low frequency. SIGNIFICANCE This controlled study reveals that ultrasonic stimulation of excitable cells is stronger at lower frequencies, which guides the choice of transducer hardware for effective ultrasonic stimulation of the peripheral nervous system in humans.
Collapse
Affiliation(s)
- Thomas Riis
- Department of Biomedical Engineering, University of Utah, UT 84112 USA
| | - Jan Kubanek
- Department of Biomedical Engineering, University of Utah, UT 84112 USA
| |
Collapse
|
10
|
Effect of extracorporeal shock waves on inflammation and angiogenesis of integumentary tissue in obese individuals: stimulating repair and regeneration. Lasers Med Sci 2021; 37:1289-1297. [PMID: 34365545 DOI: 10.1007/s10103-021-03387-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
The technology of extracorporeal shock wave therapy (ESWT) has been studied around the world for its possible benefits in the treatment and rehabilitation of aesthetic disorders. To better elucidate its real physiological effect on the integumentary tissue, this study was proposed aimed at evaluating whether ESWT can act to stimulate the inflammatory process and angiogenesis in the dermis and epidermis of obese individuals. This is an immunohistological study that evaluated a set of samples of the integumentary tissue of women with grade II obesity with weight loss of 10% of the initial weight undergoing ESWT treatment; the collection of biological material was performed at the time of surgery of bariatric surgery. For immunohistochemical evaluation, the markers to assess the presence and distribution of inflammatory cells, anti-COX-2, CD3, CD20, CD163, and NK were used. For physiological stimulus pathways for blood vessel angiogenesis, markers CD 34, CD 105 and VEGF were used. Fourteen obese women were included in the study. Positivity was evidenced in the epidermal expression of markers of the inflammatory process COX-2, CD3, CD20, NK cells, CD68, and CD163 (p < 0.0001) in the intervention sample when compared to controls. There was a positive expression for the angiogenesis markers CD105 and VEGF (p < 0.0001) when comparing the intervention group with the control group. It was concluded that ESWT can stimulate a local inflammatory process, mediating and modulating important growth factors to act in the repair process and skin tissue regeneration, being considered a promising treatment for skin diseases related to weight gain or loss.
Collapse
|
11
|
Abstract
BACKGROUND The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of response. OBJECTIVE Results from clinical trials that target different anatomical aspects of cellulite can provide insights into the underlying pathophysiology of cellulite. MATERIALS AND METHODS A search of the PubMed database and ClinicalTrials.gov website was conducted to identify clinical trials that have investigated treatments for cellulite. RESULTS A lack of trial protocol standardization, objective means for quantification of improvement and reported cellulite severity, and short-term follow-up, as well as variation in assessment methods have made comparisons among efficacy studies challenging. However, the lack of durable efficacy and inconsistency seen in clinical results suggest that dermal or adipose tissue changes are not the primary etiologies of cellulite. Clinical studies targeting the collagen-rich fibrous septae in cellulite dimples through mechanical, surgical, or enzymatic approaches suggest that targeting fibrous septae is the strategy most likely to provide durable improvement of skin topography and the appearance of cellulite. CONCLUSION The etiology of cellulite has not been completely elucidated. However, there is compelling clinical evidence that fibrous septae play a central role in the pathophysiology of cellulite.
Collapse
|
12
|
Kimura K, Tanaka Y. Facial Tightening Effects, Following Focused and Radial Acoustic Wave Therapy Assessment, Using a Three-Dimensional Digital Imaging. Lasers Surg Med 2020; 53:630-639. [PMID: 33211338 PMCID: PMC8246538 DOI: 10.1002/lsm.23353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/31/2020] [Accepted: 10/31/2020] [Indexed: 11/09/2022]
Abstract
Background and Objectives Acoustic wave therapy is a novel facial tightening technique that involves nonthermal penetration of the skin and subcutaneous tissue, affecting cells and their metabolism, and resulting in an increased release of unwanted fat and activation of blood and lymphatic flow in tissues. The objective of this study was to investigate the effectiveness of acoustic wave therapy. Study Design/Materials and Methods A total of 333 patients underwent multiple facial tightening treatment sessions using focused and radial acoustic waves. Each patient received 2,000–3,000 pulses of focused acoustic waves at a power of 0.45–0.88 mJ/mm2 with a pulse frequency of 3–5 Hz and 4,000 pulses of radial acoustic waves at 4‐bar power at a frequency of 21 Hz. These sessions were performed more than three times, and treatments were repeated at 1‐month intervals. Digital photographs superimposed three‐dimensional volumetric assessments, and three‐dimensional skin surface displacement calculations using vectors were used to evaluate the results 12 months after the last treatment. Patients also evaluated the results using a 5‐point Likert scale. Results Improvements in skin texture, clarity, and laxity were observed in digital photographs. Superimposed three‐dimensional color images showed marked volumetric reduction and/or formative modification for even contour toward the lower mid‐face. Most vectors showed three‐dimensional skin surface displacement at the lateral sides of the temples, cheeks, and chin, in an upward direction. These results were obtained and sustained for up to 12 months without edematous reactions. Almost all patients reported improvement, with 79% reporting “good” or “excellent” improvement. Complications were minor and transitory. Persistent side effects were not observed. Conclusion Acoustic wave therapy could be used as a standard facial tightening treatment, with skin rejuvenation effects shown on digital photographs and three‐dimensional quantification assessments. This noninvasive acoustic wave approach was found to be a safe, long‐lasting, and effective method for facial tightening. Lasers Surg. Med. 00:00–00, 2020. © 2020 Wiley Periodicals LLC
Collapse
Affiliation(s)
- Kuriko Kimura
- Health & Beauty Clinic Le Coquelicot, Ginza, Tokyo, 104-0061, Japan
| | - Yohei Tanaka
- Health & Beauty Clinic Le Coquelicot, Ginza, Tokyo, 104-0061, Japan.,Clinica Tanaka Plastic, Reconstructive Surgery and Anti-Aging Center, Matsumoto, Nagano, 390-0874, Japan
| |
Collapse
|
13
|
Troia S, Moreira AM, Pisco D, Noites A, Vale AL, Carvalho P, Vilarinho R. Effect of shock wave therapy associated with aerobic exercise on cellulite: A randomized controlled trial. J Cosmet Dermatol 2020; 20:1732-1742. [PMID: 33053245 DOI: 10.1111/jocd.13791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cellulite is a multifactor and controversial condition. Several methods have been explored to reduce it, not always with favorable results. Shock Wave Therapy has been shown to be effective, but the results of its association with an Aerobic Exercise Program are unknown. AIMS To verify whether Shock Wave Therapy in association with an Aerobic Exercise Program reduces the degree of severity of Cellulite in the gluteal region and in the ⅓ of the proximal posterior of the thigh. METHODS Forty-five healthy women, aged from 18 to 32, randomly assigned, considering the severity degree in the Cellulite Severity Scale and the level of physical activity, in three groups: two experimental and one control group. The control group performed the evaluations. The experimental group 1 performed an Aerobic Exercise Program, and the experimental group 2 associated this program with a Radial Shock Wave Therapy protocol. The experimental groups completed six interventions within 3 weeks. In addition, the degree of severity in the Cellulite Severity Scale, height, body composition, skin temperature, and subcutaneous adipose tissue thickness were assessed. One-way ANOVA test and Kruskal-Wallis were used to obtain the results, with level of significance of 0.05. RESULTS Forty-two women completed the study. There was a significant reduction in the severity of Cellulite between experimental group 2 and group 1 (P = 0.032), and from group 2 to the control group (P = 0.042). CONCLUSION The association of Shock Wave Therapy and Aerobic Exercise was shown to be effective in reducing the severity of cellulite.
Collapse
Affiliation(s)
- Sara Troia
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Ana Maria Moreira
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Daniela Pisco
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Andreia Noites
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal.,Center for Rehabilitation Research (CIR) - Human Movement System (Re) habilitation, Polytechnic Institute of Porto, Porto, Portugal
| | - Ana Luisa Vale
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - Paulo Carvalho
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal.,Center for Rehabilitation Research (CIR) - Human Movement System (Re) habilitation, Polytechnic Institute of Porto, Porto, Portugal
| | - Rui Vilarinho
- Department of Physiotherapy, School of Health, Polytechnic Institute of Porto, Porto, Portugal.,Center for Rehabilitation Research (CIR) - Human Movement System (Re) habilitation, Polytechnic Institute of Porto, Porto, Portugal
| |
Collapse
|
14
|
Xing J, Yu G, Li D, Tan S, Cao H, Liu Z, Bai Z. Safety parameters of in vivo low-energy shock waves and their impact on adult rat testes. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 190:110044. [PMID: 31869717 DOI: 10.1016/j.ecoenv.2019.110044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/23/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
Low-energy shock waves (LESWs) have been widely used in the intervention of a subset of diseased tissues and organs with good results. However, it is unclear whether they can be used directly to intervene in the testes. Therefore, the aim of this study was to determine a relatively safe energy density and impulse number for rat testes. A total of 176 male rats were randomly and equally assigned to different intervention groups. Among them, 144 rats were assigned to 18 shock subgroups with different energy densities (0.02, 0.04 and 0.06 mJ/mm2), different impulse numbers (500, 1000 and 1500 impulses) and different shock periods (2 and 8 weeks). The remaining 32 rats were divided into the sham intervention (S) groups and the blank control (N) groups with observation periods of 2 weeks and 8 weeks. One day after the last LESWs intervention, all the rats were weighed, and the concentrations of reproductive endocrine hormones were measured, the semen quality and testicular tissue oxidative stress levels were analyzed, and histomorphology and ultrastructures were observed. We found that there were no significant differences in the whole-body physiological state, testicular tissue morphology, oxidative stress state and sperm quality between the L1 shock group and the corresponding S group and N group (all p˃0.05, respectively). However, the other parameters of the shock groups caused different degrees of damage to the structure and function of rat testes, and the whole-body physiological state was also adversely affected. This study demonstrated that LESWs with an energy density of 0.02 mJ/mm2 and 500 impulses had no adverse effects on the rat testes.
Collapse
Affiliation(s)
- Jiansheng Xing
- Department of Urology, Haikou Hospital of Xiangya School of Medicine, Central South University, Haikou, 570208, Hainan Province, China
| | - Gang Yu
- Department of Urology, Haikou Hospital of Xiangya School of Medicine, Central South University, Haikou, 570208, Hainan Province, China
| | - Donghui Li
- Department of Urology, Haikou Hospital of Xiangya School of Medicine, Central South University, Haikou, 570208, Hainan Province, China
| | - Shun Tan
- Department of Pathology, Haikou Hospital of Xiangya School of Medicine, Central South University, Haikou, 570208, Hainan Province, China
| | - Hui Cao
- Department of Central Laboratory, Haikou Hospital of Xiangya School of Medicine, Central South University, Haikou, 570208, Hainan Province, China
| | - Zhenxiang Liu
- Department of Urology, Haikou Hospital of Xiangya School of Medicine, Central South University, Haikou, 570208, Hainan Province, China
| | - Zhiming Bai
- Department of Urology, Haikou Hospital of Xiangya School of Medicine, Central South University, Haikou, 570208, Hainan Province, China.
| |
Collapse
|
15
|
Ashem HN, Draz AH, Abdel-Aziem AA. Caffeine phonophoresis versus shock wave therapy for adult women with cellulite: a randomized controlled trial. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2019. [DOI: 10.4103/bfpt.bfpt_27_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
16
|
Vangipuram R, Hamill SS, Friedman PM. Accelerated tattoo removal with acoustic shock wave therapy in conjunction with a picosecond laser. Lasers Surg Med 2018; 50:890-892. [PMID: 29938802 DOI: 10.1002/lsm.22945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Conventional tattoo removal consists of single-pass treatments, spaced 7-8 weeks apart, for a total of 7-10 sessions. A major limiting factor of this procedure is the development of cavitation bubbles and vacuoles within the epidermis and dermis that result from the rapid heating of tattoo particles by the laser. While multiple-pass methods using the R20 protocol or the PFD patch enhance tattoo removal through epidermal clearance, they have no effect on deep-intradermal pigment associated vacuoles that arise from treatment with lasers such as the Q-switched laser. METHODS A 28-year-old female with Fitzpatrick skin Type V presented for treatment of a 6-year-old professional black tattoo on the left ventral wrist. She underwent three treatment sessions at 6-8 week intervals using a commercial 1,064-nm picosecond Nd:YAG laser (PicoWay; Candela, Wayland, MA) and a perfluorodecalin (PFD) patch (Merz; Raleigh, NC). At each treatment session, she received two passes with 1,064-nm, 4-mm spot size, a fluence ranging from 2.8 to 3.2 J/cm2 and a laser repetition rate of 2 Hz. Between laser passes and following the final laser pass, the medial portion of the tattoo was treated with acoustic shock wave therapy (ASWT) using the Zwave device (Zimmer Medizin Systems; Irvine, CA) with 90 mJ, 22 Hz, and 1,200 pulses. RESULTS After three treatment sessions, there was 80% clearance of the medial portion of the tattoo that received the ASWT compared with 60% clearance of the lateral portion of the tattoo that was treated with the picosecond 1,064-nm Nd:YAG laser and PFD patch alone. In the days following each treatment session, the patient noted consistently less edema, erythema and epidermal crusting on the portion of the tattoo that received the ASWT. CONCLUSION We report a case of 80% tattoo clearance with ASWT in a patient with Fitzpatrick type V skin compared with 60% clearance with the picosecond 1064-nm Nd:YAG laser and PFD patch alone. The concurrent use of the PFD patch, which facilitated multi-pass treatments, may have also increased tattoo fading in this patient. ASWT may enhance tattoo clearance by increasing lymphatic drainage and increasing metabolic activity in the treated area, thereby accelerating the clearance of dermal pigment vacuoles produced by the picosecond laser and minimizing epidermal side effects such as erythema, edema, and crusting. Lasers Surg. Med. 50:890-892, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ramya Vangipuram
- Department of Dermatology, University of Texas Health Sciences Center, Houston, Texas
| | | | - Paul M Friedman
- Department of Dermatology, University of Texas Health Sciences Center, Houston, Texas.,Dermatology and Laser Surgery Center, Houston, Texas
| |
Collapse
|
17
|
Development of an Omnidirectional-Capable Electromagnetic Shock Wave Generator for Lipolysis. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:9258512. [PMID: 29065664 PMCID: PMC5463193 DOI: 10.1155/2017/9258512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/18/2017] [Accepted: 04/09/2017] [Indexed: 11/17/2022]
Abstract
Traditional methods for adipose tissue removal have progressed from invasive methods such as liposuction to more modern methods of noninvasive lipolysis. This research entails the development and evaluation of an omnidirectional-capable flat-coil electromagnetic shock wave generator (EMSWG) for lipolysis. The developed EMSWG has the advantage of omnidirectional-capable operation. This capability increases the eventual clinical usability by adding three designed supports to the aluminum disk of the EMSWG to allow omnidirectional operation. The focal pressures of the developed EMSWG for different operating voltages were measured, and its corresponding energy intensities were calculated. The developed EMSWG was mounted in a downward orientation for lipolysis and evaluated as proof of concept. In vitro tests on porcine fatty tissues have been carried out. It is found that at a 6 kV operating voltage with 1500 shock wave exposures, a 2 cm thick subcutaneous hypodermis of porcine fatty tissue can be ruptured, resulting in a damaged area of 1.39 mm2. At a 6.5 kV operating voltage with 2000 shock wave exposures, the damaged area is increased to about 5.20 mm2, which can be enlarged by changing the focal point location, resulting in significant lipolysis for use in clinical applications.
Collapse
|
18
|
Modena DAO, da Silva CN, Grecco C, Guidi RM, Moreira RG, Coelho AA, Sant’Ana E, de Souza JR. Extracorporeal shockwave: mechanisms of action and physiological aspects for cellulite, body shaping, and localized fat—Systematic review. J COSMET LASER THER 2017; 19:314-319. [DOI: 10.1080/14764172.2017.1334928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Débora A. Oliveira Modena
- Department of Surgery, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Caroline Nogueira da Silva
- Human Development and Technologies, Universidade Estadual Paulista (UNESP), São Paulo, Brazil
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Clovis Grecco
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Renata Michelini Guidi
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
- Biomedical Engineering Department, Faculty of Electrical Engineering and Computing, University of Campinas (Unicamp), Campinas, Brazil
- Centro de Estudos e Formação Avançada Ibramed (CEFAI), Amparo, Brazil
| | - Renata Gomes Moreira
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Andresa A. Coelho
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - Estela Sant’Ana
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
| | - José Ricardo de Souza
- Ibramed Research Institute: Study Group in Technology Applied to Health, Amparo, Brazil
- Centro de Estudos e Formação Avançada Ibramed (CEFAI), Amparo, Brazil
| |
Collapse
|
19
|
Hexsel D, Camozzato FO, Silva AF, Siega C. Acoustic wave therapy for cellulite, body shaping and fat reduction. J COSMET LASER THER 2017; 19:165-173. [DOI: 10.1080/14764172.2016.1269928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | | | - Aline Flor Silva
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| | - Carolina Siega
- Brazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil
| |
Collapse
|
20
|
Whole-Body Rejuvenation Utilizing Energy-Based Modalities. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0138-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
21
|
Knobloch K, Kraemer R. Extracorporeal shock wave therapy (ESWT) for the treatment of cellulite – A current metaanalysis. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.644] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
22
|
Abstract
BACKGROUND Cellulite is a multifactorial condition that is present in 80-90 % of post-pubertal women. Despite its high prevalence, it remains a major cosmetic concern for women. A wide range of products and treatments for cellulite reduction is available; however, no systematic review has been performed so far to evaluate the efficacy of the available treatment options for cellulite. OBJECTIVE The objective of this review is to provide a systematic evaluation of the scientific evidence of the efficacy of treatments for cellulite reduction. METHODS This systematic review followed the PRISMA guidelines for reporting systematic reviews and meta-analyses. Only original articles in English or German reporting data on the efficacy of cellulite treatments from in vivo human studies were considered. In total, 67 articles were analyzed for the following information: therapy, presence of a control group, randomization, blinding, sample size, description of statistical methods, results, and level of evidence. RESULTS Most of the evaluated studies, including laser- and light-based modalities, radiofrequency, and others had important methodological flaws; some did not use cellulite severity as an endpoint or did not provide sufficient statistical analyses. Of the 67 studies analyzed in this review, only 19 were placebo-controlled studies with randomization. Some evidence for potential benefit was only seen for acoustic wave therapy (AWT) and the 1440 nm Nd:YAG minimally invasive laser. CONCLUSION This article provides a systematic evaluation of the scientific evidence of the efficacy of treatment for cellulite reduction. No clear evidence of good efficacy could be identified in any of the evaluated cellulite treatments.
Collapse
Affiliation(s)
| | - Nils Krueger
- Rosenpark Research, Wilhelminenstraße 13, 64283, Darmstadt, Germany
| | - Neil S Sadick
- Sadick Dermatology, 911 Park Avenue, New York, NY, USA
| |
Collapse
|
23
|
Zerini I, Sisti A, Cuomo R, Ciappi S, Russo F, Brandi C, D'Aniello C, Nisi G. Cellulite treatment: a comprehensive literature review. J Cosmet Dermatol 2015; 14:224-40. [PMID: 26147372 DOI: 10.1111/jocd.12154] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2015] [Indexed: 12/18/2022]
Abstract
An effective and long-term treatment of cellulite has not been well established. To our knowledge, no review has analyzed the whole range of treatments for this condition. We conducted a review of in vivo studies on humans adopting the key words "cellulite" and "treatment." The studies were included according to eligibility criteria. We performed an analysis to estimate the overall effect of cellulite treatments from clinical studies. Medline library was screened up to December 2014 to identify eligible studies. We included 73 original studies in the present review. All of them were clinical studies, in most of them, only women were recruited. Above the studies searched up, 66 tested the effectiveness of an exclusive treatment performed without the association to other procedures: 11 topical agents, 10 shock-wave therapy, 10 radio frequency, eight laser therapy, five oral therapy, four manual massage therapy, three carbon dioxide therapy, two compressive therapy, two infrared therapy, one dermabrasion, and 11 devices that use an association of multiple treatments. Seven papers tested a combination of two or more treatments. The mean difference of clinical morphologic features and ultrastructural changes between the treated group and the controlled showed significant heterogeneity between studies. It is still difficult to indicate an exclusive and effective single treatment for this condition. Our analysis purposed to obtain a complete overview of the available treatments in cellulite reduction.
Collapse
Affiliation(s)
- Irene Zerini
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Andrea Sisti
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Serena Ciappi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Francesco Russo
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Cesare Brandi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Carlo D'Aniello
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy
| |
Collapse
|
24
|
de Girolamo L, Stanco D, Galliera E, Viganò M, Lovati AB, Marazzi MG, Romeo P, Sansone V. Soft-focused extracorporeal shock waves increase the expression of tendon-specific markers and the release of anti-inflammatory cytokines in an adherent culture model of primary human tendon cells. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1204-1215. [PMID: 24631378 DOI: 10.1016/j.ultrasmedbio.2013.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/26/2013] [Accepted: 12/05/2013] [Indexed: 06/03/2023]
Abstract
Focused extracorporeal shock waves have been found to upregulate the expression of collagen and to initiate cell proliferation in healthy tenocytes and to positively affect the metabolism of tendons, promoting the healing process. Recently, soft-focused extracorporeal shock waves have also been found to have a significant effect on tissue regeneration. However, very few in vitro reports have dealt with the application of this type of shock wave to cells, and in particular, no previous studies have investigated the response of tendon cells to this impulse. We devised an original model to investigate the in vitro effects of soft-focused shock waves on a heterogeneous population of human resident tendon cells in adherent monolayer culture. Our results indicate that soft-focused extracorporeal shock wave treatment (0.17 mJ/mm(2)) is able to induce positive modulation of cell viability, proliferation and tendon-specific marker expression, as well as release of anti-inflammatory cytokines. This could prefigure a new rationale for routine employment of soft-focused shock waves to treat the failed healing status that distinguishes tendinopathies.
Collapse
Affiliation(s)
- Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Deborah Stanco
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Emanuela Galliera
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milan, Italy; IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Marco Viganò
- Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Arianna Barbara Lovati
- Cell and Tissue Engineering Laboratory, Gruppo Ospedaliero San Donato Foundation, Milan, Italy
| | - Monica Gioia Marazzi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Pietro Romeo
- Orthopaedic Department, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Valerio Sansone
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Orthopaedic Department, Istituto Ortopedico Galeazzi, Milan, Italy
| |
Collapse
|
25
|
Schlaudraff KU, Kiessling MC, Császár NB, Schmitz C. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite. Clin Cosmet Investig Dermatol 2014; 7:171-83. [PMID: 24920933 PMCID: PMC4043818 DOI: 10.2147/ccid.s59851] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extracorporeal shock wave therapy has been successfully introduced for the treatment of cellulite in recent years. However, it is still unknown whether the individual clinical outcome of cellulite treatment with extracorporeal shock wave therapy can be predicted by the patient's individual cellulite grade at baseline, individual patient age, body mass index (BMI), weight, and/or height. METHODS Fourteen Caucasian females with cellulite were enrolled in a prospective, single-center, randomized, open-label Phase II study. The mean (± standard error of the mean) cellulite grade at baseline was 2.5±0.09 and mean BMI was 22.8±1.17. All patients were treated with radial extracorporeal shock waves using the Swiss DolorClast(®) device (Electro Medical Systems, S.A., Nyon, Switzerland). Patients were treated unilaterally with 2 weekly treatments for 4 weeks on a randomly selected side (left or right), totaling eight treatments on the selected side. Treatment was performed at 3.5-4.0 bar, with 15,000 impulses per session applied at 15 Hz. Impulses were homogeneously distributed over the posterior thigh and buttock area (resulting in 7,500 impulses per area). Treatment success was evaluated after the last treatment and 4 weeks later by clinical examination, photographic documentation, contact thermography, and patient satisfaction questionnaires. RESULTS The mean cellulite grade improved from 2.5±0.09 at baseline to 1.57±0.18 after the last treatment (ie, mean δ-1 was 0.93 cellulite grades) and 1.68±0.16 at follow-up (ie, mean δ-2 was 0.82 cellulite grades). Compared with baseline, no patient's condition worsened, the treatment was well tolerated, and no unwanted side effects were observed. No statistically significant (ie, P<0.05) correlation was found between individual values for δ-1 and δ-2 and cellulite grade at baseline, BMI, weight, height, or age. CONCLUSION Radial shock wave therapy is a safe and effective treatment option for cellulite. The individual clinical outcome cannot be predicted by the patient's individual cellulite grade at baseline, BMI, weight, height, or age.
Collapse
Affiliation(s)
| | - Maren C Kiessling
- Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nikolaus Bm Császár
- Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christoph Schmitz
- Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, Germany
| |
Collapse
|
26
|
Percussion circuits and brain function – A hypothesis. Med Hypotheses 2014; 82:595-600. [DOI: 10.1016/j.mehy.2014.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/28/2014] [Accepted: 02/16/2014] [Indexed: 11/23/2022]
|
27
|
Knobloch K, Joest B, Krämer R, Vogt PM. Cellulite and focused extracorporeal shockwave therapy for non-invasive body contouring: a randomized trial. Dermatol Ther (Heidelb) 2013; 3:143-55. [PMID: 24297647 PMCID: PMC3889306 DOI: 10.1007/s13555-013-0039-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Focused extracorporeal shockwave therapy (ESWT) has been demonstrated to improve wound healing and skin regeneration such as in burn wounds and scars. We hypothesized that the combination of focused ESWT and a daily gluteal muscle strength program is superior to SHAM-ESWT and gluteal muscle strength training in moderate to severe cellulite. METHODS This was a single-center, double-blinded, randomized-controlled trial. For allocation of participants, a 1:1 ratio randomization was performed using opaque envelopes for the concealment of allocation. Eligible patients were females aged 18-65 years with cellulite. The primary outcome parameter was the photo-numeric Cellulite Severity Scale (CSS) determined by two blinded, independent assessors. The intervention group (group A) received six sessions of focused ESWT (2,000 impulses, 0.35 mJ/mm(2), every 1-2 weeks) at both gluteal and thigh regions plus specific gluteal strength exercise training. The control group (group B) received six sessions of SHAM-ESWT plus specific gluteal strength exercise training. RESULTS The CSS in group A was 10.9 ± 3.8 (mean ± SE) before intervention and 8.3 ± 4.1 after 12 weeks (P = 0.001, 2.53 improvement, 95% confidence interval (CI) 1.43-3.62). The CSS in group B was 10.0 ± 3.8 before intervention and 10.1 ± 3.8 after 12 weeks (P = 0.876, 95% CI 1.1-0.97). The change of the CSS in group A versus group B was significantly different (P = 0.001, -24.3 effect size, 95% CI -36.5 to -12.1). CONCLUSION The combination of non-invasive, focused ESWT (0.35 mJ/mm(2), 2,000 impulses, 6 sessions) in combination with gluteal strength training was superior to gluteal strength training and SHAM-ESWT in moderate to severe cellulite in terms of the CSS in a 3-month perspective. Long-term results have to be evaluated in terms of the sustainability of these effects.
Collapse
|
28
|
Synergistic effects of cryolipolysis and shock waves for noninvasive body contouring. Aesthetic Plast Surg 2012; 36:666-79. [PMID: 22042359 DOI: 10.1007/s00266-011-9832-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 09/23/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND Excess body fat, localized adiposity, and cellulite represent important social problems. To date, techniques using radiofrequencies, cavitation and noncavitation ultrasound, and carbon dioxide have been studied as treatments for noninvasive body contouring. Ice-Shock Lipolysis is a new noninvasive procedure for reducing subcutaneous fat volume and fibrous cellulite in areas that normally would be treated by liposuction. It uses a combination of acoustic waves and cryolipolysis. Shock waves, used normally in the treatment of renal calculi and musculoskeletal disorders, are focused on the collagen structure of cellulite-afflicted skin. When used on the skin and underlying fat, they cause a remodeling of the collagen fibers, improving the orange-peel appearance typical of the condition. Cryolipolysis, on the other hand, is a noninvasive method used for the localized destruction of subcutaneous adipocytes, with no effects on lipid or liver marker levels in the bloodstream. The combination of the two procedures causes the programmed death and slow resorption of destroyed adipocytes. METHODS In this study, 50 patients with localized fat and cellulite were treated with a selective protocol for the simultaneous use of two transducers: a Freezing Probe for localized fatty tissue and a Shock Probe for fibrous cellulite. RESULTS The procedure significantly reduced the circumference in the treated areas, significantly diminishing fat thickness. The mean reduction in fat thickness after treatments was 3.02 cm. Circumference was reduced by a mean of 4.45 cm. Weight was unchanged during the treatment, and no adverse effects were observed. Histologic and immunohistochemical analysis confirmed a gradual reduction of fat tissue by programmed cell death. Moreover, the reduction in fat thickness was accompanied by a significant improvement in microcirculation, and thus, the cellulite. The safety of the method also has been highlighted because it is accompanied by no significant increase in serum liver enzymes or serum lipids. CONCLUSION The study aimed to observe the effects of the new technique in the treatment of localized fat associated with cellulite in order to assess adipose tissue alterations, cellular apoptosis, and levels of serum lipid or liver markers. The findings show that the action of Ice-Shock Lipolysis is a safe, effective, and well-tolerated noninvasive procedure for body contouring. In particular, the authors believe that this could be an ideal alternative to liposuction for patients who require only small or moderate amounts of adipose tissue and cellulite removal or are not suitable candidates for surgical approaches to body contouring.
Collapse
|
29
|
Huang F, Kuo HK, Hsieh CH, Wu PC, Wu YC, Wang CJ. Effect of extracorporeal shockwave treatment on the melanogenic activity of cultured melanocytes. Appl Biochem Biotechnol 2011; 166:632-9. [PMID: 22116672 DOI: 10.1007/s12010-011-9454-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 11/07/2011] [Indexed: 12/01/2022]
Abstract
In addition to the traditional lithotripsy treatment, extracorporeal shockwaves (ESWs) have been shown to be effective in the treatment of certain musculoskeletal disorders and in enhancing skin flap neovascularization. However, relatively little is known about its effect on melanocytes. To investigate its effect on the melanogenic activity of cultured melanocytes, mouse B16F10 melanocytes were treated with defocused ESWs of different energies (15, 21, and 27 kV) and at different doses (300 and 600 impulses). Cell viability was measured 1 and 24 h after treatment. Melanin content was measured and compared against a standard curve generated with fungal melanin. Cellular tyrosinase activity was calculated with the 3,4-dihydroxyphenylalanine (DOPA) oxidase assay. The results demonstrated that ESW treatment reduced cell viability. Our results also indicated that the overall decrease in cell viability lasted for 6 days. After ESW treatment with 300 or 600 impulses at 21 kV, no significant change in melanin content or tyrosinase activity of the B16F10 melanocytes was noted as compared to those of the control. The present study suggests that ESW treatment does not alter the melanogenic activity of the cultured melanocytes.
Collapse
Affiliation(s)
- Faye Huang
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, No. 123, Ta-Pei Road, Niao-Sung District, Kaohsiung, Taiwan
| | | | | | | | | | | |
Collapse
|
30
|
Knobloch K, Joest B, Vogt PM. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009)--a randomized trial. BMC WOMENS HEALTH 2010; 10:29. [PMID: 20977764 PMCID: PMC2987889 DOI: 10.1186/1472-6874-10-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 10/26/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cellulite is a widespread problem involving females' buttocks and thighs based on the female specific anatomy. Given the higher number of fat cells stored in female fatty tissue in contrast to males, and the aging process of connective tissue leads to an imbalance between lipogenesis and lipolysis with subsequent large fat cells bulging the skin. In addition, microcirculatory changes have been suggested, however remain largely unknown in a controlled clinical setting. We hypothesize that the combination of extracorporeal shockwave and a daily gluteal muscle strength program is superior to the gluteal muscle strength program alone in cellulite. METHODS/DESIGN STUDY DESIGN Randomized-controlled trial. IRB approval was granted at Hannover Medical School, Germany on May 22, 2009. For allocation of participants, a 1:1 ratio randomization was performed using opaque envelopes for the concealment of allocation. Reporting: according to CONSORT 2010. Eligible patients were females aged 18 or over and 65 or younger with cellulite with documented cellulite 1°-4° according to the Nürnberger score. Exclusion criteria were suspected or evident pregnancy, no cellulite, no informed consent or age under 18 years or above 65 years. Patients were recruited by advertisements in local regional newspapers and via the Internet. ANALYSIS Intention-to-treat. OUTCOME PARAMETERS a) Photonumeric severity scale, b) Nürnberger Score, c) circumference measurements, d) capillary blood flow, e) tissue oxygen saturation, f) postcapillary venous blood flow. Intervention group: Six sessions of extracorporeal focused shock wave for six sessions (2000 impulses, 0,25 mJ/m2 every 1-2 weeks) at both gluteal and thigh regions plus a specific gluteal strength exercise training. CONTROL GROUP Six sessions of sham extracorporeal focused shock wave for six sessions (2000 impulses, 0,01 mJ/m2 every 1-2 weeks) at both gluteal and thigh regions plus a specific gluteal strength exercise training. FOLLOW-UP 12 weeks. Blinding was achieved for all participants enrolled in the trial, the photograph taking the digital images for the primary outcome measure, the two assessors of the outcome measures, all additional health care providers and for the analyst from the biometrical department. Only one researcher (BJ) was aware of the group assignment performing the randomisation and the extracorporeal shock wave therapy. DISCUSSION This randomised-controlled trial will provide much needed evidence on the clinical effectiveness of focused extracorporal shock wave therapy as an adjunct to gluteal strength training in females suffering cellulite.
Collapse
Affiliation(s)
- Karsten Knobloch
- Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Germany.
| | | | | |
Collapse
|
31
|
|
32
|
Angehrn F, Kuhn C, Sonnabend O, Voss A. Extracorporeal shock waves as curative therapy for varicose veins? Clin Interv Aging 2008; 3:175-82. [PMID: 18488887 PMCID: PMC2544363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
In this prospective design study the effects of low-energy partially focused extracorporeal generated shock waves (ESW) onto a subcutaneous located varicose vein - left vena saphena magna (VSM)- are investigated. The treatment consisted of 4 ESW applications within 21 days. The varicose VSM of both sides were removed by surgery, and samples analyzed comparing the treated and untreated by means of histopathology. No damage to the treated varicose vein in particular and no mechanical destruction to the varicose vein's wall could be demonstrated. However, an induction of neo-collagenogenesis was observed. The thickness of the varicose vein's wall increased. Optimization of critical application parameters by investigating a larger number of patients may turn ESW into a non-invasive curative varicose treatment.
Collapse
Affiliation(s)
| | | | | | - Axel Voss
- SwiTech Medical AGKreuzlingen, Switzerland
| |
Collapse
|