Effect Of Extracorporeal Shock Waves Research Articles

Impact of extracorporeal shock wave therapy (ESWT) on orthodontic tooth movement—a randomized clinical trial

This randomized clinical trial investigated the effect of extracorporeal shock waves on the amount of orthodontic tooth movement and periodontal parameters. Twenty-six adult orthodontic patients participated in this clinical trial; all of them receiving lower second molar mesially directed movement. The fixed orthodontic device included superelastic coil springs (200cN) and miniscrews as temporary anchorage device. The active treatment group received a single shock wave treatment with 1,000 impulses in the region of tooth movement. The placebo group was treated with deactivated shock wave applicator with an acoustic sham. The study period lasted 4months with amonthly data exploration. No statistically significant difference in posterior-anterior tooth movement between the treatment and placebo group was seen during observation period. Gender had no significant influence on tooth movement in either group. No significant difference occurred in mesio-distal tipping and rotation, but a significant difference (p = 0.035) in bucco-lingual tipping of the molars was found. Periodontal status of the patients (sulcus probing depth, gingival index) did not significantly differ in both groups. The plaque index showed a significant difference (p = 0.003). Single application of extracorporeal shock wave treatment was associated neither with a statistically significant acceleration of tooth movement nor with an altered periodontal status in vivo. Shock waves showed no harmful effects in the investigated area. Their clinical use for lithotripsy during orthodontic therapy might be permitted.

Clinical study on extracorporeal shock wave therapy plus electroacupuncture for myofascial pain syndrome

To observe the clinical effect of extracorporeal shock wave plus electroacupuncture (EA) on myofascial pain syndrome (MPS) and to investigate its treatment mechanism. Ninety cases who met the inclusion criteria were randomly allocated into an EA group, an extracorporeal shock wave therapy (ESWT) group and a combined therapy group, 30 in each group. EA was employed in the EA group, extracorporeal shock wave therapy in the ESWT group and EA plus extracorporeal shock wave therapy in the combined therapy group. The VAS, tenderness threshold and therapeutic efficacy were evaluated after three months of treatment. After 2 weeks, 4 weeks and 3 months of treatment, the VAS scores in all three groups were significantly reduced and the tenderness threshold significantly elevated. The recovery rate and total effective rate were 23.3% and 83.3% respectively in the EA group, versus 40.0% and 90.0% in the ESWT group and 63.3% and 96.7% in the combined therapy group, showing statistical differences (P<0.05). EA combined with EWST works remarkably well for MPS.

The effects of extracorporeal shock waves on carrageenan-induced Achilles tendinitis in rats: a biomechanical and histological analysis

The aim of this study was to investigate the influence of low-dose extracorporeal shock waves (ESW) on the healing potential of Achilles tendinitis in the rat. The 36 adult Sprague-Dawley rats used in this study were randomly divided into four groups. Group A (n=10) were injected with carrageenan, Group B (n=10) were injected with carrageenan and received ESW, Group C (n=10) received ESW only, and Group D (n=6) was a sham group. Rats were injected with 10 microliters of 3% carrageenan or a saline solution eight times during a one-week period with a subcutaneous needle. One week following the final injection, ESW was applied at a rate of 500 impulses in 5 minutes at 2 bars (comparative to 0.09 mJ/mm²) to rats in Groups B and C. Rats were sacrificed three weeks later. Tensile strength, inflammation, and vascularity and collagen density were measured. Failure of the tendon ultimate loads was significantly lower in the study groups than in the control group (p<0.05). Collagen fiber density was higher in the control group than in the other groups (p=0.59). No other histological differences were found. Low-dose ESW has a negative effect on tendon tensile strength in this animal model.

The long-term effects of extracorporeal shock waves on the epiphysis of the adolescent rat

BackgroundExtracorporeal shock waves (ESW) have been successfully used to treat musculoskeletal injuries, tendinopathy, and plantar fasciitis. Different side effects of high-energy ESWT on bones, tendons, nerves, epiphysis, and cartilage have been discussed. Although the effects of ESW on the epiphysis in animal models have been described, no studies have investigated the long-term effect of ESW on the immature epiphysis in an animal model. The purpose of this study was to investigate the long-term effects of ESW on the immature epiphysis in rats. MethodsSixteen 4-week old Wistar albino rats, average weight 116.3 grams (109.6–120.2g) were used for these experiments. The rats were randomly divided into two groups, the ESW 1500 pulses (ESW1500p) group (n=8) and the ESW 3000pulses (ESW3000p) group (n=8). In the ESW1500p group, 1500pulses, at 4 bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. In the ESW3000p group, 3000 pulses, at 4bar, of 1-Hz shockwaves were applied, once, to the left knees of the rats. The right knees (n=16) of the rats in the two groups were used as the controls. The animals were sacrificed after an 8-month follow-up period. Femoral epiphyses were assessed by use of histology. The femoral length (FL), tibial length (TL), and femoral supracondylar medio-lateral width (MLW) were measured. ResultsThere was no statistically significant difference between FL, TL, and MLW for the three groups (P>0.05). The average histological scores were 8.8 (7–10), 17.8 (15–22), and 2.7 (0–4) in the ESW1500p, the ESW3000p groups, and the controls, respectively. The average histological score for the ESW3000p group was significantly higher than those for the ESW1500p group and the controls (P<0.001). The average histological score for the ESW1500p group was significantly higher than that for the controls (P<0.001). ConclusionsThe histological findings of this study indicate that ESW increased the cellularity and basophilia of the extracellular matrix (ECM) in the adolescent rat epiphysis and there were no negative effects on extremity measurements in the long term.

Optimal Intensity Shock Wave Promotes the Adhesion and Migration of Rat Osteoblasts via Integrin β1-mediated Expression of Phosphorylated Focal Adhesion Kinase

To search for factors promoting bone fracture repair, we investigated the effects of extracorporeal shock wave (ESW) on the adhesion, spreading, and migration of osteoblasts and its specific underlying cellular mechanisms. After a single period of stimulation by 10 kV (500 impulses) of shock wave (SW), the adhesion rate was increased as compared with the vehicle control. The data from both wound healing and transwell tests confirmed an acceleration in the migration of osteoblasts by SW treatment. RT-PCR, flow cytometry, and Western blotting showed that SW rapidly increased the surface expression of α5 and β1 subunit integrins, indicating that integrin β1 acted as an early signal for ESW-induced osteoblast adhesion and migration. It has also been found that a significant elevation occurred in the expression of phosphorylated β-catenin and focal adhesion kinase (FAK) at the site of tyrosine 397 in response to SW stimulation after the increasing expression of the integrin β1 molecule. When siRNAs of integrin α5 and β1 subunit were added, the level of FAK phosphorylation elevated by SW declined. Interestingly, the adhesion and migration of osteoblasts were decreased when these siRNA reagents as well as the ERK1/2 signaling pathway inhibitors, U0126 and PD98059, were present. Further studies demonstrated that U0126 could inhibit the downstream integrin-dependent signaling pathways, such as the FAK signaling pathway, whereas it had no influence on the synthesis of integrin β1 molecule. In conclusion, these data suggest that ESW promotes the adhesion and migration of osteoblasts via integrin β1-mediated expression of phosphorylated FAK at the Tyr-397 site; in addition, ERK1/2 are also important for osteoblast adhesion, spreading, migration, and integrin expression.

The effect of extracorporeal shockwaves on cartilage end-plates in rabbits: a preliminary MRI and histopathological study

The aim of this study was to examine the changes in the lumbar intervertebral area after extracorporeal shockwave therapy (ESWT) at different energy levels in a rabbit model using magnetic resonance imaging (MRI) and histopathological evaluation. The study included 30 male New Zealand white rabbits divided randomly into five groups: Groups A and C received 1,000 shockwave impulses at an intensity of 14 kV, Groups B and D received 1,000 impulses at 21 kV, and Group E was a sham group. Side effects such as subcutaneous and paravertebral soft-tissue injuries were evaluated using MRI one day after ESWT administration. Neovascularization, edema and fibroblast activity in the intervertebral area were evaluated histopathologically. No change was observed in any group on MRI. Histopathologically, Groups A and C showed no change, whereas Groups B and D showed edema, fibroblast activity and significant neovascularization at the intervertebral end-plate (p<0.05). Our findings indicate that ESWT caused dose-dependent changes in the intervertebral end-plate. This study constitutes a preliminary evaluation of shockwave therapy to the intervertebral area in an animal model. High-dose ESWT may stimulate angiogenesis at cartilage end-plates in rabbits.

Determinação da densidade mineral e da elasticidade óssea após a aplicação de ondas de choque extracorpóreas no terceiro metacarpiano de equinos atletas

Objetivou-se neste estudo avaliar os efeitos da aplicação de ondas de choque extracorpóreas (ESWT) no terceiro metacarpiano de equinos hígidos através da determinação da elasticidade óssea. Foram utilizados 20 equinos Puro Sangue Inglês, machos e fêmeas, com dois anos de idade, em início de treinamento e selecionados quanto ao estado de higidez. No início do experimento (D0), todos os animais foram submetidos à avaliação da elasticidade óssea do terceiro metacarpiano. Os animais foram divididos em dois grupos (Grupo Controle - GC e Grupo Experimental - GE). A aplicação das ESWT foi realizada no membro torácico direito dos animais do GE, na região coincidente à da avaliação da elasticidade óssea. Foi utilizado aparelho para terapia de ondas extracorpóreas com densidade de fluxo de energia de 0,15mJ/mm² e 2000 pulsos com probe E6R20, com característica do foco da onda de choque de 20 mm. A ESWT foi repetida a cada 21 dias totalizando três sessões (D0, D21 e D42). A análise da determinação da elasticidade óssea foi realizada no D0, D21, D42 e D72. A média da velocidade ultrassonográfica diferiu entre os grupos no D21, D42 e D72, sendo que os animais do GE apresentaram menor densidade mineral óssea após as aplicações das ESWT. Houve igualmente, diferença na massa óssea entre os grupos no D21 e D42, parâmetro onde os animais do GE apresentaram diminuição significativa da massa óssea. O risco de fratura apresentou-se maior nos animais do GE no D21. Concluiu-se que, a ESWT é capaz de promover alteração da densidade mineral óssea.

A clinical study of extracorporeal shock waves (ESW) for treatment of chronic lateral epicondylitis

Background This clinical study was conducted to determine the safety and effectiveness of extracorporeal shock waves (ESW) to treat chronic lateral epicondylitis non-responsive to conservative treatment and persisting for at least 6 months. Methods Involved were seven test sites and 183 patients, divided between men and women with a mean age of 45.7 years. Test participants had a history of chronic lateral epicondylitis and were under the care of a physician. Participants were enrolled as nonrandomized and randomized to active treatment and placebo. Eight-week follow-up by blinded investigators determined baseline results of success criteria. Results Analysis showed that a single ESW treatment was effective in treating the condition when compared with placebo at 8 weeks. Long-term follow-up data showed maintenance of response in 8-week “success” patients. Of the active treatment participants who continued the study to long-term follow up, 40% met all success criteria compared with 24% of the placebo group (P=0.018). Conclusions It was concluded that the results of efficacy, which were adjusted for any differences between sites, were robust upon analysis. The data provide statistically significant outcomes indicating that ESW therapy is effective in the treatment of chronic lateral epicondylitis.

The effect of extracoporeal schock waves on intestinal anastomosis

To investigate the effect of extracorporeal shock waves on the healing of intestinal anastomosis. Thirty Wistar rats were randomly divided into three groups of ten each comprising of Group I (only laparotomy), Group II (right colon segment resection and end to end anastomosis) and Group III (right colon segment resection and end to end anastomosis). Group III animals a total of 1200 impulse 0.12 mj/mm 2 shock waves on the post-operative 3rd , 5th and 7th days in three session each of which included 400 impulse with 14KV. On the 10th post operative day, the rats were sacrificed and postmortem examination was done. The explosion pressures were measured using a sphygmomanometer specially designed for this purpose. In the study groups 4 cm intestine segments which include anastomose line was taken out. The segments which include anastomosis of the study group and the control group pieces were histopathologically examined. The fibroblast, collagen, angiogenesis and inflammatory cells were studied. The mean anastomoses explosion pressure for group III was 272 ± 7.895 and the average anastomose explosion pressure was 220 ± 6.831. The difference between the pressure means was significant (P < 0.05). Histological fibroblast/collagen ratio were 14.50 ± 5.66, 274 ± 66.21 and 416 ± 52.44 for Group I, Group II and Group III, respectively. The vein amount was 5.80 ±3.19, 51.20±10.76 and 75.10±13.80, respectively. In Group III, fibroblast/collagen and vein ratio was significantly higher compared to Group I and II (3.19, 51.20 ± 10.76 and 75.10 ± 13.80, respectively. In Group III, fibroblast/collagen and vein ratio was significantly higher compared to Group I and II (P < 0.05). From the results of our study, extracorporeal shock waves treatment (ESWT) increase the intestinal tensile strength and may be useful to enhance the mechanical strength of anastomosis of the colon during healing.

Bone morphogenetic protein-2 expression in spinal fusion masses enhanced by extracorporeal shock wave treatment: a rabbit experiment

Extracorporeal shock wave (ESW) has been introduced to enhance spinal fusion. This study was conducted to assess the effect of ESW on bone morphogenetic protein-2 (BMP-2) expression in a spinal fusion experiment. Twelve rabbits underwent fusion at bilateral L5-6 intertransverse spaces. They were evenly divided into two groups. In the study group, bilateral L5 and L6 transverse processes were treated with 1,000 impulses of ESW at 14 kV at 12 weeks. In the control group, the rabbits did not receive ESW treatment. All rabbits were sacrificed at 16 weeks, and their lumbar spines were harvested for radiographic and molecular biological study. In the study group (n = 6), the radiographs showed good fusion in all six rabbits, while in the control group (n = 6), good fusion was found only in three rabbits (50%). Although more rabbits in the study group had a good fusion result, the inter-group difference was not statistically significant (P = 0.182). In the molecular biological examination, the mean value of the normalized expression of BMP-2 mRNA in the fusion masses of the study group was 90 ± 8.4 while that of the control group was 77.33 ± 6.74. Statistical analysis showed the study group had a significantly higher BMP-2 mRNA expression in the fusion masses than the control group (P = 0.018). The current study showed that ESW treatment enhances BMP-2 mRNA expression in spinal fusion masses.

Comparison of Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopic Stone Extraction in the Treatment of Ureteral Stones

Aim: There are some controversies on the effectiveness of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic stone extraction (URS) in ureteral stones. Because, previous studies on this topic mostly included lower ureteral stones, we aimed to compare effectiveness of these two methods in both lower and upper ureteral stones. Method: After diagnosis of urolithiasis, ESWL or URS was performed to patients. Stone-free ratio, complications and necessity of an additional intervention for both procedures were recorded. The decision about the selection of method was made based on the patients’ choice. Upper and lower ureteral stones were included, while middle ureteral stones were excluded from the study. Result: Total number of patients undergone URS was 90 and ESWL was 96. There was no difference in male/female ratio, age and stone diameters between two groups (P>0.05). Upper ureteral stones were found to be more frequent in ESWL group than those in URS group (55.2% vs. 33.3%, respectively, P=0.004). Total stone-free ratio was 97.8% for URS and 68.8% for ESWL (P<0.001). Ratios of treatment failures and complications were found to be lower in URS group compared with ESWL group (P<0.05). Conclusion: Although, URS seems to be more successful in the treatment of ureteral stones, further prospective studies with more patients are needed to clarify our results.

Effect of extracorporeal shock wave on osteogenesis-related and adipogenic-related genes of mesenchymal stem cells of patients with early or moderate stage osteonecrosis of the femoral head

Objective To investigate the effect of extracorporeal shock wave (ESW) on osteogenesisrelated and adipogenic-related genes of mesenchymal stem cells (MSCs) of patients with early or moderate osteonecrosis of the femoral head (ONFH).Methods MSCs obtained from ONFH patients were divided into Group A and Group B.The proliferation was detected and compared.as well the content of alkaline phosphatase (ALP) in P_3,extracellular matrix mineralization in P_7,the expression of core-binding factor alpha 1 (Cbfα1),osteocalcin (OC) and peroxisome proliferator-activated receptor γ (PPARγ) between two groups at different time points.Results The proliferation of Group A was better than Group B significantly (except the 1st day);the ALP) content of Group A were higher than that of Group B significantly (except the 3rd day).The mineralized nodules was (6.0±1.0)/field in Group A,but negative in Group B.Cbfα 1 sustained expression in the whole process of ESW induced osteoblast differentiation,Group A was significantly stronger than the Group B every day (except the 3rd day);the OC expression of Group A was significantly earlier and stronger than that of Group B every day (except the 3rd,lay and 6th day).The PPARγ sustained expression in the whole process of ESW induced osteoblast differentiation,and that in Group A was significant stronger than that in Group B every day (exeept the 3rd day).Conclusion The appropriate intensity ESW can promote MSCs'proliferation,induce MSCs'differentiation into osteoblastic and inhibit MSCs'differentiate into fat cells,which may be an effective way of treating ONFH. Key words: High-energy shock waves; Femur head necrosis; Core binding factor alpha 1 subunit; Osteocalcin

Shock Wave Therapy Effectively Attenuates Inflammation in Rat Carotid Artery following Endothelial Denudation by Balloon Catheter

Background: This study investigates the effectiveness of extracorporeal shock wave (ECSW) in ameliorating inflammatory mediator expression and neointimal formation in a rat model of vascular injury. Methods and Results: Male Sprague-Dawley rats with left carotid artery (LCA) injury induced by balloon dilatation (BD; group 1) were compared with group 2 [LCA injury plus ECSW-181 (defined as 181 total shocks given in LCA at 0.011 mJ/mm²) on day 2 post-LCA injury], and group 3 (normal controls). The rats in each group were further divided into 3 subgroups (n = 6, each) that were sacrificed on postoperative day 3, 7 and 14, respectively. The results demonstrated that, compared to groups 2 and 3, group 1 had significantly increased cellular expression of CD40, interleukin-18, and connexin 43 at each analyzed time point (all p < 0.001). Additionally, LCCA macrophage (CD68) recruitment was substantially increased in group 1 compared to groups 2 and 3 (all p < 0.001). Furthermore, LCA neointimal proliferation and media thickness were markedly higher in group 1 than in groups 2 and 3 on days 7 and 14 post-BD (all p < 0.001). Conclusions: ECSW markedly attenuates inflammatory responses, proliferation of neointima and smooth muscle cells in a rat vascular injury model.

A preliminary trial of extracorporeal shock waves for the treatment of IIIB chronic prostatitis

Objective To assess the effect of extracorporeal shock waves(ESWs)as a treatment for ⅢB chronic prostatitis(CP).Methods Forty-six men with ⅢB CP were randomly divided into an experimental group (n=34)and a control group(n=12).The patients in experimental group received low energy ESW treatment,20000 impulses in 10 sessions over 2 weeks.The patients in control group received sham ESW treatment without shock waves energy under the same other conditions as in experimental group.Pain,urination and quality of life/impact were assessed with National Institutes of Health-chronic prostatitis symptom index(NIH-CPSI).Both groups were assessed at baseline,post-treatment and at a 4-week follow-up.Resuits The total NIH-CPSI scores,pain scores and quality of life/impact scores in experimental group decreased significantly post-treatment(P＜0.01),but urination scores did not(P＞0.05).Similar decreases of these scores were also found in control group post-treatment.The total NIH-CPSl scores and pain scores maintained at a lower level at the 4-week follow-up in experimental group,but the scores returned to the level as pre-treatment in control group.The effectiveness rates and prominent effectiveness rates in experimental group were significantly higher than those in control group post-treatment and at the 4-week follow-up(all P＜0.05). Conclusions ESWs was effective in the treatment for ⅢB CP.After ESWs treatment pain alleviated,symptoms reducea and quality of life improved. Key words: Extracorporeal shock waves; Chronic prostatitis; Pain; Treatment

Application of extracorporeal shock wave treatment to enhance spinal fusion: a rabbit experiment

Background Extracorporeal shock wave treatment has been used to treat many orthopedic disorders. However, the effect of extracorporeal shock waves on spinal fusion has not been reported. Methods Fifteen rabbits were used in this study. Spinal fusion was performed with decortication of bilateral L5 and L6 transverse processes, and placement of the bone chips onto the ipsilateral L5-L6 intertransverse space. The right L5 and L6 transverse processes in all animals were treated with 1000 impulses of ESWT at 14 kV (equivalent to 0.18 mJ/mm 2) at 3 and 6 weeks after surgery. The left transverse processes did not receive ESWT, and were served as controls. Radiographic examinations of the spines were performed at 3, 6, and 12 weeks. Computed tomography was performed at 12 weeks. The rabbits were killed at 12 weeks, and the spinal segments were harvested for histomorphological examination. Results Radiographs of the tested rabbits taken at different post-ESWT stages demonstrated repairing effect of ESWT on the fusion gap of the treated (right) sides. Statistical analysis of the image studies indicated that 11 (73%) of 15 rabbits showed superior fusion mass on the ESWT (right) side than that of control (left) side ( P < .001). The remaining 4 (27%) rabbits showed no discernable fusion difference between the ESWT side and the control side. Histomorphological examination showed good new bone formation in 9 fusion masses. All of these cases were noted on the ESWT (right) sides. Statistical analysis showed that ESWT sides had better new bone formation than the control sides ( P = .001). Conclusions Results of this study demonstrated that ESWT is effective in promoting spinal fusion in rabbits.

Temporal and spatial expression of BMP-2 in sub-chondral bone of necrotic femoral heads in rabbits by use of extracorporeal shock waves

Background and purpose Extracorporeal shock wave treatment has been used successfully for the treatment of avascular necrosis of the femoral head. The pathway of biological events by which this is accomplished has not been fully elucidated. BMP-2 is a key mediator of bone development and repair, and is uniquely required for bone formation. We therefore examined the effect of extracorporeal shock waves on induction of BMP-2 in necrotic femoral heads.Methods Femoral head necrosis was induced in rabbits by treatment with methylprednisolone and lipopolysaccharide. BMP-2 expression was assessed by immunohistochemistry, quantitative real-time PCR, and western blot analysis. Histomorphometric analysis was performed to evaluate the rate of bone formation in femoral heads treated with extracorporeal shock waves.Results Extracorporeal shock wave treatment was associated with a significant increase in expression of BMP-2 protein and mRNA in the subchondral bone of the necrotic femoral heads. Moreover, the most intensive immunostaining of BMP-2 was observed in the prolifer-ative zone above the necrotic zone. Histomorphometric analysis showed that extracorporeal shock wave treatment significantly increased the rate of bone formation in the subchondral bone.Interpretation We conclude that extracorporeal shock wave treatment significantly upregulates the expression of BMP-2 in necrotic femoral heads. The process of repair of femoral head necrosis is accelerated by the use of extracorporeal shock waves.

A comparison of the effectiveness of extracorporeal shock wave and ultrasound therapy in the management of heel pain

The aim of this study was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and ultrasound therapy (US) for managing heel pain. Thirty-seven subjects received either: ESWT (once a week), US (three times a week), or CONTROL (no treatment) for 3 consecutive weeks and were followed-up for 3 more weeks. A visual analogue scale (VAS), the maximum tolerable duration for prolonged walking or standing, and the Mayo clinical scoring system (MCSS) were evaluated. Mixed models treating baseline measures as covariates were adopted for statistical analysis. By week 3, intensity of heel pain on palpation was reduced by 37% (VAS score from 7.5 to 4.6) in the ESWT group, 24% (from 5.3 to 4.2) in the US group, and increased by 3% (5.6–5.7) in the control group; this difference was significant after adjusting for baseline VAS scores (p = 0.022). The improvements in the maximum tolerable duration of prolonged walking or standing was only significant in the ESWT group (157% increase, p = 0.043) but not the other two groups. Both active treatment groups maintained the treatment effect at the three-week follow-up. We conclude that ESWT is potentially more effective in reducing heel pain than ultrasound therapy but additional evidence is needed due to the various limitations of the study.

Upregulation of VEGF in Subchondral Bone of Necrotic Femoral Heads in Rabbits with Use of Extracorporeal Shock Waves

Extracorporeal shock wave treatment appears to be effective in patients with avascular necrosis of the femoral head. However, the pathway of biological events whereby this is accomplished has not been fully elucidated. The purpose of this study was to investigate the effect of extracorporeal shock waves on vascular endothelial growth factor (VEGF) expression in necrotic femoral heads of rabbits. VEGF expression was assessed by immunohistochemistry, quantitative real-time PCR, and Western blot analysis. The degree of angiogenesis was also assessed, as determined by the microvessel density (MVD), the assessment of which was based on CD31-expressing vessels. Bilateral avascular necrosis of femoral heads was induced with methylprednisolone and lipopolysaccharide in 30 New Zealand rabbits. The left limb (the study side) received shock wave therapy to the femoral head. The right limb (the control side) received no shock wave therapy. Biopsies of the femoral heads were performed at 1, 2, 4, 8, and 12 weeks. Western blot analysis and real-time PCR showed that shock wave therapy significantly increased VEGF protein and mRNA expression, respectively, in the subchondral bone of the treated necrotic femoral heads. Compared with the contralateral control without shock wave treatment, the VEGF mRNA expression levels increased to a peak at 2 weeks after the shock wave treatment and remained high for 8 weeks, then declined at 12 weeks, whereas the VEGF protein expression levels increased to a peak at 4 weeks after the shock wave treatment and remained high for 12 weeks. The immunostaining of VEGF was weak in the control group, and the immunoreactivity level in the shock-wave-treated group increased at 4 weeks and persisted for 12 weeks. The most intensive VEGF immunoreactivity was observed in the proliferative zone above the necrotic zone. At 4, 8, and 12 weeks after the shock wave treatment, MVD in subchondral bone from treated femoral heads was significantly higher than that in subchondral bone from untreated femoral heads. These data clearly show that extracorporeal shock waves can significantly upregulate the expression of VEGF. The upregulation of VEGF may play a role in inducing the ingrowth of neovascularization and in improving the blood supply to the femoral head.

Shock Wave Therapy Reduces Necrotic Flap Zones and Induces VEGF Expression in Animal Epigastric Skin Flap Model

The effect of extracorporeal shock wave (ESW) therapy on skin flap survival and growth factor expression was investigated in a rat model using epigastric skin flap. Treatment and control groups each contained 20 animals. ESW effectively enhanced epigastric skin flap survival by significant reduction of areas of necrotic zones. At day 7 after the operation, necrotic zones of 4.2% were found in the ESW-treated group compared with 18.3% in the control group ( P < 0.01). Concomitantly, in tissue samples adjacent to the necrosis areas, increased vascular endothelial growth factor expression was observed in the ESW-treated animals (median 84.5%, range 57.4 to 94.5%) compared with the control group (median 46.7%, range 29.1 to 93.1%; P < 0.1). However, for expression of basic fibroblast growth factor, no difference was found between the two groups. The authors conclude that the success of the shock wave treatment may partly be due to modulation of growth factor expression.

The effects of shock waves on lung tissue in acute period: an in vivo study

The acute effects of extracorporeal shock waves on lung morphology were studied by light microscopy in 30 New Zealand rabbits. The left kidneys of the ten animals were exposed to 2,000 shockwaves at 18 kV under anesthesia (ESWL group). Ten rabbits were in the control group; an intramuscular anesthetic agent (ketamine) and intravenous contrast media were administered to ten animals in the sham group. Localization of the left kidneys was achieved following contrast medium injection through an ear vein under fluoroscopic control. The animals were killed after the ESWL procedures and the lungs were removed. Edema, emphysema, hemorrhage, congestion, inflammation, loss of normal structure, and epithelial desquamation were determined and graded between 0 and 3 in all areas of both lungs. In order to determine whether proximity has any effect on the histopathological changes, left and right lungs were evaluated separately as well as upper and lower lobes. We found that ESWL exposed to kidney also affects all areas of the lungs in a rabbit model.