High-energy Shock Waves Research Articles

Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5

Application of extracorporeal shockwaves to the musculoskeletal system can induce long-term analgesia in the treatment of chronic painful diseases such as calcifying tendonitis of the shoulder, tennis elbow and chronic plantar fasciitis. However, the molecular and cellular mechanisms underlying this phenomenon are largely unknown. Recently it was shown that application of extracorporeal shockwaves to the distal femur of rabbits can lead to reduced concentration of substance P in the shockwaves' focal zone. In the present study we investigated the impact of extracorporeal shockwaves on the production of substance P within dorsal root ganglia in vivo. High-energy shockwaves were applied to the ventral side of the right distal femur of rabbits. After six weeks, the dorsal root ganglia L5 to L7 were investigated with high-precision design-based stereology. The application of extracorporeal shockwaves caused a statistically significant decrease in the mean number of neurons immunoreactive for substance P within the dorsal root ganglion L5 of the treated side compared with the untreated side, without affecting the total number of neurons within this dorsal root ganglion. No effect was observed in the dorsal root ganglia L6 and L7, respectively. These data might further contribute to our understanding of the molecular and cellular mechanisms in the induction of long-term analgesia by extracorporeal shockwave application to the musculoskeletal system.

High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Chronic Noninsertional Achilles Tendinopathy

Background High-energy extracorporeal shock wave therapy has been shown to be an effective treatment for chronic insertions Achilles tendinopathy. The results of high-energy shock wave therapy for chronic noninsertional Achilles tendinopathy have not been determined. Hypothesis Shock wave therapy is an effective treatment for noninsertional Achilles tendinopathy. Study Design Case control study; Level of evidence, 3. Methods Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated with a single dose of high-energy shock wave therapy (shock wave therapy group; 3000 shocks; 0.21 mJ/mm2; total energy flux density, 604 mJ/mm2). Thirty-four patients with chronic noninsertional Achilles tendinopathy were treated not with shock wave therapy but with additional forms of nonoperative therapy (control group). All shock wave therapy procedures were performed using regional anesthesia. Evaluation was by change in visual analog score and by Roles and Maudsley score. Results One month, 3 months, and 12 months after treatment, the mean visual analog scores for the control and shock wave therapy groups were 8.4 and 4.4 (P < .001), 6.5 and 2.9 (P < .001), and 5.6 and 2.2 (P < .001), respectively. At final follow-up, the number of excellent, good, fair, and poor results for the shock wave therapy and control groups were 12 and 0 (P < .001), 17 and 9 (P < .001), 5 and 17 (P < .001), and 0 and 8 (P < .001), respectively. A χ2 analysis revealed that the percentage of patients with excellent (“1”) or good (“2”) Roles and Maudsley scores, that is, successful results, 12 months after treatment was statistically greater in the shock wave therapy group than in the control group (P < .001). Conclusion Shock wave therapy is an effective treatment for chronic noninsertional Achilles tendinopathy.

Nonlinear effects in collision cascades and high energy shock waves during ta-C:H growth

The surface topography of hydrogenated tetrahedral amorphous carbon (ta-C:H) is critical for various applications such as microelectromechanical devices, magnetic and optical storage devices, and medical implants. The surface topography of ta-C:H films deposited by distributed electron cyclotron resonance plasma from C2H2 gas precursor was investigated. The effects of pressure, together with ion flux and energy, are studied by atomic force microscopy in relation to the structural evolution of the films. The results are compared with the predictions of the Edward-Wilkinson model [Proc. R. Soc. London, Ser. A 44, 1039 (1966)] recently proposed to account for ta-C:H growth and with previous interpretations based on hypersonic shock waves. The random hillocks observed on the smooth surfaces of ta-C:H films deposited at high pressure are thought to result from the interference of high energy shock waves triggered by C4Hx+ ions that produce overlapping collision cascades and induce nonlinear effects.

Refining Histotripsy: Defining the Parameter Space for the Creation of Nonthermal Lesions With High Intensity, Pulsed Focused Ultrasound of the In Vitro Kidney

Focused ultrasound therapy is a promising modality for noninvasive tissue ablation. However, the relative contributions of thermal and cavitational effects are poorly defined. We characterized the ultrasound parameters within which tissue ablation occurs by cavitational mechanisms without significant thermal effect. In vitro porcine kidneys were submerged in degassed water. Tissue ablation was performed by delivering ultrasound (750 kHz and 20 microsecond pulses) of constant spatial peak energy dose (100 J/cm(2)) to adjacent foci in a 3 x 3 grid configuration. For each ablation different intensity (0.11 to 211 kW/cm(2)) and duty cycle (0.04% to 100%) parameters were selected. A thermocouple co-localized with the center of each grid continuously measured temperature. Following ablation each kidney was examined grossly and histologically. Ablated tissue lesions were classified into 4 discrete morphological categories, including blanched--firm, pale, desiccated tissue, disrupted--a cavity containing thin, isochromatic liquid, mixed--a cavity containing pale, thick liquid with minimal blanching and no grossly visible effect. Morphologically similar lesions clustered at separable regions of the ultrasound parameter space. The maximal temperature attained in disrupted lesions was similar to that attained when there was no effect (44.2C and 47.2C, respectively, p = 0.31), although it was significantly lower than the maximal temperatures for desiccated or mixed lesions (67.5C and 59.4C, each p <0.0001). In an in vitro model we defined the ultrasound parameter region within which purely cavitational ablation of tissue is possible with a negligible thermal component. Additional research is needed to optimize the parameters for in vivo cavitational tissue ablation, incorporating the influence of tissue perfusion.

The Use of Extracorporeal Shock Waves in the Treatment of Delayed Unions and Nonunions

ABSTRACT This study highlights the emerging use of extracorporeal shock waves to treat nonunions and delayed unions. An overview of previous work performed in this area is presented. A feasibility study conducted by OssaTron (HealthTronics) is also reviewed, showing the results of high-energy extracorporeal shock wave for the treatment of nonunions in the proximal fifth metatarsal. Preliminary results support its effectiveness as a safe and less invasive means of treating difficult cases of nonunions or delayed unions. More research is needed to demonstrate the physiology of bone-healing induced by the use of shock wave therapy.

High Energy Shock Waves Activate 5′-Aminolevulinic Acid and Increase Permeability to Paclitaxel: Antitumor Effects of a New Combined Treatment on Anaplastic Thyroid Cancer Cells

Multimodal treatments do not meaningfully improve survival of anaplastic thyroid cancer. Consequently, new effective therapeutic modalities are needed. The use of paclitaxel is under clinical investigation; it shows about a 50% response rate, but it is not able to alter the fatal outcome for patients with anaplastic carcinoma. High energy shock waves (HESW) have been shown to cause a transient increase in the permeability of cell membranes thus allowing higher intracellular drug concentrations. 5-Aminolevulinic acid (ALA) is used in the photodynamic therapy (PDT) of cancer, and HESW are under evaluation for their use as an activator in ALA-PDT. We investigated the effect of HESW produced by a piezoelectric generator on the sensitivity to paclitaxel and ALA treatments of two different anaplastic thyroid cancer cell lines (ARO and CAL-62). Cells, treated sequentially with ALA and paclitaxel were exposed to HESW; thereafter, cell viability and apoptosis induction were evaluated. Combined exposure to ALA, paclitaxel, and shock waves resulted in a significant enhancement of cytotoxicity and induction of apoptosis in thyroid cancer cells with respect to cells treated with paclitaxel alone. These preliminary data suggest the possibility of using HESW and ALA in combination with paclitaxel as a promising new therapy in the treatment of anaplastic thyroid cancer.

High-temperature corrosion-resistance performance of electro-thermal explosion plasma spraying FeAl-base coatings

As a new spraying technology used in the remanufacturing engineering, electro-thermal explosion plasma spraying technique holds a lot of advantages. Three kinds of FeAl-base plasma spraying coatings, FeAl, FeCrAl and FeCrAlRE coatings, were prepared by using instantaneous high-energy shock wave effect produced by the electro-thermal explosion of metal conductor alloy foil of FeAl base. Nano-structure and micro-structure especially a metallurgy binding layer with FeAl-base body are formed. It is shown that microstructures of the FeCrAl and FeCrAlRE coatings were greatly improved due to the addition of Cr and RE. Meanwhile corrosion changing laws of these three plasma spray coatings can be gained after anti-corrosion tests under the conditions of high temperature and then sequentially select better electro-thermal explosion plasma spray coating of anti-corrosion and heat resistance.

High-energy extracorporeal shock waves in treatment of nonunion and delayed union: preliminary results

目的 观察Ossatron高能体外震波仪治疗骨不连和骨延迟愈合的效果.方法2004年10月～2005年10月采用体外震波治疗18例四肢骨折术后骨不连和4例骨延迟愈合患者,C型臂X线机透视定位,根据不同骨折部位选择合适的震波能量、频率和冲击次数.内固定不稳定者震波治疗后以石膏或支具固定6～8周.术后6、12周及以后每个月随访复查X线片,直至骨折愈合.结果所有患者获3～12个月(平均6.7个月)随访.10例患者震波后出现局部瘀斑或肿胀,术后1～3 d缓解;无其它并发症发生.22例患者中,13例(59.1%)获骨性愈合,骨折愈合时间平均为4.3个月(6周～6个月).18例内固定稳定的患者中12例骨折获愈合,其愈合率为66.7%.9例患者(40.9%)骨折未愈合.结论震波治疗对骨折断端稳定的骨不连和延迟愈合具有一定疗效,其突出特点是安全、无创。

High energy shock waves enhance the cytotoxic effect of doxorubicin and methotrexate to human osteosarcoma cell lines

Despite recent advances, the prognosis of relapsed osteosarcoma patients remains very poor. Application of high energy shock waves may change the tumour cell growth and increase the cytotoxic effect of in vivo and in vitro chemotherapeutic agents. We studied the effect of their association with doxorubicin or methotrexate on three in vitro osteosarcoma cell lines. The effect of these combinations on SJSA-1, MG-63 and HOS human osteosarcoma cell lines were evaluated through incubation with doxorubicin or methotrexate and high energy shock wave treatment with 1000 shots at 0.22 mJ/mm(2) and an evaluation of the cell number, cell proliferation and apoptosis at days 1, 3 and 6 from the start of treatment. The combination of high energy shock waves and doxorubicin induced a statistically significant advantage in terms of a decrease in cell number on the SJSA-1 and HOS cell lines, a decrease of cell proliferation on all three cell lines and an increase of apoptosis only on the SJSA-1 cell line. The combination of high energy shock waves with methotrexate induced a decrease of the cell number only in the SJSA-1 and in the HOS cell lines, of the cell proliferation in the SJSA-1 and in the MG-63 cell lines, and an increase of apoptosis only on the SJSA-1 cell line. In conclusion, these experiments show an interesting effect of high energy shock waves on osteosarcoma cell lines, which could lead to future studies of the in vivo effects of high energy shock waves in the murine model as well.

Feasibility of cord blood stem cell manipulation with high-energy shock waves: An in vitro and in vivo study

Cord blood CD34+ cells are more uncommitted than their adult counterparts as they can be more easily maintained and expanded in vitro and transduced with lentiviral vectors. The aim of this study was to evaluate whether pretreatment with high-energy shock waves (HESW) could further enhance the expansion of cord blood progenitors and the transduction efficiency with lentiviral vectors. Human cord blood CD34+ cells underwent HESW treatment with a wide range of energy and number of shots (from 0.22 mJ/mm2 to 0.43 mJ/mm2 and from 200 to 1500 shots). Cells were then evaluated both for their in vitro expansion ability and in vivo engraftment in primary, secondary, and tertiary NOD/SCID mice. The transduction efficiency with a lentiviral vector (LV) was also evaluated in vitro and in vivo. Cell viability following HESW ranged from 75 to 92%. Pretreatment with HESW significantly improved early progenitor cell expansion after short-term suspension culture. Upon transplantation in primary NOD/SCID mice, the HESW treatment enhanced progenitor cell engraftment (total human CD45(+)CD34+ cells were 10% in controls and 14.5% following HESW, human CD45(+)CD34(+)CD38(-) cells were 0.87% in controls and 1.8% following HESW). HESW treatment enhanced the transduction of a GFP+ lentiviral vector (e.g., at day 42 of culture 6.5% GFP+ cells in LV-treated cell cultures compared to 11.4% of GFP+ cells in HESW-treated cell cultures). The percentage of human GFP+ cell engrafting NOD/SCID mice was similar (34% vs 26.4% in controls); however, the total number of human cells engrafted after HESW was higher (39.6% vs 15%). The pretreatment of CD34+ cells with HESW represents a new method to manipulate the CD34+ population without interfering with their ability to both expand and engraft and it might be considered as a tool for genetic approaches.

The Isolated Perfused Kidney: Anin VitroTest System for Evaluation of Renal Tissue Damage Induced by High-Energy Shockwaves Sources

Most of our knowledge of shockwave-induced renal damage is based on animal experiments and clinical observation. We developed a tissue model using isolated porcine kidneys perfused with Berliner Blau dye in physiologic saline using a Ureteromat Perez-Castro peristaltic pump connected to the renal artery. Reproducible results were obtained under a variety of experimental conditions. Further refinements of the model might consist of interposition of tissue layers in the shockwave path or simulation of ventilatory movements.

Nephrolithiasis and hematuria - sometimes a stony road to diagnosis

We report a case of a young man with a history of kidney stones. Occurrence of gross hematuria several months after the extracorporeal shock wave, lithotripsy (ESWL) treatment lead to hospitalization. By ultrasound and abdominal CT scan, the urologist could exclude post-renal causes of the gross hematuria and acute renal failure. After transfer to a department of nephrology hemodialysis was started, an immediate kidney biopsy was performed and prednisolone was administered on the same day. The kidney biopsy revealed an anti-glomerular basement membrane (GBM) disease. The renal function did not recover and the patient remained on hemodialysis. In the literature it has been hypothesized that ESWL-treated patients are prone to develop anti-GBM disease by liberation of glomerular basement antigen through the ESWL high energy shock waves. An additional hypothesis considering the higher susceptibility for anti-GBM disease among certain HLA-tissue types is discussed with regard to our case. Unfortunately, the prolonged track to diagnosis and delayed immunosuppressive treatment could not prevent poor clinical outcome. Although anti-GBM disease is a rather rare disease, it should be included as a differential diagnosis for hematuria--especially months after ESWL treatment. Otherwise early diagnosis may be missed and as in our patient immunosuppressive treatment will remain unsuccessful to recover renal function.

Chronic Plantar Fasciitis: Acute Changes in the Heel after Extracorporeal High-Energy Shock Wave Therapy—Observations at MR Imaging

To prospectively evaluate with magnetic resonance (MR) imaging the acute changes in the heel associated with extracorporeal shock wave therapy (ESWT). Institutional clinical study review board approved the study, and informed consent was obtained. MR imaging was performed within 24 hours before and after ESWT on 18 feet of 12 patients (eight women and four men; age range, 33-63 years; average, 49.9 years) with chronic plantar fasciitis. ESWT was applied to the most painful point on the plantar surface of the heel, with a total of 1500 shocks at 18 kV. The MR imaging protocol consisted of sagittal and coronal T1- and T2-weighted images with and without fat saturation. The images were reviewed to assess the post-ESWT changes in soft-tissue and bone marrow edema, the thickness of the proximal plantar fascia, and the presence of a heel spur. Paired t test was used for the statistical analysis. Soft-tissue edema, which was present in 16 (89%) of 18 heels before ESWT, had increased in severity in 12 (75%) heels after ESWT. Calcaneus bone marrow edema at the insertion site was observed in eight heels before ESWT. After ESWT, the extant of bone marrow edema had increased in one heel and had newly developed in another heel. The heel spur seen in nine (50%) feet was not affected by ESWT. In 17 (94%) heels, the proximal plantar fascia was abnormally thick, with thickness not significantly changed with use of ESWT (P > .05). Increase in soft-tissue edema is the most common acute response associated with ESWT.

La lithotritie focalisée dans le traitement des tendinopathies calcifiantes de l’épaule: Résultats à 2 mois et un an

Objective The authors report their experience with extracorporeal lithotripsy in 30 patients with calcific tendinosis of the rotator cuff. Materials and method This technique is based upon the utilization of high-energy shockwaves (6000 shocks in 3 sessions Day 1, D8, D30) under continuous ultrasound localization of the lesion (EPOS Ultra 1). Calcification were evaluated at plain film, US and CT to characterize their length and features. Results Complete or partial resorption of calcifying deposits within 2 months and one year was observed in 27.5% and 25% of cases respectively. Clinical improvement results are encouraging at two months (50%), but reduced at one year (28.5%), consistent with the rate of resorption of calcifications. Conclusion This painful, long, and expensive technique seems to be disappointing in the treatment of the calcific tendinosis.

Current limitations of radiofrequency ablation in renal cell carcinoma.

Current limitations of radiofrequency ablation in renal cell carcinoma.

Operative und nichtoperative Behandlung bei Pseudarthrosen

This review article summarizes our present knowledge on the physiological and on impaired processes in bone healing. All the clinical procedures applied are based on empirical clinical data and do not qualify as evidence-based medicine. Against this backdrop, high-energy shockwave treatment may well be a treatment alternative in selected patients who have already undergone surgery but are still suffering from a pseudarthrosis. For the time being, however, this form of therapy should be used only in clinical studies.

Effects of high-energy shock wave on organs adjacent to the kidney in the growing rat

To assess the effects of high-energy shock waves (HESW) on organs adjacent to the kidney, in the growing rat. We studied 60 Wistar male rats. Upon completing 30 days of age, a radiopaque marker was placed in the animals' left renal cavity. With 40 days of age, after radiologically confirming the markers' position, the rats were divided into 2 groups: control-group--30 rats that did not receive shock waves; experimental group--30 rats exposed to 1000 shock waves of 17.2 KV in intensity. The rats were sacrificed 7, 90 and 180 days after exposure to HESW. The bodily growth was assessed and the analysis of macro- and microscopic morphology of liver, spleen, pancreas, lungs and adrenals. There was no statistical difference in the animals' bodily growth. The microscopic morphologic analysis demonstrated significant alterations in spleen (proliferative changes in the red pulp) and liver (cloudy swelling) of the animals submitted to HESW and sacrificed on the seventh day. These changes completely disappeared in subsequent analyses. HESW applied to rat did not inhibit the animals' growth and caused transitory histological lesion in spleen (proliferative changes in the red pulp) and in liver (cloudy swelling of hepatocytes). Such changes were observed only in the group that was exposed to HESW and was sacrificed 7 days following the experiment, presenting spontaneous recovery.

1114: Same-Pole Application of Low- and High-Energy Shock Waves Protects Kidney from Swl-Induced Tissue Injury

You have accessJournal of UrologyDiscussed Poster, Monday, May 10, 2004, 1:00 - 5:00 pm1 Apr 20041114: Same-Pole Application of Low- and High-Energy Shock Waves Protects Kidney from Swl-Induced Tissue Injury Lynn R. Willis, Andrew P. Evan, Bret A. Connors, Philip M. Blomgren, Rajash K. Handa, and James E. Lingeman Lynn R. WillisLynn R. Willis More articles by this author , Andrew P. EvanAndrew P. Evan More articles by this author , Bret A. ConnorsBret A. Connors More articles by this author , Philip M. BlomgrenPhilip M. Blomgren More articles by this author , Rajash K. HandaRajash K. Handa More articles by this author , and James E. LingemanJames E. Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)38351-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1114: Same-Pole Application of Low- and High-Energy Shock Waves Protects Kidney from Swl-Induced Tissue Injury." The Journal of Urology, 171(4S), p. 294 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 294 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Lynn R. Willis More articles by this author Andrew P. Evan More articles by this author Bret A. Connors More articles by this author Philip M. Blomgren More articles by this author Rajash K. Handa More articles by this author James E. Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...

274 The isolated perfused kidney — A suitable test kit for the evaluation of high energy shockwave induced renal tissue damage

274 The isolated perfused kidney — A suitable test kit for the evaluation of high energy shockwave induced renal tissue damage

Simultaneous Double External DC Shock Technique for Refractory Atrial Fibrillation in Concomitant Heart Disease

Atrial fibrillation (AF) has been treated with DC shocks delivered transthoracically, but in 5-30% of patients, the procedures fail to restore sinus rhythm (SR). We hypothesized that applying high energy shock waves to the chest may overcome the inadequate penetration of electrical shock to the atrium. The aim of this study was to evaluate the efficacy of higher energy external DC shock for the treatment of refractory AF coexisting with cardiovascular disease using a synchronized double external defibrillator. Fifteen patients (mean age 65 +/- 8) with refractory AF to standard DC cardioversion (CV) underwent higher energy DC shock using a double external defibrillator. Concomitant heart disease was present in all patients. Warfarin and amiodarone (600 mg/day), were administered for at least three weeks duration before DC CV. Sedation was performed with IV midazolam. Two defibrillator paddles were positioned on the anterior and posterior chest wall in a right lateral decubitus position. Defibrillators were synchronized to the R waves and simultaneously 720 joules of energy was administered to the patients. Amiodarone (200 mg/day) was continuously administered after DC shock to maintain SR. Sinus rhythm was obtained in 13 patients. Sinus rhythm was persistent in 11 patients for six months duration. Creatine kinase MB fractions were normal at 4 (22 +/- 4 IU/L) and 12 hours (18 +/- 4 IU/L). None of the patients developed significant hemodynamic compromise or congestive heart failure, higher AV block, stroke, or transient ischemic cerebral events. The results indicate that higher energy DC shock application using a double external defibrillator is an effective and safe method for the cardioversion of refractory AF. We believe this procedure should be performed before internal atrial cardioversion.