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Abo Elyazed TI, Al-Azab IM, Abd El-Hakim AAEM, Elkady SM, Afifi RMM, Obaya HE. Effect of high-intensity laser therapy versus shockwave therapy on selected outcome measures in osteoporotic long-term hemiparetic patients: a randomized control trial. J Orthop Surg Res 2023; 18:653. [PMID: 37660042 PMCID: PMC10475189 DOI: 10.1186/s13018-023-04141-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/26/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND This study aimed to compare the effects of high-intensity laser therapy (HILT) and extracorporeal shock wave therapy (ESWT) in treating consequences of osteoporosis in hemiparetic patients. METHODS A randomized controlled trial was conducted on hemiplegic patients with osteoporosis. They were randomly classified into three equal groups (n = 40 in each group). The control group received medication and traditional physiotherapy programs for stroke patients. The high-intensity laser (HIL) group received the same intervention as the control group in addition to high-intensity laser therapy. The shock wave (SW) group received the same intervention as the control group in addition to shock wave therapy. The three groups received an intervention that lasted 3 sessions/week for 12 weeks). All groups were assessed before and after therapy for the degree of pain, fall risk, and quality of life. RESULTS A statistically significant difference (p < 0.05) was found concerning VAS, which had a significant difference in favor of HILT and ESWT groups compared to the control group; however, no significant difference was determined between HIL and SW groups. Regarding the overall stability index, SFBBS, and QUALEFFO-41, there was a significant difference in favor of HIL and SW groups compared to the control group, and a significant difference was found in HIL when compared to SW. CONCLUSION The current study indicates that the combined traditional physical therapy and HILT and ESWT have clinical significance in improving osteoporotic long-term hemiparetic patients with more favor to HILT. TRIAL REGISTRATION The study was registered as a clinical trial at ClinicalTrial.gov ID (NCT05616611).
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Affiliation(s)
- Tamer I Abo Elyazed
- Department of Physical Therapy for Internal Medicine, Faculty of Physical Therapy, Beni-Suef University, Beni Suef, Egypt.
| | - Islam M Al-Azab
- Department of Physical Therapy for Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, October 6th University, Giza, Egypt
| | | | - Sabah Mohamed Elkady
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Hany Ezzat Obaya
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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2
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Arora NK, Sharma S, Sharma S, Arora IK. Physical modalities with eccentric exercise are no better than eccentric exercise alone in the treatment of chronic achilles tendinopathy: A systematic review and meta-analysis. Foot (Edinb) 2022; 53:101927. [PMID: 36037777 DOI: 10.1016/j.foot.2022.101927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To investigate the available evidence and conduct a systematic review with meta-analysis to determine the effectiveness of physical modalities combined with eccentric exercise (PMEE) with eccentric exercise (EE) alone for improvements in pain and function in individuals with chronic Achilles tendinopathy (AT) at short-term (4 weeks) and long-term (12-16 weeks) follow-ups. MATERIALS AND METHODS A systematic literature review identified 8 papers (from 6404 possible inclusions) that allowed the comparison of PMEE with EE alone, in the treatment of chronic AT. We extracted the mean and standard deviations for Victorian Institute of Sports Assessment Achilles Tendinopathy (VISA-A), Numerical Pain Rating Scale (NPRS), and load-induced pain (NRS). Standardized mean difference (SMD) of the included variables was presented, and all the studies had low risk of bias. RESULTS Non-significant results were achieved for short-term (pooled SMD = 0.03; 95% CI= -0.46 to 0.53, p = 0.89, I2 = 60%) and long- term follow-ups (pooled SMD =0.43; 95% CI= -0.05 to 0.92, p = 0.08, I2 = 82%) of VISA-A. Short-term (pooled SMD = -0.16; 95% CI= -0.72 to 0.40, p = 0.57, I2 = 40%) and long-term (pooled SMD = -0.39;95% CI= -1.11 to 0.32, p = 0.28, I2 = 62%) follow-up analysis of NPRS and long-term(pooled SMD = -0.46; 95% CI= -1.08 to 0.15, p = 0.14, I2 = 74%) follow-up of load induced pain also demonstrated non-significant improvements when comparing two groups. CONCLUSION Meta- analysis of the results published in the 8 papers that met theinclusion criteria showed no significant differences between PMEE and EE, in terms of load-induced pain (NRS) and numerical pain rating scales (NPRS) at 4 and 12-16 weeks. Thus, the meta-analysis reflects the other cited published work that PMEE shows no greater advantage than EE in the treatment of Chronic Achilles Tendinopathy.
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Affiliation(s)
- Nitin Kumar Arora
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India; Hochschule fur Gesundheit Bochum, 44801, Germany
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India.
| | - Shalini Sharma
- Department of Physiotherapy, Geri Care Home, Melbourne, Victoria, Australia
| | - Ishant Kumar Arora
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India
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3
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Samitier Pastor CB, Climent Barbera JM, Cutillas Ruiz R, Formigo Couceiro J, Vázquez Doce A. [Clinical practice guideline for the treatment of spasticity: Consensus and algorithms]. Rehabilitacion (Madr) 2022; 56:204-214. [PMID: 35428487 DOI: 10.1016/j.rh.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/23/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
Spasticity is a complex phenomenon of extremely variable clinical expression, a dynamic and evolutionary process that can condition the activity and treatment of the patient. The current recommendation for early treatment aims to avoid progression and complications, and involves an individualized approach based on a wide range of pharmacological and non-pharmacological measures. This guide results from a forum of expert specialists who faced some frequent uncertainties in the assessment process and therapeutic approach of the spastic patient such as the suitability of initiating treatment, considerations for initiating, continuing and ceasing treatment with botulinum toxin, adjuvant treatments, pain or follow-up. The result is one algorithm of decision for the therapeutic approach of spasticity. Both scientific progress and the exchange of clinical experience on which this guide is based, can support decision-making on some areas of gloom that we find in daily practice.
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Affiliation(s)
- C B Samitier Pastor
- Servicio de Rehabilitación, Hospital Asepeyo, Sant Cugat, Sant Cugat del Vallés, Barcelona, España.
| | - J M Climent Barbera
- Servicio de Rehabilitación, Hospital General Universitario de Alicante, Alicante, España
| | - R Cutillas Ruiz
- Servicio de Rehabilitación, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - J Formigo Couceiro
- Servicio de Rehabilitación, Complexo Hospitalario Universitario A Coruña, A Coruña, España
| | - A Vázquez Doce
- Servicio de Medicina Física y Rehabilitación, Hospital Universitario de La Princesa, Madrid, España
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4
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Verstraelen F, Verhagen S, Giesberts A, Bonneux I, Koot H, Boer WD, van der Steen M. Needle aspiration of calcific deposits versus shock wave therapy for conservative therapy resistant calcifying tendinitis of the shoulder: protocol of a randomized, controlled trial. BMC Musculoskelet Disord 2022; 23:308. [PMID: 35361169 PMCID: PMC8968770 DOI: 10.1186/s12891-022-05259-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Calcific tendinitis of the shoulder (CT) is a common disorder with a large disease burden. The initial treatment is with conservative measures. However, when this fails the next step treatment remains unclear. Minimal invasive treatment modalities have emerged. Needle aspiration of the calcific deposits (NACD) and extracorporeal shock wave therapy (ESWT) have both shown good clinical results. Nonetheless, in the current orthopedic literature there are not any studies available that compare both the effectiveness and cost-effectiveness of those two treatment modalities. Therefore, our primary objective is to compare the effectiveness of NACD to ESWT. A secondary objective is to compare the cost-effectiveness of both treatment modalities and workability. METHODS Following a power calculation using the minimal clinical important difference of our primary outcome (Constant-Murley score, CMS) 140 patients will be included in the study. Enrolment is based upon strict inclusion/ exclusion criteria outlined in the Methods section. Participants will be randomized by computer in two groups (e.g. 70 patients will receive NACD and 70 patients will receive ESWT). The NACD treatment will consist of a sonographically guided removal of the calcific deposits and the ESWT treatment will be a focused ESWT. Both treatments will be conducted according to a standardized protocol, as part of care as usual in our hospital. The primary outcome will be the between group differences in functional outcome (measured with the CMS) between baseline and after 12 months follow-up. Secondary outcomes will be questionnaires regarding the clinical outcome (SST) and quality of life (EQ-5D-5L). Furthermore, NRS pain and cost related questionnaires (iPCQ and ProDisQ) will be collected during follow-up after two months, six months and at final follow-up after 12 months. DISCUSSION This study will provide more insight regarding treatment for conservative therapy resistant calcific tendinitis of the shoulder by comparing NACD to focused ESWT, which will aid the physician and patient in determining the appropriate treatment plan. TRIAL REGISTRATION Dutch trial register: NTR7093 registered on 11 March 2018.
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Affiliation(s)
- Freek Verstraelen
- Department of Orthopaedic Surgery & Trauma, Máxima MC, PO box 5600 PD, Eindhoven, the Netherlands.
| | - Stéphanie Verhagen
- Department of Orthopaedic Surgery & Trauma, Máxima MC, PO box 5600 PD, Eindhoven, the Netherlands
| | - Anouk Giesberts
- Department of Orthopaedic Surgery & Trauma, Máxima MC, PO box 5600 PD, Eindhoven, the Netherlands
| | | | - Henk Koot
- Department of Orthopaedic Surgery & Trauma, Máxima MC, PO box 5600 PD, Eindhoven, the Netherlands
| | - Willem den Boer
- Department of Orthopaedic Surgery & Trauma, Máxima MC, PO box 5600 PD, Eindhoven, the Netherlands
| | - Marieke van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima MC, PO box 5600 PD, Eindhoven, the Netherlands.,Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, PO box 1350, 5602 ZA, Eindhoven, The Netherlands
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Kudo N. Shock wave lithotripsy and therapy. J Med Ultrason (2001) 2022:10.1007/s10396-022-01202-w. [PMID: 35347482 DOI: 10.1007/s10396-022-01202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/28/2022] [Indexed: 10/18/2022]
Abstract
The biological effects of ultrasound exposure are classified into thermal and mechanical effects. The medical application of shock waves has been explored widely as a technique that exerts a mechanical effect with no thermal effect on the living body. The application of shock waves started in urology as a method to disintegrate calculi by impulsive force. During widespread use in urology, it was confirmed that shock waves could also induce some changes in the bones and soft tissues located in the propagation path, and application of shock waves in the field of orthopedics is currently under intensive investigation. In this brief review, we first discuss the similarities of and differences between shock waves and ultrasound. The characteristics of shock wave sources used to generate therapeutic shock waves are then described, and the mechanisms by which shock waves induce stone fragmentation and other therapeutic effects are discussed.
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Affiliation(s)
- Nobuki Kudo
- Faculty of Information Science and Technology, Hokkaido University, N14W9, Kita-ku, Sapporo, 060-0814, Japan.
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6
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Choi MJ, Lee JY, Park EJ. First report on the persist time of the free radical produced by shock wave pulses employed in clinical ESWL. Ultrason Sonochem 2022; 83:105927. [PMID: 35081507 PMCID: PMC8790656 DOI: 10.1016/j.ultsonch.2022.105927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
The shock wave used in extracorporeal shock wave lithotripsy (ESWL) induces strong cavitation and generates a large amount of free radicals (FR). In order to evaluate the harmfulness of FR in the ESWL, information on the incidence and persist time of FR caused by shock waves is required. FR markers can estimate the amount of FR generated, but not how long the FRs will survive. The OH* FR generated by the ESWL shock wave reacts with luminol and emits blue light, which is called sonochemical luminescence (SCL) phenomenon. In this study, FR generation and persist time were measured by recording SCL phenomenon with a sensitive photomultiplier tube (PMT) that responds in nanoseconds. As a result of measurement with the PMT, when the electromagnetic shock wave used in clinical practice was irradiated to the luminol solution, the amount of light emitted per unit time reached its maximum value within a very short time (< ∼600us) and then exponentially decreased for a long time (∼several hundred ms). The measured FR persist time reaches a maximum of 1000 ms. As the output setting of the shock wave generator increases, the minimum or average FR persist time increases, but the maximum value does not show a high correlation with the output setting. The amount of generated FR shows a very high correlation with the shock wave setting, and when the setting is changed from low to high, it increases very sensitively, rapidly and non-linearly. In order to reduce the risk of FR in patient treatment using lithotripsy, the output setting of the shock wave should be minimized, and the interval between the shock wave pulses should be sufficiently larger than the FR persist time. Therefore, it is recommended to avoid increasing the output setting and setting the shock wave irradiation frequency below 1 Hz to shorten the treatment time in clinical practice. For the purpose of formulating these recommendations, additional studies on the generation and persist time of FR depending on the shock wave generation method and set conditions in living tissue or similar environment are required in the future.
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Affiliation(s)
- Min Joo Choi
- Department of Medicine, College of Medicine, Jeju National University, Jeju, Korea; Interdisciplinary Postgraduate Program in Biomedical Engineering, Jeju National University, Jeju, Korea
| | - Jae-Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea; Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Joo Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
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7
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Wheeler PC. Novel interventions for recalcitrant patella tendinopathy: Results may favour autologous blood injection (ABI) over radial-extra-corporeal shockwave therapy (r-ESWT) - A prospective cohort study. J Clin Orthop Trauma 2022; 26:101781. [PMID: 35211372 PMCID: PMC8851283 DOI: 10.1016/j.jcot.2022.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Patella tendinopathy is a common condition in a number of sports and can have a significant impact on activity and quality of life. Whilst rehabilitation leads to improvements in the majority of cases, a number of adjunct treatments are available for resistant cases with limited evidence supporting the use of one treatment over another.Hypothesis/Purpose: To compare the outcomes for patients with chronic patella tendinopathy, following either radial-Extra-Corporeal Shockwave Therapy (r-ESWT) or Autologous Blood Injection (ABI). STUDY DESIGN Prospective cohort study. METHODS 28 consecutive patients with chronic patella tendinopathy, treated with radial-ESWT (n = 14) or ABI (n = 14), with minimum three-month follow-up. Mean age 34.2 years, mean duration of symptoms 32.8 months. Patients received either three sessions of radial-Extra-Corporeal Shockwave Therapy (one session per week for 3 weeks), or two ultrasound-guided Autologous Blood Injections (2 injections performed 2-4 weeks apart). All patients received standardised after-care, including continuation of a structured home exercise programme of flexibility and progressive loading (eccentric strengthening) exercises. Main Outcome Measures were Victoria Institute of Sport - Patella questionnaire (VISA-P), plus 0-10 Visual Analogue Scale (VAS) for self-reported levels of "average pain". RESULTS There were statistically significant improvements in self-reported measures of pain/function following either procedure at 6-weeks and at 3-months, but only in the ABI group at 6-months. At 3-months: VISA-P was improved from 32.4% ± 11.7%-60.0% ± 20.7% (p < 0.01) in the ABI group, and from 34.2% ± 14.6%-48.9% ± 17.8% (p < 0.001) in the r-ESWT group. CONCLUSIONS Patients with chronic patella tendinopathy improved at 6-weeks and 3-months following either ABI or r-ESWT procedure, with significant benefits at 6-months seen only in the ABI group. Between group analysis demonstrated improved outcomes favouring ABI compared to r-ESWT at the 6-month timepoint using VISA-P, and at all time-points using VAS as outcome measures. The small sample sizes in this pragmatic study are however noted, which limit interpretation, and larger more robust studies are required to investigate this further. This pragmatic prospective cohort study demonstrates improvements following either r-ESWT or ABI procedures, with results potentially favouring ABI over r-ESWT for patients with chronic patella tendinopathy.
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Affiliation(s)
- Patrick C. Wheeler
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK,National Centre for Sport and Exercise Medicine, Loughborough, UK,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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8
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Xie Y, Zhang C, Liang B, Wang J, Wang L, Wan T, Xu F, Lei L. Effects of shock wave therapy in patients with carpal tunnel syndrome: a systematic review and meta-analysis. Disabil Rehabil 2022; 44:177-188. [PMID: 32419508 DOI: 10.1080/09638288.2020.1762769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To determine whether shock wave therapy could improve symptoms and hand function in patients with carpal tunnel syndrome. MATERIALS AND METHODS Medline, Embase, Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, OpenGrey, CNKI, VIP, Wang Fang databases, and China Biological Medicine were searched, from inception to December 2019. RESULTS Ten trials involving 433 patients (501 wrists) were included in this systematic review. The shock wave therapy was observed to have a significant effect on pain relief (MD: -0.60, 95% CI: -1.16 to -0.05, p = 0.03), syndrome alleviation (MD: -2.26, 95% CI: -3.24 to -1.27, p < 0.00001) and functional recovery (MD: -1.25 95% CI: -2.08 to -0.43, p = 0.003) among the carpal tunnel syndrome patients. As revealed by the subgroup analysis, radial shock wave therapy made a significant difference in pain relief, syndrome alleviation, and functional recovery (p < 0.05). Focused shock wave had no significant effect on pain relief, syndrome alleviation, and functional recovery (p > 0.05). CONCLUSION Shock wave therapy could be conductive to improve syndrome and hand function for carpal tunnel syndrome patients.Implications for rehabilitationShock wave therapy is beneficial for alleviating syndrome and improving hand function of carpal tunnel syndrome patients.Radial shock wave therapy seems superior to focused shock wave therapy on syndrome alleviation and functional recovery of hand in carpal tunnel syndrome patients.
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Affiliation(s)
- Yujie Xie
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Chi Zhang
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Bin Liang
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Jianxiong Wang
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Li Wang
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Tenggang Wan
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Fangyuan Xu
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
| | - Lei Lei
- Rehabilitation Medicine Department, The Affiliated Hospital Of Southwest Medical University, Luzhou, People's Republic of China.,Rehabilitation Medicine Department, Southwest Medical University, Luzhou, People's Republic of China
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9
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Häußer J, Wieber J, Catalá-Lehnen P. The use of extracorporeal shock wave therapy for the treatment of bone marrow oedema - a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:369. [PMID: 34107978 PMCID: PMC8188716 DOI: 10.1186/s13018-021-02484-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Extracorporeal shock wave therapy (ESWT) has been used for various pathologies associated with bone marrow oedema (BME). However, it is still not clear whether ESWT may be favourable in the treatment of BME. Therefore, the aim of this systematic review was to assess the efficacy of ESWT for the treatment of BME. METHODS MEDLINE was searched for relevant literature with no time constraints. Both randomized and non-randomized trials were included. Case reports and conference abstracts were excluded. Titles and abstracts were screened and full-text articles of included studies were retrieved. Data on the effect of ESWT on pain, function, and the BME area on magnet resonance imaging were extracted. RESULTS Pain, function, and magnet resonance imaging results all improved across the studies - regardless of whether it was a randomized or non-randomized study. This effect was consistent across multiple pathologies such as osteonecrosis of the femoral head, BME associated with knee osteoarthritis, Kienböck's disease, and osteitis pubis. The meta-analysis showed that pain (after 1 month: weighted mean difference (WMD) = - 2.23, 95% CI - 2.58 to - 1.88, P < 0.0001; after 3-6 month: WMD = - 1.72, 95% CI - 2.52 to - 0.92, P < 0.00001) and function (after 1 month: WMD = - 1.59, 95% CI - 2.04 to - 1.14, P < 0.0001; after 3-6 month: WMD = - 2.06, 95% CI - 3.16 to - 0.96, P = 0.0002; after ≥ 12 month: WMD = - 1.20, 95% CI - 1.83 to - 0.56, P = 0.0002) was reduced in terms of ESWT treatment compared to a control group. CONCLUSIONS Based on the available evidence, ESWT may be an adequate option for conservative therapy in pathologies involving BME. TRIAL REGISTRATION PROSPERO, CRD42021201719 . Registered 23 December 2020.
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Affiliation(s)
- Jonathan Häußer
- LANS Medicum Hamburg — Center for Sports and Regenerative Medicine, Stephansplatz 5, 20354 Hamburg, Germany
| | - Juliane Wieber
- LANS Medicum Hamburg — Center for Sports and Regenerative Medicine, Stephansplatz 5, 20354 Hamburg, Germany
- LANS Medicum Hamburg — Center for Sports and Regenerative Medicine, Hohe Bleichen 24/26, 20354 Hamburg, Germany
| | - Philip Catalá-Lehnen
- LANS Medicum Hamburg — Center for Sports and Regenerative Medicine, Stephansplatz 5, 20354 Hamburg, Germany
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10
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Gollmann-Tepeköylü C, Pölzl L, Graber M, Hirsch J, Nägele F, Lobenwein D, Hess MW, Blumer MJ, Kirchmair E, Zipperle J, Hromada C, Mühleder S, Hackl H, Hermann M, Al Khamisi H, Förster M, Lichtenauer M, Mittermayr R, Paulus P, Fritsch H, Bonaros N, Kirchmair R, Sluijter JPG, Davidson S, Grimm M, Holfeld J. miR-19a-3p containing exosomes improve function of ischaemic myocardium upon shock wave therapy. Cardiovasc Res 2021; 116:1226-1236. [PMID: 31410448 DOI: 10.1093/cvr/cvz209] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/28/2019] [Accepted: 08/12/2009] [Indexed: 12/27/2022] Open
Abstract
AIMS As many current approaches for heart regeneration exert unfavourable side effects, the induction of endogenous repair mechanisms in ischaemic heart disease is of particular interest. Recently, exosomes carrying angiogenic miRNAs have been described to improve heart function. However, it remains challenging to stimulate specific release of reparative exosomes in ischaemic myocardium. In the present study, we sought to test the hypothesis that the physical stimulus of shock wave therapy (SWT) causes the release of exosomes. We aimed to substantiate the pro-angiogenic impact of the released factors, to identify the nature of their cargo, and to test their efficacy in vivo supporting regeneration and recovery after myocardial ischaemia. METHODS AND RESULTS Mechanical stimulation of ischaemic muscle via SWT caused extracellular vesicle (EV) release from endothelial cells both in vitro and in vivo. Characterization of EVs via electron microscopy, nanoparticle tracking analysis and flow cytometry revealed specific exosome morphology and size with the presence of exosome markers CD9, CD81, and CD63. Exosomes exhibited angiogenic properties activating protein kinase b (Akt) and extracellular-signal regulated kinase (ERK) resulting in enhanced endothelial tube formation and proliferation. A miRNA array and transcriptome analysis via next-generation sequencing were performed to specify exosome content. miR-19a-3p was identified as responsible cargo, antimir-19a-3p antagonized angiogenic exosome effects. Exosomes and target miRNA were injected intramyocardially in mice after left anterior descending artery ligation. Exosomes resulted in improved vascularization, decreased myocardial fibrosis, and increased left ventricular ejection fraction as shown by transthoracic echocardiography. CONCLUSION The mechanical stimulus of SWT causes release of angiogenic exosomes. miR-19a-3p is the vesicular cargo responsible for the observed effects. Released exosomes induce angiogenesis, decrease myocardial fibrosis, and improve left ventricular function after myocardial ischaemia. Exosome release via SWT could develop an innovative approach for the regeneration of ischaemic myocardium.
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Affiliation(s)
- Can Gollmann-Tepeköylü
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Michael Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Felix Nägele
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Daniela Lobenwein
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael W Hess
- Division of Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael J Blumer
- Division of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Kirchmair
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Johannes Zipperle
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Center, Vienna, Austria
| | - Carina Hromada
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Center, Vienna, Austria
| | - Severin Mühleder
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Center, Vienna, Austria
| | - Hubert Hackl
- Division of Bioinformatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hermann
- Department of Anesthesiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hemse Al Khamisi
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martin Förster
- Department of Cardiology, Pneumology and Angiology, Friedrich-Schiller-University Jena, Jena, Germany
| | - Michael Lichtenauer
- Department of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Rainer Mittermayr
- Austrian Cluster for Tissue Regeneration, Vienna, Austria.,AUVA Trauma Center Meidling, Vienna, Austria
| | - Patrick Paulus
- Department of Anesthesiology and Operative Intensive Care Medicine, Kepler University Hospital Linz, Linz, Austria
| | - Helga Fritsch
- Division of Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Rudolf Kirchmair
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Joost P G Sluijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sean Davidson
- Hatter Cardiovascular Institute, University College London, London, UK
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
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11
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Veser J, Jahrreiss V, Seitz C, Özsoy M. The effect of focus size and intensity on stone fragmentation in SWL on a piezoelectric lithotripter. World J Urol 2020; 38:2645-2650. [PMID: 31925550 PMCID: PMC7508739 DOI: 10.1007/s00345-019-03069-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose We aim to analyze the efficacy of different focus sizes and the influence of pulse pressure (intensity) during shock wave lithotripsy (SWL) in terms of stone fragmentation. Methods Combination of three focal sizes (F1 = 2 mm, F2 = 4 mm, F3 = 8 mm) and 11 output pressure settings (intensity 10–20) of a piezoelectric lithotripter (Wolf PiezoLith 3000) were tested on artificial stones (n = 99). The stones were placed within a 2 mm mesh cage. The needed number of shockwaves (SW) to first visible crack, 50% and 100% stone disintegration were recorded. Results Similar number of SW’s were observed until the first crack 10, 11 and 11 SW’s for F1, F2, and F3, respectively (p > 0,05). The median number of SW needed for 50% stone disintegration was 245 for F1 group, 242 for F2 group and 656 for F3 group. F1 vs F2 p = 0.7, F1 vs F3 and F2 vs F3 p < 0.05. Similarly, with larger focus size a higher number of shockwaves were necessary for 100% stone disintegration. 894, 877 and 1708 SW’s for F1, F2 and F3, respectively. Only for F1 vs F3 and F2 vs F3 (all p < 0.05) a statistical difference was observed. These findings were consistent in all different power settings, with an increased difference in lower power levels (≤ 14). Conclusions A smaller focus size, as well as a higher peak pressure results in a more effective stone fragmentation. However, these results need to be confirmed in an in vivo setting with multiple parameters interfering the efficacy, like BMI, respiration or stone migration.
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Affiliation(s)
- Julian Veser
- Department of Urology, Comprehensive Cancer Center, Medical Vienna General Hospital, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Victoria Jahrreiss
- Department of Urology, Comprehensive Cancer Center, Medical Vienna General Hospital, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical Vienna General Hospital, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Mehmet Özsoy
- Department of Urology, Comprehensive Cancer Center, Medical Vienna General Hospital, University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Karl Landsteiner SocietyUrology and Andrology, Vienna, Austria.
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12
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Everding J, Freistühler M, Stolberg-Stolberg J, Raschke MJ, Garcia P. [Extracorporal shock wave therapy for the treatment of pseudarthrosis : New experiences with an old technology]. Unfallchirurg 2019; 120:969-978. [PMID: 27638552 DOI: 10.1007/s00113-016-0238-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Between 5 and 10 % of all fractures show disturbed healing or nonunion formation. Extracorporeal shock wave therapy (ESWT) has been described as a non-surgical treatment option. Even though the outcome has shown promising results, the procedure is not commonly used in clinical practice. The purpose of this study was to analyze the union rate of pseudarthrosis and the cost savings after ESWT. METHODS In this study 42 nonunions were treated with shock waves (LithSpaceOrtho, JenaMedtech). The follow up examinations were performed over a period of six months. Outcome measurement included radiological fracture union and pain (VAS). The study group contained 39 pseudarthrosis in the six-week follow-up (93 %), 41 after three months (98 %) and 41 after six months (98 %). RESULTS After six weeks, 13 % of patients showed fracture union. After three months 61 % and after six months 73 % of the fractures were completely healed. The fracture healing was significantly lower in older nonunions. All patients presented significantly lower pain levels six weeks after ESWT. Shock wave treatment of all 42 pseudarthrosis made up less than one quarter of the overall operative costs. CONCLUSION We established the ESWT as an important treatment option for fracture nonunion in our clinic. Considering the selection of patients in this study with a high mean time from injury to ESWT and multiple prior operations, the fracture healing rate of 73 % after ESWT is comparable with operative healing rates of nonunions. Further prospective, randomized and controlled studies are needed to show the effectiveness of ESWT in the treatment of nonunions on a higher level of evidence and to identify pseudarthrosis that particularly responds to the EWST.
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Affiliation(s)
- J Everding
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland.
| | - M Freistühler
- Medizinisches Management, Medizincontrolling, Universitätsklinikum Münster, Münster, Deutschland
| | - J Stolberg-Stolberg
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - M J Raschke
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - P Garcia
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
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13
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Mattyasovszky SG, Langendorf EK, Ritz U, Schmitz C, Schmidtmann I, Nowak TE, Wagner D, Hofmann A, Rommens PM, Drees P. Exposure to radial extracorporeal shock waves modulates viability and gene expression of human skeletal muscle cells: a controlled in vitro study. J Orthop Surg Res 2018; 13:75. [PMID: 29625618 PMCID: PMC5889540 DOI: 10.1186/s13018-018-0779-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/23/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Recent clinical and animal studies have shown that extracorporeal shock wave therapy has a promoting influence on the healing process of musculoskeletal disorders. However, the underlying biological effects of extracorporeal shock wave therapy on human skeletal muscle cells have not yet been investigated. METHODS In this study, we investigated human skeletal muscle cells after exposure to radial extracorporeal shock waves in a standardized in vitro setup. Cells were isolated from muscle specimens taken from adult patients undergoing spine surgery. Primary muscle cells were exposed once or twice to radial extracorporeal shock waves in vitro with different energy flux densities. Cell viability and gene expression of the paired box protein 7 (Pax7), neural cell adhesion molecule (NCAM), and myogenic factor 5 (Myf5) and MyoD as muscle cell markers were compared to non-treated muscle cells that served as controls. RESULTS Isolated muscle cells were positive for the hallmark protein of satellite cells, Pax7, as well as for the muscle cell markers NCAM, MyoD, and Myf5. Exposure to radial extracorporeal shock waves at low energy flux densities enhanced cell viability, whereas higher energy flux densities had no further significant impact. Gene expression analyses of muscle specific genes (Pax7, NCAM, Myf5, and MyoD) demonstrated a significant increase after single exposure to the highest EFD (4 bar, 0.19 mJ/mm2) and after double exposure with the medium EFDs (2 and 3 bar; 0.09 and 0.14 mJ/mm2, respectively). Double exposure of the highest EFD, however, results in a significant down-regulation when compared to single exposure with this EFD. CONCLUSIONS This is the first study demonstrating that radial extracorporal shock wave therapy has the potential to modulate the biological function of human skeletal muscle cells. Based on our experimental findings, we hypothesize that radial extracorporal shock wave therapy could be a promising therapeutic modality to improve the healing process of sports-related structural muscle injuries.
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Affiliation(s)
- Stefan G Mattyasovszky
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Eva K Langendorf
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ulrike Ritz
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christoph Schmitz
- Extracorporeal Shock Wave Research Unit, Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Irene Schmidtmann
- Institue for Medical Biometry, Epidemiology and Computer Science, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Tobias E Nowak
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Daniel Wagner
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Alexander Hofmann
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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14
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Takakuwa Y, Sarai M, Kawai H, Yamada A, Shiino K, Takada K, Nagahara Y, Miyagi M, Motoyama S, Toyama H, Ozaki Y. Extracorporeal Shock Wave Therapy for Coronary Artery Disease: Relationship of Symptom Amelioration and Ischemia Improvement. Asia Ocean J Nucl Med Biol 2018; 6:1-9. [PMID: 29333461 PMCID: PMC5765327 DOI: 10.22038/aojnmb.2017.9899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective(s): The current management of coronary artery disease (CAD) relies on three major therapeutic options, namely medication, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). However, severe CAD that is not indicated for PCI or CABG still bears a poor prognosis due to the lack of effective treatments. In 2006, extracorporeal cardiac shock wave (SW) therapy reported on human for the first time. This treatment resulted in better myocardial perfusion as evaluated by dipyridamole stress thallium scintigraphy, angina symptoms, and exercise tolerance. The aim of the present study was to investigate: myocardial perfusion images and evaluate the relationship between the ischemia improvement and symptom amelioration by SW therapy. Methods: We treated ten patients (i.e., nine males and one female) with cardiac SW therapy who had CAD but not indicated for PCI or CABG and aged 63–89 years old. After the SW therapy, all patients were followed up for three months to evaluate any amelioration of the myocardial ischemia based on symptoms, adenosine stress thallium scintigraphy, transthoracic echocardiography, and blood biochemical examinations. Results: The changes in various parameters were evaluated before and after cardiac SW therapy. The cardiac SW therapy resulted in a significant improvement in the symptoms as evaluated by the Canadian Cardiovascular Society [CCS] class score (P=0.016) and a tendency to improve in summed stress score (SSS) (P=0.068). However, no significant improvement was observed in the summed rest score (SRS), summed difference score (SDS), left ventricular wall motion score index (LVWMSI), N-terminal pro-brain natriuretic, and troponin I. The difference of CCS class score (ΔCCS) was significantly correlated with those of SSS (ΔSSS) and SDS (ΔSDS) (r=0.69, P=0.028 and r=0.70, P=0.025, respectively). There was no significant correlation between ΔCCS and other parameters. Furthermore, no significant difference was observed between the CCS improved and non-improved groups in terms of the baseline characteristics. Conclusion: The current study demonstrated the potential efficacy and safety of Cardiac SW therapy in CAD patients. As the findings indicated, symptom amelioration was associated with ischemia improvement by extracorporeal shock wave therapy for the CAD patients.
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Affiliation(s)
- Youko Takakuwa
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hideki Kawai
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Akira Yamada
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kenji Shiino
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kayoko Takada
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yasuomi Nagahara
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Meiko Miyagi
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Sadako Motoyama
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Yukio Ozaki
- Department of Cardiology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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15
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Schöberl M, Prantl L, Loose O, Zellner J, Angele P, Zeman F, Spreitzer M, Nerlich M, Krutsch W. Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study. Knee Surg Sports Traumatol Arthrosc 2017; 25:1958-66. [PMID: 28093636 DOI: 10.1007/s00167-017-4423-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 01/03/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardised non-surgical treatment for swift return-to-football. METHODS In a prospective double-blinded controlled study, 143 amateur football players with groin pain as well as radiological signs and clinical symptoms of pubic overload were analysed for 1 year. Two randomised study groups participated in an intensive physical rehabilitation programme, either with or without shock wave therapy. The control group did not participate in any standardised rehabilitation programme but only stopped participating in sports activity. Follow-up examinations took place 1, 3 months and 1 year after the beginning of therapy. Endpoints were visual analogue scale (VAS), functional tests, the time of return-to-football, recurrent complaints and changes in the MR image. RESULTS Forty-four football players with groin pain and aseptic osteitis pubis were randomised into two study groups; 26 received shock wave therapy, 18 did not. Clinical examination showed pubic overload as a multi-located disease. Players receiving shock wave therapy showed earlier pain relief in the VAS (p < 0.001) and returned to football significantly earlier (p = 0.048) than players without this therapy. Forty-two of 44 players of both study groups returned to football within 4 months after the beginning of therapy and had no recurrent groin pain within 1 year after trauma. Fifty-one players of the control group returned to football after 240 days (p < 0.001), of whom 26 (51%) experienced recurrent groin pain. Follow-up MRI scans did not show any effect of shock wave therapy. CONCLUSION Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shock wave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma. Early and correct diagnosis is essential for successful intensive physiotherapy. LEVEL OF EVIDENCE I.
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16
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Horstmann H, Clausen JD, Krettek C, Weber-Spickschen TS. [Evidence-based therapy for tendinopathy of the knee joint : Which forms of therapy are scientifically proven?]. Unfallchirurg 2017; 120:199-204. [PMID: 28138766 DOI: 10.1007/s00113-017-0310-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Tendinopathy in the region of the knee joint is a common pathological disorder. People active in sports, in particular, have a high probability of suffering from tendinopathy. Despite its high clinical relevance, the level of evidence of therapy options for tendinopathy in the knee region differs greatly. This review gives an overview of current evidence levels for therapy options in tendinopathy of the quadriceps, patellar and pes anserinus insertion tendons as well as of the distal iliotibial tract tendon. The treatment with platelet-rich plasma showed a significantly better outcome when used correctly and treatment with shock waves, operative treatment and sclerotherapy have also shown positive effects. Treatment with corticosteroid injections and with oral non-steroidal anti-inflammatory drugs (NSAID) showed positive short-term effects (follow-up ±4 weeks). No reasonable data are available for the treatment of tendinopathy in the knee region by acupuncture, fascial therapy or cryotherapy. The use of kinesio taping showed no significant relief from complaints compared with standard conservative treatment. The use of multimodal therapy without evidence is, therefore, particularly common in elite athletes.
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Affiliation(s)
- H Horstmann
- Orthopädische Klinik, Medizinische Hochschule Hannover, Anna-von-Borries-Straße 1-7, 30625, Hannover-Kleefeld, Deutschland
| | - J D Clausen
- Unfallchirurgische Klinik und Sportmedizinisches Institut, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - C Krettek
- Unfallchirurgische Klinik und Sportmedizinisches Institut, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| | - T S Weber-Spickschen
- Orthopädische Klinik, Medizinische Hochschule Hannover, Anna-von-Borries-Straße 1-7, 30625, Hannover-Kleefeld, Deutschland.
- Unfallchirurgische Klinik und Sportmedizinisches Institut, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
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17
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Krukowska J, Wrona J, Sienkiewicz M, Czernicki J. A comparative analysis of analgesic efficacy of ultrasound and shock wave therapy in the treatment of patients with inflammation of the attachment of the plantar fascia in the course of calcaneal spurs. Arch Orthop Trauma Surg 2016; 136:1289-1296. [PMID: 27402210 DOI: 10.1007/s00402-016-2503-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Troublesome heel spur is a nuisance condition that affects people of all ages. Treatment of patients with heel spur is a difficult and lengthy process requiring patience from both the patient and the therapist. Sometimes, the only and ultimate method of treatment is surgery, although spurs tend to recur. The aim of the study is a comparative analysis of the analgesic efficacy of ultrasound and shock wave therapy in patients with heel spur. The cause of pain in the course of calcaneal spur is inflammation of the attachment of the plantar fascia, which plays an important role in the process of walking and is seriously strained during different types of movement. Treatment of patients is a difficult and lengthy process. MATERIALS AND METHODS The study was conducted on a group of 47 patients of both sexes, aged 38-60 years (mean 51.3) with a plantar calcaneal spur confirmed by X-ray images. Patients were randomly assigned into two groups using a simple randomization: Group 1-ultrasound therapy group (a series of ten treatments) and Group 2-the radial shock wave group (series of four treatments). In all patients, pain intensity was assessed three times: before therapy, after the first and second weeks of treatment. A version of Laitinen's pain assessment questionnaire and the Huskisson visual analogue scale (VAS) were used. Of the group of studied respondents, 47 patients of both sexes and aged 38-60 years (mean age 51.3) with a heel spur (confirmed on X-rays), who had pain for at least a month, were randomly included in the study. The patients were classified into: Group 1-US therapeutic group (a series of ten treatments) and Group 2-with RSWT (a series of five treatments). Pain intensity was assessed three times: before the treatment, after the first and second week of the treatment with the application of the VAS and the Leitinen Pain Questionnaire. RESULTS However, a decrease in pain sensation was reported in all test intervals, and its largest decrease occurred in both groups within 1 week of beginning treatment. More dynamic change in this period was recorded in Group 1. CONCLUSION The conclusion is that while ultrasound and shock wave therapy show significant analgesic efficacy in patients with heel spur, fewer shock wave therapy sessions are needed than ultrasound sessions for effective relief, suggesting that the shock wave therapy has greater analgesic efficacy. A similar analgesic effect was achieved with the administration of a smaller number of shock wave treatments and a full series of ultrasound treatments.
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Affiliation(s)
- Jolanta Krukowska
- Physiotherapy Laboratory, Department of Physical Medicine, Medical University of Lodz, Lodz, Poland.,Faculty of Pedagogy and Health Promotion, Some College of Informatics and Skills of Lodz, Lodz, Poland
| | - Jacek Wrona
- Outpatient for the Rehabilitation of Communal Health Outpatient Clinic in Andrespol, Andrespol, Poland
| | - Monika Sienkiewicz
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz Poland, Hallera 1, 90-549, Lodz, Poland.
| | - Jan Czernicki
- Faculty of Pedagogy and Health Promotion, Some College of Informatics and Skills of Lodz, Lodz, Poland
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18
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Holfeld J, Tepeköylü C, Reissig C, Lobenwein D, Scheller B, Kirchmair E, Kozaryn R, Albrecht-Schgoer K, Krapf C, Zins K, Urbschat A, Zacharowski K, Grimm M, Kirchmair R, Paulus P. Toll-like receptor 3 signalling mediates angiogenic response upon shock wave treatment of ischaemic muscle. Cardiovasc Res 2015; 109:331-43. [PMID: 26676850 DOI: 10.1093/cvr/cvv272] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 11/18/2015] [Indexed: 01/22/2023] Open
Abstract
AIMS Shock wave therapy (SWT) represents a clinically widely used angiogenic and thus regenerative approach for the treatment of ischaemic heart or limb disease. Despite promising results in preclinical and clinical trials, the exact mechanism of action remains unknown. Toll-like receptor 3, which is part of the innate immunity, is activated by binding double-stranded (ds) RNA. It plays a key role in inflammation, a process that is needed also for angiogenesis. We hypothesize that SWT causes cellular cavitation without damaging the target cells, thus liberating cytoplasmic RNA that in turn activates TLR3. METHODS AND RESULTS SWT induces TLR3 and IFN-β1 gene expression as well as RNA liberation from endothelial cells in a time-dependant manner. Conditioned medium from SWT-treated HUVECs induced TLR3 signalling in reporter cells. The response was lost when the medium was treated with RNase III to abolish dsRNAs or when TLR3 was silenced using siRNAs. In a mouse hind limb ischaemia model using wt and TLR3(-/-) mice (n = 6), SWT induced angiogenesis and arteriogenesis only in wt animals. These effects were accompanied by improved blood perfusion of treated limbs. Analysis of main molecules of the TLR3 pathways confirmed TLR3 signalling in vivo following SWT. CONCLUSION Our data reveal a central role of the innate immune system, namely Toll-like receptor 3, to mediate angiogenesis upon release of cytoplasmic RNAs by mechanotransduction of SWT.
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Affiliation(s)
- Johannes Holfeld
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Can Tepeköylü
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Christin Reissig
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Daniela Lobenwein
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Bertram Scheller
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Elke Kirchmair
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Radoslaw Kozaryn
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | | | - Christoph Krapf
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Karin Zins
- Department of Anatomy and Cell Biology, Vienna Medical University, Vienna, Austria
| | - Anja Urbschat
- Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michael Grimm
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Rudolf Kirchmair
- Department of Internal Medicine III, Innsbruck Medical University, Innsbruck, Austria
| | - Patrick Paulus
- Department of Anesthesiology and Operative Intensive Care Medicine, Kepler University Hospital, Linz, Austria
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19
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Abstract
We have used the principles of extracorporeal shock wave therapy (ESWT) in the treatment of nonunion of fractures in 44 patients (49 bones).There were 35 males and 9 females with a mean age of 34 years(range14-70). Clinical and radiological assessment was performed at regular time intervals with a minimum follow up of 18 months. Most common sites involved were the femur and tibia. The average time from initial fracture treatment to intervention with ESWT was 11.9 months (6 months to 5 years). Thirty eight non-union sites had one session of treatment and the rest (11) had more than one session. Union was successful in 75.5% of cases at a mean time of 10.2 months (range 3-19). Failure in the remaining cases was due to more than 5mm gap, instability, compromised vascularity (type of bone) and deep low grade infection; which was discovered at the time of surgical intervention when no signs of radiological healing occurred after 6 months from treatment. Failing sites were shaft of femur, scaphoid, neck of humerus and neck of femur. No local complications were observed.
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Affiliation(s)
- Hazem M I Alkhawashki
- Department of Orthopaedics, College of Medicine, King Saud University, Riyadh, KSA, Saudi Arabia.
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20
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Hein S, Miernik A, Wilhelm K, Adams F, Schlager D, Herrmann TRW, Rassweiler JJ, Schoenthaler M. Clinical significance of residual fragments in 2015: impact, detection, and how to avoid them. World J Urol 2015; 34:771-8. [PMID: 26497824 DOI: 10.1007/s00345-015-1713-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/12/2015] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Residual fragments are common after stone treatment. Little is known about clinical outcomes relevant to the patient. This comprehensive review of the literature highlights the impact of residual fragments, modes of detection, and treatment strategies to avoid residual fragments in shock wave therapy, ureteroscopy, and percutaneous nephrolithotomy. METHODS A comprehensive review of current literature was performed using PubMed(®), MEDLINE(®), Embase™, Ovid(®), Google Scholar™, and the Cochrane Library. Publications relevant to the subject were retrieved and critically appraised. RESULTS Residual fragments after treatment for urinary stones have a significant impact on a patient's well-being and future course. (Ultra-) low-dose non-contrast computed tomography detects small residuals most reliably. In shock wave lithotripsy, adherence to basic principles helps to improve results. Various techniques and devices facilitate complete stone clearance in conventional and miniaturized percutaneous nephrolithotomy and (flexible) ureteroscopy. Promising new technologies in shock waves, lasers, and robotics (and potentially microrobotics) are on the horizon. CONCLUSIONS Residual fragments are relevant to patients. Contemporary treatment of urolithiasis should aim at complete stone clearance.
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Affiliation(s)
- Simon Hein
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Konrad Wilhelm
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Fabian Adams
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Daniel Schlager
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Thomas R W Herrmann
- Department of Urology and Urooncology, Hannover Medical School (MHH), Carl Neuberg Str. 1, 30625, Hannover, Germany
| | - Jens J Rassweiler
- Department of Urology and Pediatric Urology, SLK Kliniken Heilbronn, University of Heidelberg, Am Gesundbrunnen 20 - 26, 74078, Heilbronn, Germany
| | - Martin Schoenthaler
- Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany
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21
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Alkhamaali ZK, Crocombe AD, Solan MC, Cirovic S. Finite element modelling of radial shock wave therapy for chronic plantar fasciitis. Comput Methods Biomech Biomed Engin 2015; 19:1069-78. [PMID: 26465270 DOI: 10.1080/10255842.2015.1096348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression-rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot.
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Affiliation(s)
- Zaied K Alkhamaali
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK.,b Department of Mechanical Engineering Sciences , University of Surrey , Guildford , UK
| | - Andrew D Crocombe
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK
| | - Matthew C Solan
- c Department of Orthopaedic Surgery , Royal Surrey County Hospital, Guildford , UK
| | - Srdjan Cirovic
- a The Centre for Biomedical Engineering , University of Surrey , Guildford , UK.,b Department of Mechanical Engineering Sciences , University of Surrey , Guildford , UK
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22
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Gerdesmeyer L, Schaden W, Besch L, Stukenberg M, Doerner L, Muehlhofer H, Toepfer A. Osteogenetic effect of extracorporeal shock waves in human. Int J Surg 2015; 24:115-9. [PMID: 26455534 DOI: 10.1016/j.ijsu.2015.09.068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/18/2015] [Accepted: 09/13/2015] [Indexed: 11/26/2022]
Affiliation(s)
- L Gerdesmeyer
- Dept Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, 24105 Kiel, Germany; Dept for Orthopedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany.
| | - W Schaden
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria
| | - L Besch
- Dept Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, 24105 Kiel, Germany
| | - M Stukenberg
- Dept Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, 24105 Kiel, Germany
| | - L Doerner
- Dept Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Arnold Heller Strasse, 24105 Kiel, Germany
| | - H Muehlhofer
- Dept for Orthopedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany
| | - A Toepfer
- Dept for Orthopedics, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675 Munich, Germany
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23
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Serviat-Hung N, Carvajal-Veitía W, Medina-Sánchez M, Gutiérrez-Jorge Y, Croas-Fernández A. [Extracorporeal shockwave terapy in sports and non-sports population. Preliminary results]. Acta Ortop Mex 2015; 29:254-260. [PMID: 27218249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Inflammatory and calcifying diseases of the soft tissues are disorders having significant economical and social repercussions. They can be treated with drugs or physical therapy, and if these fail, surgery used to be the last existing therapeutic step. In recent years, a non-surgical alternative is being used to treat them, the application of extracorporeal shock waves. This work aims to verify the capacity of this therapeutic technique to diminish pain and to define its application rules. METHOD We treated 18 athletes and 12 patients from normal population with heel spurs, calcified and noncalcified tendonitis and plantar fasciitis. The results were evaluated with a visual analogical scale of pain and by echography, prior to treatment and after. RESULTS The treatment was effective in 100% of the subjects. CONCLUSIONS We conclude that once the medical therapeutic and the physical therapy measures are used up, treatment with shock waves is a good alternative to using surgery.
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Affiliation(s)
- N Serviat-Hung
- Instituto de Medicina del Deporte. Cerro Pelado, calle 100 s/n entre 10 y 14. Reparto Embil. Altahabana, La Habana, Cuba
| | - W Carvajal-Veitía
- Instituto de Medicina del Deporte. Cerro Pelado, calle 100 s/n entre 10 y 14. Reparto Embil. Altahabana, La Habana, Cuba
| | - M Medina-Sánchez
- Instituto de Medicina del Deporte. Cerro Pelado, calle 100 s/n entre 10 y 14. Reparto Embil. Altahabana, La Habana, Cuba
| | - Y Gutiérrez-Jorge
- Instituto de Medicina del Deporte. Cerro Pelado, calle 100 s/n entre 10 y 14. Reparto Embil. Altahabana, La Habana, Cuba
| | - A Croas-Fernández
- Instituto de Medicina del Deporte. Cerro Pelado, calle 100 s/n entre 10 y 14. Reparto Embil. Altahabana, La Habana, Cuba
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24
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Omar MTA, Alghadir A, Al-Wahhabi KK, Al-Askar AB. Efficacy of shock wave therapy on chronic diabetic foot ulcer: a single-blinded randomized controlled clinical trial. Diabetes Res Clin Pract 2014; 106:548-54. [PMID: 25451894 DOI: 10.1016/j.diabres.2014.09.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/02/2014] [Accepted: 09/14/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study was conducted to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) on the healing rate, wound surface area and wound bed preparation in chronic diabetic foot ulcers (DFU). METHODS Thirty eight patients with 45 chronic DFU were randomly assigned into; the ESWT-group (19 patients/24 ulcers) and the control-group (19 patients/21 ulcers). Blinded therapist measured wound surface area (WSA), the percentage of reduction in the WSA, rate of healing and wound bed preparation at baseline, after the end of the interventions (W8), and at 20-week follow-up (W20). The ESWT group received shock wave therapy twice per week for a total of eight treatments. Each ulcer was received ESWT at a frequency of 100 pulse/cm(2), and energy flux density of 0.11mJ/cm(2). All patients received standardized wound care consisting of debridement, blood-glucose control agents, and footwear modification for pressure reduction. RESULTS The overall clinical results showed completely healed ulcers in 33.3% and 54% in ESWT-groups and 14.28% and 28.5% in the control group after intervention (W8), and at follow-up (W20) respectively. The average healing time was significantly lower (64.5 ± 8.06 days vs 81.17 ± 4.35 days, p<0.05) in the ESWT-group compared with the control group. CONCLUSION ESWT-treated ulcers had a significant reduction in wound size and median time required for ulcer healing, with no adverse reactions. So, the ESWT is advocated as an adjunctive therapy in chronic diabetic wound.
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Affiliation(s)
- Mohammed T A Omar
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmad Alghadir
- Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia; Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Abeer B Al-Askar
- Physical Therapy Department, King Saud Medical City, Riyadh, Saudi Arabia
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25
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Tepeköylü C, Lobenwein D, Blunder S, Kozaryn R, Dietl M, Ritschl P, Pechriggl EJ, Blumer MJF, Bitsche M, Schistek R, Kotsch K, Fritsch H, Grimm M, Holfeld J. Alteration of inflammatory response by shock wave therapy leads to reduced calcification of decellularized aortic xenografts in mice†. Eur J Cardiothorac Surg 2014; 47:e80-90. [PMID: 25422292 DOI: 10.1093/ejcts/ezu428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Tissue-engineered xenografts represent a promising treatment option in heart valve disease. However, inflammatory response leading to graft failure and incomplete in vitro repopulation with recipient cells remain challenging. Shock waves (SWs) were shown to modulate inflammation and to enhance re-epithelialization. We therefore aimed to investigate whether SWs could serve as a feasible adjunct to tissue engineering. METHODS Porcine aortic pieces were decellularized using sodium deoxycholate and sodium dodecylsulphate and implanted subcutaneously into C57BL/6 mice (n = 6 per group). The treatment (shock wave therapy, SWT) group received SWs (0.1 mJ/mm(2), 500 impulses, 5 Hz) for modulation of inflammatory response directly after implantation; control animals remained untreated (CTR). Grafts were harvested 72 h and 3 weeks after implantation and analysed for inflammatory cytokines, macrophage infiltration and polarization, osteoclastic activity and calcification. Transmission electron microscopy (TEM) was performed. Endothelial cells (ECs) were treated with SWs and analysed for macrophage regulatory cytokines. In an ex vivo experimental set-up, decellularized porcine aortic valve conduits were reseeded with ECs with and without SWT (0.1 mJ/mm(2), 300 impulses, 3 Hz), fibroblasts as well as peripheral blood mononuclear cells (all human) and tested in a pulsatile flow perfusion system for cell coverage. RESULTS Treated ECs showed an increase of macrophage migration inhibitory factor and macrophage inflammatory protein 1β, whereas CD40 ligand and complement component C5/C5a were decreased. Subcutaneously implanted grafts showed increased mRNA levels of tumour necrosis factor α and interleukin 6 in the treatment group. Enhanced repopulation with recipient cells could be observed after SWT. Augmented macrophage infiltration and increased polarization towards M2 macrophages was observed in treated animals. Enhanced recruitment of osteoclastic cells in proximity to calcified tissue was found after SWT. Consequently, SWT resulted in decreased areas of calcification in treated animals. The reseeding experiment revealed that fibroblasts showed the best coverage compared with other cell types. Moreover, SW-treated ECs exhibited enhanced repopulation compared with untreated controls. CONCLUSIONS SWs reduce the calcification of subcutaneously implanted decellularized xenografts via the modulation of the acute macrophage-mediated inflammatory response and improves the in vitro repopulation of decellularized grafts. It may therefore serve as a feasible adjunct to heart valve tissue engineering.
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Affiliation(s)
- Can Tepeköylü
- University Hospital for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Lobenwein
- University Hospital for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Blunder
- University Hospital for Dermatology and Venerology, Medical University of Innsbruck, Innsbruck, Austria
| | - Radoslaw Kozaryn
- University Hospital for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Marion Dietl
- University Hospital for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Ritschl
- University Hospital for Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth J Pechriggl
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael J F Blumer
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mario Bitsche
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Roland Schistek
- University Hospital for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Katja Kotsch
- University Hospital for Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Helga Fritsch
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- University Hospital for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Holfeld
- University Hospital for Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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26
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Alunni G, Marra S, Meynet I, D'amico M, Elisa P, Fanelli A, Molinaro S, Garrone P, Deberardinis A, Campana M, Lerman A. The beneficial effect of extracorporeal shockwave myocardial revascularization in patients with refractory angina. Cardiovasc Revasc Med 2015; 16:6-11. [PMID: 25555620 DOI: 10.1016/j.carrev.2014.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 10/12/2014] [Accepted: 10/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The incidence of patients with refractory angina (RA) is increasing. Medical therapy for RA is limited and prognosis is poor. Experimental data suggest that the use of Extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms of angina in patients with RA. Purpose of our study is to determine the efficacy of cardiac shock wave therapy (ESMR) in the management of patients with nonrevascolarized coronary artery disease (CAD). METHODS We performed a prospective cohort study to examine the efficacy of ESMR applcation in patients with RA despite optimal medical therapy, not suitable for further PCI or CABG. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization rate among cases (patients with RA who received ESMR) and controls (patients with RA who did not receive ESMR) were compared at baseline and 6 months after ESMR therapy. In patients receiveing d ESMR the effect of on cardiac perfusion was assessed. RESULTS There were 43 patients in the case group and 29 patients in the control group. The mean age of the patients was 70 ± 9.5 years in the case group and 71 ± 5.3 years in the control group. Other characteristics (diabetes, coronary artery bypass graft, percutaneus coronary intervention, baseline CCS class score) were similar in both groups. There was a significant improvement in CCS class score (1.33 ± 0.57 in cases and 1.92 ± 0.69 in controls; p = 0.0002), nitroglycerin consumption (20% in case cases, and 44.8% in controls; P < 0.03) and hospitalization rate significantly reduced (13.9% in case cases, and 37.9% in controls; P < 0.03). The patients who received ESMR, there was a significantly improvement in myocardial perfusion after 6 months with a 33% relative reduction of summed stress score (SSS) (p = 0.002). CONCLUSION This case control study demonstrates the beneficial effect of ESMR therapy on cardiac symptoms, myocardial perfusion and reduced hospitalization in patients with refractory angina. Ther current study supports a role for ESMR as a non-invasive therapuetic option for patients with RA.
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27
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Sun CK, Shao PL, Wang CJ, Yip HK. Study of vascular injuries using endothelial denudation model and the therapeutic application of shock wave: a review. Am J Transl Res 2011; 3:259-268. [PMID: 21633631 PMCID: PMC3102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 04/05/2011] [Indexed: 05/30/2023]
Abstract
As death toll from cardiovascular diseases has reached historic heights in the developed world, research efforts have been focused on both the understanding of disease progression and also the choice of appropriate treatment strategies. Moreover, to facilitate research, an appropriate animal model is needed to mimic the pathological changes and follow treatment results. This article reviewed the disease mechanisms underlying vascular injuries and also the animal model of endothelial denudation using balloon catheter. On the other hand, the biological effects of shock wave including angiogenesis and the suppression of inflammation were reviewed. Its therapeutic impact on the cardiovascular system and its potential clinical application as well as limitations were also discussed.
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Affiliation(s)
- Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University School of MedicineKaohsiung
| | - Pei-Lin Shao
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical UniversityTaiwan
| | - Ching-Jen Wang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University School of MedicineKaohsiung
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University School of MedicineKaohsiung
- Center for Translational Research in Biomedical Science, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University School of MedicineKaohsiung
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28
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Abstract
Achilles tendinopathy has been reported as the most common overuse injury in sports medicine clinics (Clement et al. Am J Sports Med 12: 179-184, 1984). Standard treatment regimens include activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading. There is a lack of consensus regarding treatment. Even so, most athletes will respond to this regimen. However, conservative management will prove to be inadequate for a subset of patients. When conservative therapy fails, other noninvasive treatment measures may be considered. Extracorporeal shock wave therapy (ESWT) has been used in soft-tissue disorders including lateral epicondylitis, plantar fasciitis, and calcific tendonitis of the shoulder. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is lacking. This article explores the role of shock wave therapy in the management of recalcitrant Achilles tendinopathy in patients attempting to avoid an invasive intervention.
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