High-energy Shock Research Articles

Phase Entrainment of Induced Ventricular Fibrillation: A Human Feasibility and Proof of Concept Study.

Cardioversion and defibrillation by a single high energy shock applied by myocardial or body surface electrodes is painful, causes long term tissue damage, and is associated with worsening long term outcomes, but is almost always required for treatment of ventricular fibrillation . As a initial step towards developing methods that can terminate ventricular arrhythmias painlessly, we aim to determine if pacing stimuli at a rate of 5/s applied via an implantable cardiac defibrillator (ICD) can modify human ventricular fibrillation. In 8 patients undergoing defibrillation testing of a new/exchanged intracardiac defibrillator, five seconds of pacing at five stimuli per second was applied during the 10-20 seconds of induced ventricular fibrillation before the defibrillation shock was automatically applied, and the cardiac electrograms recorded and analyzed. The high frequency pacing did not entrain the ventricular fibrillation, but altered the dominant frequency in all 8 patients, and modulated the phase computed via the Hilbert Transform, in four of the patients. In this pilot study we demonstrate that high frequency pacing applied via ICD electrodes during VF can alter the dominant frequency and modulate the probability density of the phase of the electrogram of the ventricular fibrillation.

Novel Multicomponent Powders from the AlCrFeMnMo Family Synthesized by Mechanical Alloying

High‐entropy alloys (HEAs) and multicomponent alloys are known for their promising properties and the almost infinite possibilities of the design of new compositions. The Al–Cr–Fe–Mn–Mo family of HEAs is chosen to promote the formation of a body‐centered cubic (bcc) structure that exhibits high hardness and yield strength. Powder metallurgy is preferred to the liquid route to avoid segregation problems. Two compositions of alloyed powder, equiatomic and optimized, are successfully prepared by mechanical alloying. X‐ray diffraction (XRD) indicates the formation of two major bcc phases: bcc#1 (a1 = 3.13–3.14 Å) and bcc#2 (a2 = 2.87–2.94 Å). Energy transferred during milling depends greatly on the milling device and process conditions. Scanning electron microscopy–energy‐dispersive X‐ray spectroscopy (SEM–EDX) images reveal that high‐energy shocks of balls enable to elaborate homogeneous powder with controlled Fe contamination coming from the grinding vial and balls, whereas low‐energy shocks enable to produce powder free of contamination by Fe, with heterogeneous particles. Finally, the milling process is optimized to obtain a homogeneous alloyed powder with as little contamination as possible.

Detonation spray method: features of technical implementation of the process and technology for obtaining ultrathin layers of semiconductor oxides

The design has been developed and the main components of the equipment for detonation growth have been modernized, which allows conducting the synthesis of semiconductor ultrathin films. The equipment was modernized taking into account the features of the thermodynamic properties of semiconductor materials. The data on the main adapted elements of the equipment are given, their functional purpose is indicated. Special attention is paid to the principles of operation of both the modified units of equipment and their functional interrelations in managing the process of the synthesis of layers. The conditions for the functioning and burning of gaseous hydrogen - oxygen mixture to obtain a high-energy shock wave, which provided the process of mass transfer of matter from source to substrate during the synthesis of ultrathin oxide semiconductor layers, are found. Particular attention is paid to ensuring optimal gas-dynamic conditions for the propagation of the zone of increased pressure in the process of transferring the substance from the source to the growth substrate. The design has been developed and systems of check valves have been manufactured that provide a given rate of switching gas flows during the synthesis of semiconductor oxides. The detonation spray method was used to synthesize ultrathin layers of the PbO and ZnO systems. The crystallographic and morphological properties of the surface of layers synthesized by detonation growth were investigated by optical methods. The obtained photographic images were analyzed by the method of multifractal analysis. It is proved that the multifractal parameters of the spectrum of the nanoform surface area formed on the growth surface of the layers are comparable in size with the corresponding parameters for the spectra from the surface of the layers synthesized by vacuum technologies.

Comparison of clinical efficacy of proximal medial gastrocnemius release and shock wave for treating unilateral chronic plantar fasciitis

Objective To explore the validity of proximal medial gastrocnemius release (PMGR) for treating unilateral chronic plantar fasciitis. Methods The prospective study was conducted. From January 2018 to July 2018, 56 patients who were diagnosed chronic plantar fasciitis in Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, were enrolled and divided into study group(n=28) and control group(n=28) according to different therapies. Fifty-six patients were enrolled including 33 males and 23 females, the age was (48.1±6.2) years (range, 43.9-57.1 years). The patients in study group were treated with PMGR for unilateral chronic plantar fasciitis. Meanwhile, the patients in control group were treated by shock wave therapy, one extracorporeal shock wave therapy was accepted every 3 days, each impact 2 000 times, a total of five times. Visual analogue scale(VAS), the American orthopaedic foot and ankle hindfoot scale (AOFAS) and dorsal extension range of ankle joint of all patients before treatment and 3 months after treatment were recorded and compared. All the patients were outpatient followed for (3.9±0.7) months until October 2018, the pain and function of feet were recorded. Measurement data with normal distribution were expressed as mean±standard deviation (Mean±SD). The data were statistically analyzed by t test between two groups.Count data were analyzed by chi-square test between two groups. Results In study group, preoperative VAS, AOFAS and dorsal extension angleof ankle joint were (6.9±0.8) scores, (48.4±2.8) scores and (10.8±3.9)°, while 3 months after treatment VAS, AOFAS and dorsal extension angleof ankle joint were (2.1±1.0) scores, (82.8±3.6) scores and (21.9±4.8)°. The difference between pre-operation and 3 months after treatment of study group was significant(P 0.05). At 3 months after treatment, there were significant differences in VAS, AOFAS and dorsal extension angle of ankle joint between two groups(P<0.05), and the outcome of study group was better than the control group. Conclusions PMGR can not only relief pain of foot but also improve ankle function. This is an effective surgical treatment for unilateral chronic plantar fasciitis. Key words: Metatarsus; Fasciitis; High-energy shock waves; Gastrocnemius

Multicentre early experience with totally subcutaneous cardioverter-defibrillators in Poland.

IntroductionImplantable cardioverter-defibrillators (ICD) have a strong position in the prevention of sudden death. Nowadays, the most commonly used high-energy cardiac devices are transvenous ICDs. A new technology of totally subcutaneous ICDs (S-ICD) was invented and recently introduced into clinical practice in order to reduce lead-related complications of conventional ICDs. The aim of this paper is to present early experience with this new technology implemented in a few centres in Poland.Material and methodsMedical records of patients who had S-ICD-related interventions in Poland were retrospectively analysed.ResultsDuring the first year of S-ICD introduction into the Polish health system 18 patients underwent surgery connected with S-ICDs. Majority of them (17 patients) were implanted de novo. In one patient surgical revision of a device implanted abroad was performed. Most of patients (78%) had S-ICDs implanted for secondary prevention. Inability of transvenous system implantation due to venous access obstruction or high risk of infection related with transvenous leads accounted for 83% of indications for S-ICD. Only in three patients were S-ICDs implanted due to young age and active mode of life. The implantations of S-ICDs were performed without important early or late complications. During follow-up one patient had episodes of ventricular arrhythmia successfully terminated with high-energy shocks. One patient died due to progression of heart failure.ConclusionsS-ICD implantation procedure has been successfully and safely introduced in Polish clinical routine. Nevertheless, despite clear indications in recent ESC guidelines, this therapy is not directly reimbursed in Poland and needs individual application for refund.

Results of rest, soft sole slippers, contrast bath and plantar stretches physiotherapy in case of plantar fasciitis

Almost 10 lakh patients are affected by plantar fasciitis (PF), which is the commonest cause of chronic heel pain. This condition is often managed conservatively, and many rehabilitation protocols, some with the aid of orthoses, have been adopted, with good-to-excellent clinical results. Although most cases of chronic PF can be successfully managed with a conservative approach, alternative treatments, including high-energy shock wave therapy and corticosteroid injections, are commonly accepted as second-line treatment when traditional conservative therapy fails.The literature suggests that, initially, traditional conservative treatments consisting of rest, oral nonsteroidal anti-inflammatory drugs, foot orthotics, and stretching exercises can be tried for several weeks. In patients with chronic recalcitrant PF, extracorporeal shock wave therapy or corticosteroid injection can be considered. Surgery (Minimally invasive techniques) should be considered only after failure of the conservative treatments. Objectives: To study the effectiveness of Rest, exercises (Plantar fascia stretching technique), soft sole slippers and contrast bath with in patients with plantar fasciitis in fresh as well as recurrent cases. Materials and Methods: In the prospective study totally 30 subjects was taken, between the age group of 20 to 70 years in our Patients department Orthopedics at Tertiary care Hospital Surat with short follow-up of 2 weeks. Results: On comparing the Pre and post -test mean values of group nova’s score and foot functional index shows significant reduction in posttest mean in both the group. No patient in our study was non compliant to conservative treatment in 2 weeks follow-up.Conclusions: The Present study concluded that 2-weeks treatment program performed on subjects with plantar fasciitis demonstrated that both contrast bath and plantar fascia stretching exercises combined with rest & soft sole slippers were effective in reducing pain intensity and improving functional activities.

Vibroacoustic measurements and analysis of blasting works

Blasting works cause short-term high-energy shock waves - acoustic, air (airblast) and paraseismic. The duration of the event can be up to 2-3 seconds, while the rise time to the peak value is directly related to the delay between the individual explosive material (EM) and the firing sequence and ranges from a few to several milliseconds. Their propagation in the environment can affect people, animals and construction structures located not only in the close but also further distance from their source. If EM is placed on the surface of the earth during the detonation, the shock wave spreads evenly in all directions in the half-space, and when the detonation follows in rock, the wave usually travels in one direction and is accompanied by a paraseismic wave. However, the sound heard when detonating is part of the wave spectrum in the band from 20 to 20000 Hz, while the airblast itself has a frequency of less than 20 Hz. Since at some distance from the detonated EM, the parameters of the airblast are close to the parameters of the acoustic wave, the method of spreading the acoustic wave depends to a great extent on atmospheric conditions, i.e. density, temperature and humidity of the air, and from wind speed and its direction. To get to know the essence of the phenomenon of the impact of blasting works, measurements are carried out considering the propagation conditions, i.e. meteorological conditions as well as vibration analysis in the ground itself and on the building substructure. This paper presents the results of research carried out by the Authors in terms of the correct assessment of the impact range (acoustic, airblast, paraseismic waves) during EM detonation placed on the surface.

Subcutaneous implantable cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy: Results from an Italian multicenter registry

BackgroundDespite expanding indication of the subcutaneous implantable cardioverter defibrillator (S-ICD) in clinical practice, limited data exists on safety and efficacy of S-ICD in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. The aim of this multicenter study was to evaluate the safety and efficacy of S-ICD in ARVC patients. MethodsThe study population included 44 consecutive patients with definite ARVC diagnosis according to the 2010 ITF criteria (57% male, mean age 37 ± 17 years [range 10–75 years]) who received an S-ICD. Eighteen (41%) patients were implanted for secondary prevention. ResultsAt implant, all inducible patients (34/44) had conversion of ventricular fibrillation at 65 J. No early complications occurred. During a median follow-up of 12 months (7–19), 3 (6.8%) patients experienced complications requiring surgical revision. No local or systemic device-related infections were observed. Six patients (14%) received a total of 61 appropriate and successful shocks on ventricular arrhythmias. Six (14%) patients experienced 8 inappropriate shocks for oversensing of cardiac signal (4 cases) and non-cardiac signal (4 cases) with one patient requiring device explantation. No patients had the device explanted due to the need for antitachycardia pacing. ConclusionsThe study shows that S-ICD provides safe and effective therapy for termination of both induced and spontaneous malignant ventricular tachyarrhythmias with high energy shocks in ARVC patients, but the risk of inappropriate shocks and complications needing surgical revision should be considered.

Studying the influence of high-speed disintegrator activation on the properties of radiocontrast agents

Under the initiative and direct scientific supervision of academician I.V. Gorynin, researchers of CRISM “Prometey” began to study effects of high-energy shock disintegrator technology for processing materials of various classes and different purposes. In particular, much attention was paid to the activation of biomaterials in supersonic action in the working zone of disintegrators. This article studies effects of high-energy activation on biological activity of pharmaceutical and medical products.

Effect of different energy of extracorporeal shock waves on diabetic neuralgia in rats

Objective To observe the effects of different energy of extracorporeal shock waves(ECSWs)on diabetic neuralgia in rats. Methods Fifty clean-grade healthy male Sprague-Dawley rats of both sexes, aged 8 weeks, weighing 180-200 g, were divided into 5 groups (n=10 each) using a random number table method: control group (group C), diabetic neuralgia group (group DN), low-energy ECSW group (group L+ DN), medium-energy ECSW group (group M+ DN), and high-energy ECSW group (group H+ DN). Diabetic neuralgia models were established by intraperitoneally injecting streptozotocin (60 mg/kg) in DN, L+ DN, M+ DN and H+ DN groups.ECSWs at 1, 2 and 3 bar were applied during 4 consecutive weeks after successful establishment of the model once a week (T1-T4) in L+ DN, M+ DN and H+ DN groups, respectively.The mechanical paw withdrawal threshold (MWT), thermal paw withdrawal latency (TWL) and motor nerve conduction velocity (MNCV) were measured at T1-T4.Animals were sacrificed after the last measurement, and the sciatic nerve samples were obtained for determination of the expression of tumor necrosis factor-alpha(TNF-α) and interluekin-6(IL-6) (by Western blot) and expression of TNF-α and IL-6 mRNA (by real-time polymerase chain reaction). Results Compared with group C, MWT, TWL and MNCV were significantly decreased at T1-T4, and the expression of TNF-α and IL-6 protein and mRNA was up-regulated in the other groups (P<0.05). Compared with group DN, MWT at T2-4 and TWL and MNCV at T3, 4 were significantly increased, and the expression of TNF-α and IL-6 protein and mRNA was down-regulated in L+ DN, M+ DN and H+ DN groups (P<0.05). Compared with group H+ DN, MWT at T2-4 and TWL and MNCV at T3, 4 were significantly increased, and the expression of TNF-α and IL-6 protein and mRNA was down-regulated in L+ DN and M+ DN groups, and the expression of IL-6 mRNA was significantly down-regulated in group L+ DN (P<0.05). Conclusion ECSWs can mitigate diabetic neuralgia in rats, and the low- and medium-energy ECSWs produce better efficacy, and the mechanism is related to inhibiting inflammatory responses. Key words: High-energy shock waves; Diabetic neuropathies

Demethylation of ITGAV accelerates osteogenic differentiation in a blast-induced heterotopic ossification in vitro cell culture model.

Trauma-induced heterotopic ossification is an intriguing phenomenon involving the inappropriate ossification of soft tissues within the body such as the muscle and ligaments. This inappropriate formation of bone is highly prevalent in those affected by blast injuries. Here, we developed a simplified cell culture model to evaluate the molecular events involved in heterotopic ossification onset that arise from the shock wave component of the disease. We exposed three subtypes of human mesenchymal cells in vitro to a single, high-energy shock wave and observed increased transcription in the osteogenic master regulators, Runx2 and Dlx5, and significantly accelerated cell mineralisation. Reduced representation bisulfite sequencing revealed that the shock wave altered methylation of gene promoters, leading to opposing changes in gene expression. Using a drug to target ITGAV, whose expression was perturbed by the shock wave, we found that we could abrogate the deposition of mineral in our model. These findings show how new therapeutics for the treatment of heterotopic ossification can be identified using cell culture models.

Protective effects of breviscapine adjuvant therapy in renal injury caused by extracorporeal shock wave therapy for renal calculi

Objective To investigate the protective effects of breviscapine in renal injury caused by extracorporeal shock wave therapy for renal calculi. Methods Totally 120 patients with renal calculi treated in our hospital from January 2015 to January 2017 were selected and randomly divided into the control group and the study group with 60 cases in each group. The patients in the control group were treated with extracorporeal shock wave, and patients in the study group were treated with breviscapine assisted extracorporeal shock wave. Serum related factors [serum endothelin 1 (ET-1), malondialdehyde (MDA), kidney injury molecule-1 (Kim-1)], biochemical parameters of renal injury [blood urea nitrogen (BUN), β2 microglobulin (β2-MG), urinary N-acetyl β-D glucosaminidase (NAG)], clinical curative effect and prognosis [the World Health Organization Quality of Life Scale (WHOQOL-BRFE) score] were observed before and after treatment. Results There were no significant differences in ET-1, MDA, Kim-1, BUN, β2-MG, NAG and WHOQOL-BRFE scores between the two groups before treatment (P>0.05). After treatment, ET-1, MDA, BUN and WHOQOL-BRFE scores were significantly higher, and Kim-1, β2-MG and NAG were significantly lower than those before treatment, and the changes in the study group were more obvious than those in the control group (P<0.05). After treatment, the total effective rate of the study group was [90.00%(54/60)] was higher than that of the control group [75.00%(45/60)] (P<0.05). Conclusions Breviscapine adjuvant therapy is significantly effective in the treatment of patients with renal injury caused by extracorporeal shock wave therapy for renal calculi. It can improve the clinical curative effect, the prognosis and quality of life through effective regulation of related factors in serum biochemical indexes of renal injury. Key words: Kidney Calculi; ERIGERON BREVISCAPUS; Kidney; High-Energy Shock Waves

Shock Mitigation in Open-Celled TiNi Foams

High-energy shock events generated by impacts are effectively mitigated by Nitinol materials. Initial evidence of this capability was suggested by the dramatically superior cavitation-erosion performance of Nitinol coatings made by plasma spray processes, over steels and brasses. A fast acting hysteretic stress–strain response mechanism was proposed to explain this result, transforming the shock energy into heat. Extending this work to bulk TiNi, dynamic load characterization using Split Rod Hopkinson Bar techniques on solid porous TiNi confirmed that the mechanical response to high strain rates below 4200 s−1 were indeed hysteretic. This paper reports on dynamical load characterization on TiNi foams made by Self-Propagating High-Temperature Synthesis (SHS) using Split Rod Hopkinson Bar and gas-gun impact characterization to compare these foams to alternative materials. This work verified that SHS-derived TiNi foams were indeed hysteretic at strain rates from 180 to 2300 s−1. In addition, Shock Spectrum Analysis demonstrated that TiNi foams were very effective in mitigating the shock spectrum range below 5 kHz, and that increasing porosity increased the amount of shock attenuation in that spectral range. Finally under impact loading, 55% porous TiNi foams were a factor of 7 superior to steel and a factor of 4 better than Al 6061 or Cu in mitigating peak g-loads and this attenuation improved with bilayer structures of 57 and 73% porous TiNi foam article.

Efficacy of extracorporeal shock wave therapy combined with traditional Chinese medicine iontophoresis in elderly patients with knee osteoarthritis

Objective To investigate the clinical efficacy of extracorporeal shock wave therapy combined with traditional Chinese medicine iontophoresis in elderly patients with knee osteoarthritis(KOA). Methods Fifty-six patients with KOA were randomized into the drug therapy group(n=28)receiving only traditional Chinese medicine iontophoresis therapy for four weeks and the combined treatment group(n=28)receiving extracorporeal shock wave therapy combined with traditional Chinese medicine iontophoresis therapy for four weeks.WOMAC score as an specific severity-of-illness score was used to evaluate knee joint function of patients before and four-week after treatment. Results WOMAC scores of all patients were significantly decreased which indicated states of an illness were improved after four-week treatment as compared with pre-treatment(all P<0.05). The combined treatment group versus the drug therapy group showed markedly lower WOMAC scores, including pain score(3.17±1.03 vs.5.27±1.58, t=7.316, P<0.05), morning stiffness score(2.23±0.91 vs.3.32±1.14, t=3.440, P<0.05), activity restrict of daily living score(20.13±6.46 vs.27.35±13.28, t=4.691, P<0.05)and total score(28.37±11.62 vs.40.16±5.93, t=8.015, P<0.05). Conclusions Compared with single traditional Chinese medicine iontophoresis, the extracorporeal shock wave therapy combined with traditional Chinese medicine iontophoresis therapy may significantly reduce the pain and morning stiffness degree, and enhance activities of daily living in elderly patients with KOA. Key words: Osteoarthritis, knee; Iontophoresis; High-energy shock waves

Wearable cardioverter defibrillators in schools: A guide for parents and educators.

Keeping children safe is a goal for everyone. To stay safe, some children need a wearable cardioverter defibrillator (WCD). WCDs protect individuals who are at risk for life-threatening arrhythmias. The LifeVest® (ZOLL, Pittsburgh, PA, USA) is a WCD that identifies, records, and treats potentially life-threatening abnormal heartbeats, or arrhythmias. The WCD will provide electrical energy to the heart with up to five high-energy shocks if a potentially dangerous cardiac arrhythmia is detected. This type of arrhythmia, if not treated within a short time period (less than 2 minutes), can result in disruption of blood flow to the brain and other vital organs (that is, a sudden cardiac arrest), and death can occur within minutes. A shock delivered by the LifeVest can terminate an arrhythmia and restore a normal heart rhythm and blood flow to the body. In December 2015, the Food and Drug Administration approved the LifeVest for patients under 18 years old. The purpose of this guide is to serve as a resource for parents and educators, to promote awareness of the LifeVest, and to answer questions about the safety of the LifeVest in schools.

Gender Differences in Cardiac Resynchronization Therapy Device Choice and Outcome in Patients ≥75 Years of Age with Heart Failure

Cardiac resynchronization therapy (CRT) is an established therapy for heart failure and can be delivered through a CRT pacemaker (CRT-P) or a CRT defibrillator (CRT-D). CRT-P devices are smaller and less expensive, have better battery longevity, and have been subject to fewer recalls and advisories but cannot deliver high-energy shocks to terminate potentially lethal ventricular arrhythmias. As published guidelines do not distinguish between CRT-P and CRT-D indications, we examined the practice of prescribing these devices in older women and men with heart failure. A total of 512 CRT recipients (age ≥75 years, 26% women, 21% CRT-P) were included in this analysis. Baseline characteristics were collected on all patients, and overall survival was compared by gender and type of CRT device implanted. Women were more likely to receive CRT-Ps than men (26% vs 19%). Men with CRT-Ps were significantly older than women with CRT-Ps and both men and women with CRT-Ds (p = 0.04). In addition, women had lower all-cause mortality compared with men (hazard ratio [HR] 0.75, confidence interval [CI] 0.58 to 0.99, p = 0.04), mainly among CRT-P recipients (HR 0.48, CI 0.26 to 0.8, p = 0.02), but this association was attenuated after adjusting for differences in patient characteristics (HR 0.56, CI 0.26 to 1.18, p = 0.13). In conclusion, women are more likely to receive CRT-Ps than men. Whether this difference is driven by patient preference or physician biases remains unclear. Women with CRT, particularly CRT-Ps, have a better overall survival than men. These differences, which may be driven by unbalanced baseline characteristics of patients or by differences in gender response to CRT, deserve further investigation.

Advances in study of extracorporeal shock wave therapy for chronic overuse disease of shoulder joint

Chronic overuse disease of the shoulder is very common in clinical practice. Its pathogenesis is complicated and its treatment is often a combination of medication, rehabilitation and surgery. In recent years, its diagnosis tends to be more definite, leading to more specific treatment. Extracorporeal shock wave therapy has been successfully used in the treatment of such orthopaedic diseases as plantar fasciitis and lateral epicondylitis, and has been tried by some scholars in the treatment of chronic overuse disease of the shoulder. Its therapeutic effect has also been demonstrated to some extent on calcific tendonitis, non-calcific tendonitis and adhesive capsulitis. This review outlines the progress in research of extracorporeal shock wave therapy for the treatment of chronic overuse disease of the shoulder. Key words: Shoulder joint; Chronic disease; High-energy shock waves

An Attempt at Evaluation of the Remnant Influence On the Occurrence of Seismic Phenomena in a Room-and-Pillar Mining System with Roof Deflection

Abstract Experience gained until now underground mining worldwide and in Poland indicates that remnants may have an impact on the occurrence of seismic phenomena. Remnants are stress concentration sites encompassing both the deposit and the layers of rock mass located above and below the undisturbed rock. In the case where stresses in the remnant exceed its strength, it may collapse, and under unfavourable geomechanical conditions, stress-induced rockburst may occur. Remnants may also cause breaking of strong roof layers above their edges, which results in the occurrence of high-energy shocks (Salustowicz [30], Adach [3], Adach and Butra [4]). This article presents the possibility of utilizing numerical modeling to evaluate the influence of remnant upon the occurrence of seismic phenomena. The results of numerical calculations performed for a model room-and-pillar mining system with roof deflection under the conditions of copper ore mines in the Legnica-Głogów Copper District (LGOM) are presented. Numerical calculations in a plane strain state were performed by means of Phase2 v. 8.0 software for the analyzed mining system in which remnant was left behind. The results of numerical modeling showed that sudden fracturing of roof layers above the mined out space may occur on the edge of the remnant. This may cause a shock with very high energy, and under the appropriate conditions, this may lead to the rockburst phenomenon.

Effects of high- and low-energy radial shock waves therapy combined with physiotherapy in the treatment of rotator cuff tendinopathy: a retrospective study

Purpose: The aim of this study was to investigate the efficacy of high- and low-energy radial shock waves combined with physiotherapy for rotator cuff tendinopathy patients.Methods: Data from rotator cuff tendinopathy patients received high- or low-energy radial shock waves combined with physiotherapy or physiotherapy alone were collected. The Constant and Murley score and visual analog scale score were collected to assess the effectiveness of treatment in three groups at 4, 8, 12, and 24 weeks.Results: In total, 94 patients were involved for our retrospective study. All groups showed remarkable improvement in the visual analog scale and Constant and Murley score compared to baseline at 24 weeks. The high-energy radial shock waves group had more marked improvement in the Constant and Murley score compared to the physiotherapy group at 4 and 8 weeks and at 4 weeks when compared with low-energy group. Furthermore, high-energy radial shock waves group had superior results on the visual analog scale at 4, 8, and 12 weeks compared to low-energy and physiotherapy groups.Conclusions: This retrospective study supported the usage of high-energy radial shock waves as a supplementary therapy over physiotherapy alone for rotator cuff tendinopathy by relieving the symptoms rapidly and maintaining symptoms at a satisfactory level for 24 weeks.Implications for RehabilitationHigh-energy radial shock waves can be a supplemental therapy to physiotherapy for rotator cuff tendinopathy.We recommend the usage of high-energy radial shock waves during the first 5 weeks, at an interval of 7 days, of physiotherapy treatment.High-energy radial shock waves treatment combined with physiotherapy can benefit rotator cuff tendinopathy by relieving symptoms rapidly and maintain these improvements at a satisfactory level for quite a long time.

Optimal management of Brugada syndrome

Brugada syndrome can induce malignant ventricular arrhythmias in the absence of structural heart disease. The hallmark of the condition is the ’’coved’’ (type I) or ’’saddle-back’’ (types II and III) ST segment elevation in the right precordial leads. The definite diagnosis requires the documentation of the type I morphology. The electrocardiographic pattern is often dynamic, but it can be unmasked by sodium channel blockers such as flecainide. We report the case of a 33-year old male, with family history significant for sudden cardiac death, who underwent successful cardio-pulmonary resuscitation for ventricular fibrillation-associated cardiac arrest. The 12 lead electrocardiogram performed after the resuscitation maneuvers showed intermittent type 1 Brugada pattern. General physical examination and routine laboratory evaluation were unremarkable. A repeated electrocardiogram revealed sinus tachycardia with right bundle branch block. We performed a flecainide challenge test which reproduced the initial coved-type ST segment elevation in V1 and V2. We decided to implant a ventricular single chamber cardioverter-defibrillator with one therapeutical window for ventricular fibrillation (at 300 ms), high energy shocks without antitachycardia pacing. The device was successful in preventing another episode of ventricular fibrillation just 2 days after the procedure. Implantable cardioverter-defibrillators are the most effective secondary prophylaxis therapeutic options for individuals with Brugada Syndrome, but they subject the patient to complications related to device implantation and inappropriate shocks.