Shock Wave Treatment Research Articles

Treatment of chronic plantar fasciitis: a comparative study between shockwave therapies and local corticosteroid injection

Introduction One of the most prevalent ailments for which people seek treatment at a foot and ankle surgery facility is heel discomfort. Plantar fasciitis (PF) is one of the most common causes of adult heel pain and accounts for 11 to 15 % of all foot illnesses requiring medical care. The major symptom is pain and soreness at the heel where the plantar fascia is attached while starting weight- bearing after lengthy periods of rest. Rest, non-steroidal anti-inflammatory drugs (NSAIDs), stretching of the plantar fascia, physical therapy, foot cushioning, and orthotic devices, which may be utilized to meet the patient's demands, are some of the current conservative therapies for PF(planter fasciitis). In intractable instances of plantar fasciitis, where conservative therapy have failed to provide relief, steroid injections into the plantar fascia are often employed. Other treatment options for PF, including extracorporeal shockwave therapy (ESWT) are advised if patients do not react to conservative therapies. Patients and methods This study included 50 patients with chronic PF who had failed to react to conservative treatments such as physical therapy, NSAIDs, stretching exercises, and heel cushions for at least 6 months, and who did not have flatfeet or gastrocnemius contracture met the inclusion criteria. Patients were randomly divided into 2 groups: 25 patients received radial extracorporeal shockwave therapy (ESWT) once a week for six weeks (Group I); 25 patients got a single local corticosteroid injection at the plantar fascia's origin (40 mg / 2 ml of methylprednisolone together with 1 ml of local anesthesia, once) (Group II). Assessment of heel pain was done at the start of the trial and before each session using VAS score which was the primary outcome measure at 1, 3 and 6 months. Results A total of 50 individuals with persistent planter fasciitis (PF) were included in this investigation. Their age varied from 25 to 45 years old. Females made up 70 % of the sample, while males made up 30 %. Group I: 25 patients with PF who got extracorporeal shockwave treatment for 6 weeks at a time (once a week). There were 17 females (68 %) and 8 males (32 %), in the age ranging from 28 to 44 (mean SD 18.2).Group II: consisted of 25 individuals with PF who were given a local corticosteroid injection. There were 18 females (86.7 percent) and 7 males (13.3 percent) with ages ranging from 25 to 45 years (mean SD 21.9). Group I included 20 patients (80 %) and group II had 22 patients (88 %) who had pain in one foot, whereas 5 (20 %) patients and 3 (12 %) patients had pain in both feet, with no statistically significant difference. There was no significant difference between the groups in terms of the VAS score at the start of the trial (p = 0.26), the mean VAS scores were 6.4 and 6.2 in groups I and II, respectively. At one month, the mean VAS scores were 1.6 and 1.2 in group I and II, respectively. At 3 months, the mean VAS score were 2.2 and 1.7, at 6 months 5.1 and 2.3 for groups I and II, respectively. Conclusion ESWT and local corticosteroid injection therapies are safe and effective but local corticosteroid injection is more effective than ESWT in the treatment of chronic plantar fasciitis.

Clitoral Dysesthesia Following Suprapubic Liposuction: A Case Report of Injury to the Nerves Adjacent to the Clitoris

ABSTRACT Introduction Clitorodynia is a bothersome genito-pelvic dysesthesia characterized by atypical sensations such as burning, stinging, and/or sharp pain confined to the glans clitoris, common clitoral shaft and/or prepucial (hood) area that may be constant, intermittent or occurring only when provoked. Clitorodynia, like other genito-pelvic dysesthesia conditions, may result from a trigger in the end organ (clitoris), pelvic/perineum (pudendal/pelvic nerve neuropathy), cauda equina (Tarlov cyst, annular tear), spine, or brain. While the primary sensory nerve of the clitoris is the dorsal nerve, there are sensory nerves adjacent to the clitoris in the suprapubic area. A 55 year old woman who presented to our sexual medicine clinic for evaluation of clitoral dysesthesia following a suprapubic liposuction in May 2016. She described a 5 year history of unusual, unwanted, unrelenting sensations that felt weird, electrical, uncomfortable, and "nervy", were located to the left side of her clitoris/upper left inner labia, were present all the time at a minimum 5/10 intensity increasing to 7-8/10 that prevented her from focusing on tasks, including sexual activity. Objective We herein describe our evaluation and management of this patient with clitoral genito-pelvic dysesthesia. Methods The evaluation involved a detailed biopsychosocial assessment including: medical history; psychologic assessment; hormone assessment; vulvoscopy with cotton-tip swap testing; neurogenital testing for assessment of the integrity of the pudendal and sciatic nerves; and left clitoral/left inner labia anesthesia testing to assess for clinically significant symptom reduction. Results History was positive for diabetes mellitus, hypercholesterolemia, hypertension, abdominoplasty surgery (2007) and L5-S1 fusion (2010). Physical examination using vulvoscopy with cotton-tip swab testing revealed a focal region of dysesthesia (∼ 4 cm long, ∼2 cm wide) to the left of the clitoris and left upper inner labia associated with significant tenderness (7/10). Pudendal nerve integrity testing was normal. Sciatic nerve integrity testing was abnormal consistent with her previous spine surgery. Cotton-tip swab testing after focal anesthesia of the region of dysesthesia with benzocaine 20%, lidocaine 8% and tetracaine 6% revealed a clinically significant symptom reduction to pain free (0/10). Conclusions Clitoral dysesthesia can occur from injury to the nerves adjacent to the clitoris. This is a case of clitoral genito-pelvic dysesthesia in the end organ following a liposuction procedure to the suprapubic area. The most likely trigger was iatrogenic neuropathic injury of the left anterior labial branch of the genital branch of the genitofemoral nerve and/or left anterior labial branch of the ilioinguinal nerve. These latter nerves course in the suprapubic area and do not innervate the clitoris itself. Nerve testing of the clitoris, innervated by the dorsal nerve branch of the pudendal nerve, was unremarkable. Proposed management of the clitoral dysesthesia will focus on treating the iatrogenic peripheral neuropathy in the end organ and include perineural 5% dextrose injections, low intensity shockwave treatments, platelet rich plasma injections, and/or steroid injections. Disclosure No

Effect of Early Radial Shock Wave Treatment on Spasticity in Subacute Stroke Patients: A Pilot Study.

Background Spasticity is a complication that can start immediately after stroke. Radial extracorporeal shock wave therapy (rESWT) is a physical therapy tool used to manage chronic spasticity. However, the effect of rESWT's early use to treat spasticity after stroke is still not clearly investigated. The aim of this study is to evaluate the efficacy of rESWT in improving poststroke spasticity of the upper limb in patients with a recent onset of spasticity compared to conventional physiotherapy alone. Methods 40 stroke patients were randomly assigned to experimental (EG) or control group (CG). Both groups underwent two daily sessions of conventional rehabilitation therapy (CRT) 5 days per week; the EG underwent one rESWT session a week for 4 weeks. The modified Ashworth scale (MAS) tested at the shoulder, elbow, and wrist was used as outcome measure. MAS was evaluated at baseline, after 2 and 4 rESWT session, and one month after the last session (follow-up). Results No significant differences between groups were found at baseline in terms of age, days from onset of spasticity after stroke, and MAS at each body segment. The sample lost eight drop-out patients. Except for the shoulder MAS values, the EG showed statistically significant lower MAS values already after the second rESWT session compared to CG. This significant difference was maintained until the follow-up. The CG showed a significant increase of wrist spasticity after the second evaluation, while the EG maintained constant MAS values throughout the observational period. The elbow spasticity was significantly higher in the CG at the follow-up evaluation. Conclusion The rESWT combined with CRT seems to be effective in avoiding the increasing progression of spasticity after stroke.

Shockwave impact on the stability of anatase titania nanoparticles

The stability of anatase titania nanoparticles was investigated under exposure to repeated loading of shockwaves produced in a diaphragm-driven high-pressure shock tube. The titania samples were exposed to 20 shocks with pressure, temperature, and steady exposure time in the range of 20.5 – 26 bar, 1399 – 2101 K, and 1.74 – 1.83 ms, respectively. The crystal structure and surface morphology were analyzed before and after the shockwave treatment using various characterization techniques. After repeated shock exposure, there was reduction in crystallite size by ~ 40%, modification in the surface charge, and an increase in the hydroxyl groups in titania. The onset of phase transformation from anatase to rutile was observed after 20 shocks. This work gives insights into the structural changes induced by shockwaves in anatase nanoparticles which can help improve their performance as a catalytic support in heterogeneous catalysis.

The efficacy and safety of low-intensity extracorporeal shock wave treatment combined with or without medications in Chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis.

We performed this systematic review and meta-analysis to investigate the efficacy and safety of Li-ESWT combined with or without medications for patients with Chronic prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS). A comprehensive search was conducted of PUBMED, Cochrane Library, and Web of Science databases from inception to February 2022 for randomized controlled trials (RCTs) assessing the efficacy and safety of Li-ESWT with or without the combination of medications compared with the control group. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Visual Analogue Scale/Score (VAS), International Index of Erectile Function (IIEF), and International prostate symptom score (IPSS) were used to assess the improvements of symptoms in CP/CPPS patients. 651 patients from 12 randomized controlled studies were included in this study. The total NIH-CPSI scores, pain domain scores, and quality of life (QOL) scores were significantly lower in the Li-ESWT group than those in the control group at the termination of treatment, and 1, 4, 12, and 24 weeks after treatment. And these scores were significantly reduced in the Li-ESWT group than in baselines. In the subgroup analysis, reductions of these scores lasted longer and were greater in Li-ESWT combined with medications than in Li-ESWT alone. In the Li-ESWT group, the VAS score; IIEF score; and IPSS score were significant improvements than those in control group at the termination of treatment, and 1, 4, and 12 weeks after treatment; 4, 12, and 24 weeks after treatment; and 1, 4, and 12 weeks after treatment, respectively. Li-ESWT is a safe, non-invasive, and effective option for patients with CP/CPPS, whether combined with medications or not, should be recommended for widespread use in clinical practice.

The Efficacy of Li-ESWT Combined With VED in Diabetic ED Patients Unresponsive to PDE5is: A Single-Center, Randomized Clinical Trial.

IntroductionPhosphodiesterase type 5-inhibitors (PDE5is) are the first-line treatment for patients with diabetes mellitus-induced erectile dysfunction (DMED), however, some patients are non-responser to PDE5is. We performed a perspective, randomized, comparative study to explore the efficacy of low intensity extracorporeal shock wave treatment (Li-ESWT) combined with vacuum erectile device (VED) in the treatment of DMED patients who were unresponsive to PDE5is.MethodsOne hundred and five eligible patients were randomly divided into three groups: group A (VED), group B (Li-ESWT) and group C (VED plus Li-ESWT). Follow-up was conducted at 4 weeks, 8 weeks and 12 weeks after the end of treatment. The erectile function was estimated by the international index of erectile function-erectile function domain (IIEF-EF), erection hardness score (EHS), sexual encounter profile questions 2 and 3 (SEP2 and SEP3) and global assessment question 1 and 2 (GAQ1 and GAQ2) before and after treatment. The changes of five points in IIEF-EF were calculated as the minimal clinical important difference (MCID), which was considered as the main index of efficacy.ResultsThe MCID was achieved in 14.7%, 14.7% and 17.6% patients in group A at the follow up on 4 weeks, 8 weeks and 12 weeks, respectively (36.4%, 39.4% and 36.4% in group B; 36.4%, 51.5%, and 66.7% in group C). There were significant differences in the percentage of MCID cases between group A and group C at the follow up on 12 weeks (P<0.001), as well as that between group B and group C (P=0.014). Additionally, comparison in MCID within group C showed that there were significant differences between 4 weeks and 12 weeks follow-up (P=0.014).ConclusionOur findings indicated the combined therapy Li-ESWT and VED was more beneficial to shift turn PDE5is non-responders to responders for moderate patients with DMED than VED or Li-ESWT monotherapy. Moreover, this study provided evidence that patients with DMED who failed after taking oral PDE5is could attempt to opt for an alternative physicotherapy (Li-ESWT or VED) prior to more invasive alternatives.

Efficacy of Low-Intensity Extracorporeal Shock Wave Treatment in Erectile Dysfunction Following Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Erectile dysfunction (ED) is a well-known complication of radical prostatectomy (RP). Oral 5-phosphodiesterase inhibitors are currently the most widely used penile rehabilitation treatment for ED following RP, but they are less effective than for those with general ED. Low-intensity extracorporeal shock wave treatment (LI-ESWT), causing a biological change that induces neovascularization, has recently been used as a treatment for ED. Therefore, we conducted a systematic review and meta-analysis to investigate the efficiency of LI-ESWT in ED following RP. PubMed, Embase, and the Cochrane Library were searched up until December 2021. The endpoint was the change in IIEF scores after LI-ESWT. Five papers (460 patients) were included in the final analysis. In IIEF scores performed 3–4 months after LI-ESWT, the group receiving LI-ESWT showed statistically significantly better results than the control (WMD = −2.04; 95% CI, −3.72 to −0.35; p = 0.02). However, there were a total of two studies that measured the results after 9–12 months. There was no statistical difference between the two groups (WMD = −5.37; 95% CI, −12.42 to 1.69; p = 0.14). The results of this analysis indicate that LI-ESWT showed a statistically significant effect on early recovery in penile rehabilitation of ED following RP. However, the level of evidence was low. Therefore, careful interpretation of the results is required.

Coccydynia in postpartum women: A retrospective study of final results of extracorporeal shock wave treatment

Introduction: Postpartum coccydynia is pain that appears as soon as a sitting position is adopted after delivery. Coccyx morphology, body mass index, vaginal delivery, instrumental delivery, multiparity, female sex, mature age and short perineum in women with difficult delivery are risk factors. Coccydynia is pain around the coccygeal region, which is caused by sudden impact over the coccyx area from falling from height or traumatic injuries, prolonged sitting for a long time in a narrow space, leaning back while in a seated position leads to increased pressure on the coccyx, vaginal birth delivery etc. which results in pain and inflammatory changes around the surrounding ligaments and muscles. Most patients prefer the conservative treatment with non-invasive methods for coccydynia. In recent years (ESWT) is suggestive for the non-invasive treatment of many musculoskeletal conditions, including plantar fasciitis, epicondylitis and shoulder calcification and coccydynia. Aim and objectives: The purpose of the study is to evaluate the effects of ESWT on the outcomes of Coccydynia in postpartum women. Materials and methods: This study had a retrospective design from january 2018 to december 2021.The clinical data of 22 patients treated with ESWT were analysed and followed up at regular intervals of 1month, 3months, 6months. All the patients were referred from department of obstetrics &amp; gynaecology or an obstetrics &amp; gynaecology consultant to Orthocare, Vijayawada and department of orthopaedics, NRI general hospital, chinnakakani. We have given three sessions per week, preferably on the alternative days. The number of sessions per patient varies from 6 -10. Visual analog scale (vas) scores were noted at the initial consultation, at each session, and during the initial and final follow-up (at 6 months) examinations after the treatment. The 36-item short-form (sf-36) quality of life scale survey was conducted at the beginning and end of the treatment. Results: The mean VAS score was 9.6 (9–10) before the treatment and 3.4 (0–2) after the treatment (p &lt; 0.05). The VAS score decreased to ≤3 in 79.4% of patients. Compared with the preoperative SF-36 scores for physiological function, mental health, and social function, the postoperative scores were significantly improved. Conclusion: ESWT is a cost-effective treatment method with low rates of complications especially in breast feeding mothers where anti inflammatory analgesics are not a good choice to control the pain. In our study, ESWT provided effective pain control for chronic coccydynia. At least four sessions are needed to achieve a successful outcome.

Clinical study of type Ⅲ prostatitis treated with "warming and promoting technique" of acupuncture combined with extracorporeal shock wave

To observe the clinical curative effect of wentongzhenfa (warming and promoting technique of acupuncture) combined with extracorporeal shock wave in treatment of type Ⅲ prostatitis. A total of 96 patients with type Ⅲ prostatitis were randomly divided into an observation group (48 cases) and a control group (48 cases). In the control group, the extracorporeal shock wave was combined with even-needling technique of acupuncture at Guanyuan (CV4), Mingmen (GV4), Zhongji (CV3), Zusanli (ST36), etc. In the observation group, the extracorporeal shock wave was combined with "warming and promoting technique" of acupuncture at the same acupoints as the control group. The treatment lasted 30 min each time, once daily in either group. There were 2 days of interval after consecutive treatment for 5 days. Totally, the duration of treatment was 1 month in two groups. The clinical curative effect was assessed after treatment. Before and after treatment, the changes in the concentrations of tumor nerosis factor-α (TNF-α), interleukin-1β(IL-1β) and IL-6 in prostatic fluid were determined; and the symptoms were scored, i.e. frequent, urgent and burning painful urine, difficulty in urination, dribbling urine, distending pain in perineum, bitter taste and dry mouth, and scrotal dampness. The changes in the scores of National Institute of Health chronic prostatitis symptom index (NIH-CPSI), international index of erectile function (IIEF), visual analogue scale (VAS) were evaluated befroe and after treatment. Successively, before treatment, after treatment, as well as 1 and 3 months after treatment, the quality of life was evaluated by Karnofsky in the patients of two groups. After treatment, the total effective rate was 89.6% (43/48) in the observation group, higher than 70.8% (34/48) in the control group (P<0.05). Compared with those before treatment, the concentrations of TNF-α and IL-1β in the prostatic fluid were all decreased (P<0.05) and the concentration of IL-6 was increased (P<0.05), the scores of symptoms, NIH-CPSI, IIEF and VAS were all reduced (P<0.05) in two groups. The changes of the above indexes were more obvious in the observation group than those in the control group (P<0.05). After treatment and 1 and 3 months after treatment, Karnofsky scores all increased (P<0.05) in two groups，and the increases were more significant in the observation group (P<0.05). "Warming and promoting technique" of acupuncture combined with extracorporeal shock wave promotes the elimination of local inflammatory factors, relieves clinical symptoms, improves the quality of life, as well as has a satisfactory short-term and medium-term curative effect on type Ⅲ prostatitis.

Shockwave effects in the technology of meat raw material processing

Meat tenderness is recognized as the most important quality characteristic determining consumer acceptability of fresh meat and meat products. Therefore, the development of effective methods for meat tenderization is a topical direction. The review considers the main aspects of the development of shockwave (SW) technology as an alternative method for meat tenderization. The paper analyzes the means of shockwave formation as well as possible mechanisms responsible for meat tenderization caused by shockwave treatment and related to the energy dissipation and mechanical load on the boundary zones of a biological material under processing. The results of the investigations of a shockwave effect on meat tenderness, microbial inactivation, structure and assimilability of muscle protein and other functional and technological properties of a product are presented. The majority of researchers who studied a SW effect on meat tenderization showed different degrees of the improvement in the Warner-Bratzler shear force and increase in sensory scores of meat tenderness. This review shows the main problems linked with commercialization of the meat treatment process using SW based on electrical discharges under water. This method of SW generation is considered safest but infeasible today due to occurrence of restrictions such as damage of packaging materials after treatment, a need to ensure effective SW propagation in a commercial unit and determine optimal treatment parameters in the process of shockwave tenderization. Furthermore, potential possibilities of using shockwave technologies in the food industry are discussed. In particular, shockwave treatment upon extraction is an effective method for extracting juice/ oil/ bioactive components from various plant materials, which can be used as the pretreatment or independent process.

Patient Perception, Rather Than Magnitude of Objective Improvement, Predicts Desire for Treatment Amongst Men Undergoing Penile Shockwave Therapy

ABSTRACT Introduction Novel treatments options for refractory erectile dysfunction, including penile shockwave therapy, have recently been introduced. Despite uncertain clinical efficacy, direct-to-consumer marketing has resulted in increased patient interest in these treatments, often associated with high out-of-pocket costs. Objective In the current study, we sought to assess outcomes in men with refractory erectile dysfunction undergoing penile shockwave therapy, as well as patient's perception of treatment outcomes. Methods Community-dwelling men receiving care at a local county hospital were prospectively recruited to undergo penile shockwave therapy for treatment of refractory erectile dysfunction. Men underwent a total of six treatment sessions free of charge. Response to therapy was tracked utilizing the Sexual Health Inventory for Men (SHIM), with successful response defined as an increase in average SHIM score following treatment, as compared to baseline scores. Upon completion of treatment, defined as 4 out of 6 sessions or more, men were asked about their subjective perception of treatment benefit, including whether they would repeat treatment and recommend treatment to others. Logistic regression and Pearson's chi-squared test were used to determine whether objective treatment effect predicted men's attitudes towards penile shockwave therapy. Results A total of 23 men were prospectively recruited to our study. Of these, 19 patients (83%) completed 4 out 6 shockwave treatments. Based on increase in SHIM score, 13 men (68%) were deemed responders to therapy, while 6 men (32%) were deemed non-responders. Amongst all-comers, the median change in SHIM score before and after treatment was 0.7 points (interquartile range: 3 points). Amongst responders, the median increase was 1.3 points, while non-responders experienced a median decrease in SHIM score of 2 points after completion of treatment. No statistically significant differences were noted between responders and non-responders with regard to important patient characteristics such as age, BMI, and smoking status, as well as comorbidities including diabetes, peripheral arterial disease, and history of myocardial infarction. Amongst patients completing treatment, 50% noted subjective improvements, while 93% stated they would repeat treatment and recommend treatment to others. On univariate logistic regression, objective response to therapy, based on increase in SHIM score, failed to predict patient's subjective sense of improvement (OR=5, 95% CI 0.3-72.8, p=0.24) and the frequency subjective improvement was not statistically different amongst responders and non-responders (Pearson's chi-squared; p=0.22). Conclusions Objective, clinically significant improvement in SHIM scores was not seen amongst men undergoing penile shockwave therapy for erectile dysfunction. Despite this, men experienced subjective improvement and a high rate of desire to continue treatment and recommend treatment to others, which could not be predicted by objective response to treatment. Increased patient education is required in order to set treatment expectations for costly novel therapies. Disclosure No

Vascular and Erectile Tissue Health Changes Pre- and Post- Low Intensity Shockwave Treatment of the Erect Penis

ABSTRACT Introduction In 2010, low-intensity shockwave therapy (LiSWT) was first described for used on the flaccid penis as a novel and minimally invasive regenerative treatment for men with ED. A standardized protocol for use of LiSWT either in the flaccid or erect state has not yet been established. Erect penile LiSWT, in contrast to flaccid penile LiSWT, is performed with maximal penile shaft blood volume under conditions of greatest acoustic impedance. This minimizes transfer of shockwave energy though the erectile tissue enabling the greatest uptake of shockwave energy to the erectile tissue. We review our experience with LiSWT during pharmacologic erection. Objective Assess arterial blood flow and erectile tissue health parameters in ED patients prior to and following erect penile LiSWT to better document the hypothesized vascular/erectile tissue regenerative benefits associated with LiSWT in men with ED. Methods A retrospective chart review was performed. Prior to LiSWT (Urogold 100 MTS). ED patients underwent a baseline penile Grayscale/Doppler ultrasound (G/DUS) with Grade 3-4/4 erection following appropriate visual/pharmacologic stimulation. A B-mode ultrasound (Aixplorer 15.4 MHz transducer) was then performed at specific settings to avoid reader bias. This included 12 total axial images obtained at proximal, midshaft and distal dorsal penis at a fixed dynamic range of 70 dB with B-mode gain values of increased brightness (45%, 55%, 65%). The fourth image at each axial location was taken at a dynamic range of 49 dB and a B-mode gain value identified as providing the best discrimination between Grayscale black/white. Subsequently, in the erect shaft right/left sagittal planes, cavernosal artery peak systolic velocity (PSV) and end diastolic velocity (EDV) values were obtained. ED patients then underwent 6 erect penile LiSWT treatments over varying intervals. The protocol included: appropriate visual/pharmacologic stimulation to obtain Grade 3-4/4 erection, 600 shocks using a parabolic reflector probe (OP-155), energy flux density 0.13mJ/mm2, 3 Hz, membrane pressure 3, applied each to dorsal, ventral, right/left lateral erect penile shafts, and right/left erect crura (total shocks 3600, duration of LiSWT ∼ 28 minutes). Patients returning for erect penile LiSWT completed a PGI-I score. Approximately one month after the last erect penile LiSWT, a post-treatment penile G/DUS with Grade 3-4/4 erection was repeated resulting in 24 Grayscale images. Baseline and post-treatment G/DUS were de-identified and read by two experts reaching consensus concerning erectile tissue homogeneity/inhomogeneity on Grayscale with 0/3 no inhomogeneity, 1/3 mild inhomogeneity (&amp;lt;25% of cross-sectional area revealing hypo- or hyper-echoic regions), 2/3 moderate inhomogeneity (25% - 50%), and 3/3 severe inhomogeneity (&amp;gt;50%), respectively. PGI-I scores were also assessed and compared to ultrasound findings. Results 79 patients (mean age 44 +/- 21, range 19 – 85) met inclusion criteria. 53/79 (67%) had improved erectile tissue homogeneity post-LiSWT from baseline, 10/79 (13%) were unchanged, 15/79 (19%) worsened. Of the 53 patients with improved G/DUS findings, 40/53 patients (75%) rated PGI-I as improved. 37/53 (70%) patients had PSV increase and 18/53 (34%) had EDV decrease. Conclusions The mechanisms by which erect penile LiSWT improves erectile function, in part, involve enhanced erectile tissue homogeneity, increased cavernosal arterial PSV and decreased EDV. Disclosure No

Effects of Extracorporeal Shock Wave Combined with Vivaphototherapy on Blood Perfusion, Inflammatory Response, and Prognosis in Burn Patients.

Objective To investigate the effect of extracorporeal shock wave treatment (ESWT) combined with water-filtered infrared-A (wIRA) therapy on pain, blood perfusion, and inflammatory response in burn patients. Methods A total of 120 burn patients treated in our hospital from May 2019 to June 2021 were selected and randomly divided into observation group (n = 60) and control group (n = 60). The control group was treated with wIRA, and the observation group was treated with ESWT combined with wIRA. The hospitalization conditions of the two groups were observed; the visual analogue scale (VAS) was used to evaluate the pain on the 1st, 7th, and 14th days of treatment in the two groups; the blood perfusion was compared between the two groups; the levels of cerebral neuropeptide (NPY), 5-serotonin (5-HT), prostaglandin E2 (PGE2), C-reactive protein (CRP), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α), serum intercellular adhesion molecule-1 (sICAM-1), soluble-triggering receptor expressed myeloidcells-1 (sTREM-1), and soluble hemoglobin scavenger receptor (sCD163) were measured. Modified Vancouver Scar Scale (mVSS) was used to evaluate the wound scar at 3 and 6 months after the end of treatment. Results The wound healing rate in the observation group was significantly higher than that in the control group, and the wound healing time and hospitalization time were significantly shorter than that in the control group (P < 0.05). On the 7th and 14th days of treatment, the VAS scores of the observation group were significantly lower than those of the control group (P < 0.05). On 1st, 7th, and 14th days of treatment, the blood perfusion volume in the observation group was significantly higher than that in the control group (P < 0.05). The scar scores in the observation group at 3 months and 6 months after treatment were significantly lower than those in the control group (P < 0.05). After treatment, the levels of NPY, 5-HT, PGE2, CRP, IL-10, TNF-α, sICAM-1, sTREM-1, and sCD163 in the observation group were improved more than those in the control group, and the differences were statistically significant (P < 0.05). Conclusion ESWT combined with wIRA therapy can effectively improve the hospitalization situation of burn patients, relieve pain, improve blood perfusion, reduce scar hyperplasia, reduce inflammation, and have a good therapeutic effect.

Effectiveness and safety of extracorporeal shock wave treatment for low back pain：a systematic review and meta-analysis of RCTs

This meta-analysis was designed to assess the effectiveness and safety of extracorporeal shock wave therapy (ESWT) for patients with low back pain (LBP). Pubmed, Embase, Cochrane's library, PEDro (Physiotherapy Evidence Database), China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched until December 2019 to identify studies assessing the effectiveness and safety of EPSW for LBP. The prime outcome is pain intensity measured by Visual Analog Scale (VAS) or numeric rating scale (NRS). Other outcomes included functional status, quality of life, psychological outcomes measured by Oswestry Disability Index (ODI), as well as the adverse events. Mean differences (MD) were calculated for continuous outcomes, while odd ratios (OR) were calculated for binary outcomes. Revman 5.3 software was used for statistical analysis. Five randomized controlled trials (RCTs) were finally included in this meta-analysis. The pooled mean difference in post-treatment pain scores was −2.37 (P ＜0.0001), indicating that post-treatment pain scores was significantly higher by 2.37 in control group than in ESWT group. At a mean follow-up time of 4–6 weeks, the pooled mean difference in ODI scores was −14.10 (P ＜0.00001), indicating that the pooled mean difference of post-treatment ODI scores was 14.10 higher in control group than in ESWT group. The use of ESWT is effective in alleviating pain and improving the general functional state for patients with LBP. However, more evidence was needed to verify its safety.

Shockwave lithotripsy compared with ureteroscopic stone treatment for adults with ureteric stones: the TISU non-inferiority RCT.

Urinary stone disease affects 2-3% of the general population. Ureteric stones are associated with severe pain and can have a significant impact on a patient's quality of life. Most ureteric stones are expected to pass spontaneously with supportive care; however, between one-fifth and one-third of patients require an active intervention. The two standard interventions are shockwave lithotripsy and ureteroscopic stone treatment. Both treatments are effective, but they differ in terms of invasiveness, anaesthetic requirement, treatment setting, number of procedures, complications, patient-reported outcomes and cost. There is uncertainty around which is the more clinically effective and cost-effective treatment. To determine if shockwave lithotripsy is clinically effective and cost-effective compared with ureteroscopic stone treatment in adults with ureteric stones who are judged to require active intervention. A pragmatic, multicentre, non-inferiority, randomised controlled trial of shockwave lithotripsy as a first-line treatment option compared with primary ureteroscopic stone treatment for ureteric stones. Urology departments in 25 NHS hospitals in the UK. Adults aged ≥ 16 years presenting with a single ureteric stone in any segment of the ureter, confirmed by computerised tomography, who were able to undergo either shockwave lithotripsy or ureteroscopic stone treatment and to complete trial procedures. Eligible participants were randomised 1 : 1 to shockwave lithotripsy (up to two sessions) or ureteroscopic stone treatment. The primary clinical outcome measure was resolution of the stone episode (stone clearance), which was operationally defined as 'no further intervention required to facilitate stone clearance' up to 6 months from randomisation. This was determined from 8-week and 6-month case report forms and any additional hospital visit case report form that was completed by research staff. The primary economic outcome measure was the incremental cost per quality-adjusted life-year gained at 6 months from randomisation. We estimated costs from NHS resources and calculated quality-adjusted life-years from participant completion of the EuroQol-5 Dimensions, three-level version, at baseline, pre intervention, 1 week post intervention and 8 weeks and 6 months post randomisation. In the shockwave lithotripsy arm, 67 out of 302 (22.2%) participants needed further treatment. In the ureteroscopic stone treatment arm, 31 out of 302 (10.3%) participants needed further treatment. The absolute risk difference was 11.4% (95% confidence interval 5.0% to 17.8%); the upper bound of the 95% confidence interval ruled out the prespecified margin of non-inferiority (which was 20%). The mean quality-adjusted life-year difference (shockwave lithotripsy vs. ureteroscopic stone treatment) was -0.021 (95% confidence interval 0.033 to -0.010) and the mean cost difference was -£809 (95% confidence interval -£1061 to -£551). The probability that shockwave lithotripsy is cost-effective is 79% at a threshold of society's willingness to pay for a quality-adjusted life-year of £30,000. The CEAC is derived from the joint distribution of incremental costs and incremental effects. Most of the results fall in the south-west quadrant of the cost effectiveness plane as SWL always costs less but is less effective. A limitation of the trial was low return and completion rates of patient questionnaires. The study was initially powered for 500 patients in each arm; however, the total number of patients recruited was only 307 and 306 patients in the ureteroscopic stone treatment and shockwave lithotripsy arms, respectively. Patients receiving shockwave lithotripsy needed more further interventions than those receiving primary ureteroscopic retrieval, although the overall costs for those receiving the shockwave treatment were lower. The absolute risk difference between the two clinical pathways (11.4%) was lower than expected and at a level that is acceptable to clinicians and patients. The shockwave lithotripsy pathway is more cost-effective in an NHS setting, but results in lower quality of life. (1) The generic health-related quality-of-life tools used in this study do not fully capture the impact of the various treatment pathways on patients. A condition-specific health-related quality-of-life tool should be developed. (2) Reporting of ureteric stone trials would benefit from agreement on a core outcome set that would ensure that future trials are easier to compare. This trial is registered as ISRCTN92289221. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 19. See the NIHR Journals Library website for further project information.

„Skuteczność stosowania fali uderzeniowej w wybranych dysfunkcjach narządu ruchu”

"Effectiveness of using the shock wave in selected dysfunctions of the musculoskeletal system"&#x0D; mgr. Magdalena Momot-Kuryło Rehabilitation and Sports Center "Medi-Sport" in Lublin&#x0D; dr Michał Grzegorczyk Department of Physiotherapy Rehabilitation, Chair of Rehabilitation and Balneotherapy, Faculty of Health Sciences, Medical University of Lublin.&#x0D; &#x0D; Introduction&#x0D; In medicine, the shockwave was first used in the 1980s for lithotripsy [1]. Over time, new reports appeared about its positive impact on the human body, including on the musculoskeletal system. Nowadays it is successfully used in many fields of medicine.&#x0D; &#x0D; Objective of the work&#x0D; The aim of the study was to evaluate the effectiveness of the shock wave application in patients with patellar ligament enthesopathy, lateral epicondylitis of the humerus and heel spur.&#x0D; &#x0D; Material and methods&#x0D; The research was carried out in CM Luxmed, ul. Zwycięska 6a and CM MEDISPORT at ul. Łabędzia in Lublin in the period from 01/12/2020. until December 10, 2021 75 patients took part in them. 25 of them were diagnosed with patellar ligament enthesopathy, another 25 with lateral epicondylitis of the humerus. The remaining 25 people received shock wave treatments for the heel spur. Each respondent underwent 5 shock wave treatments. Before starting the research, the respondents were informed about the purpose of the research. Moreover, they were guaranteed anonymity.&#x0D; &#x0D; Results:&#x0D; Among the surveyed people, in general, 50.7% (n = 38) of all respondents were women, and 49.3% (n = 37) - men. 36% (n = 9) women and 64% (n = 16) men were among the respondents treated for lateral epicondylitis of the humerus. In the case of the jumper's knee, the study group consisted of 60% (n = 15) women and 40% (n = 10) men, while in the group of patients with the heel spur, women constituted 56% (n = 14), and men 44% (n = 11).&#x0D;

Extracorporeal shockwave relieves endothelial injury and dysfunction in steroid-induced osteonecrosis of the femoral head via miR-135b targeting FOXO1: in vitro and in vivo studies.

Injury and dysfunction of endothelial cells (ECs) are closely related to the pathogenesis of steroid-induced osteonecrosis of the femoral head (ONFH), while MicroRNAs (miRNAs) play an essential role in the processes. Extracorporeal shockwave treatment (ESWT) has been used in the non-invasive treatment of various diseases including musculoskeletal and vascular disorders. In particular, ESWT with low energy levels showed a beneficial effect in ischemic tissues. However, there has been no comprehensive assessment of the effect of ESWT and miRNAs on steroid-induced ONFH. In the present study, we investigated the role and mechanism of ESWT and miRNAs both in vitro and in vivo. Using a steroid-induced ONFH rat model, we found that ESWT significantly enhances proliferation and angiogenesis as well as alleviates apoptosis. In two types of ECs, ESWT can promote cell proliferation and migration, enhance angiogenesis, and inhibit apoptosis. Notably, our study demonstrates that miR-135b is downregulated and modulated forkhead box protein O1 (FOXO1) in ECs treated with dexamethasone. Remarkably, both miR-135b knockdown and FOXO1 overexpression reversed the beneficial effect of ESWT on ECs. Additionally, our data suggest that ESWT activates the FOXO1-related pathway to impact proliferation, apoptosis, and angiogenesis. Taken together, this study indicates that ESWT relieves endothelial injury and dysfunction in steroid-induced ONFH via miR-135b targeting FOXO1.

Improved biomechanics in experimental chronic rotator cuff repair after shockwaves is not reflected by bone microarchitecture.

PurposeThe aim of this study was to investigate the effect of extracorporeal shockwave therapy (ESWT) on bone microstructure as well as the bone-tendon-interface and the musculo-tendinous transition zone to explain the previously shown improved biomechanics in a degenerative rotator cuff tear animal model. This study hypothesized that biomechanical improvements related to ESWT are a result of improved bone microstructure and muscle tendon properties.MethodsIn this controlled laboratory study unilateral supraspinatus (SSP) tendon detachment was performed in 48 male Sprague-Dawley rats. After a degeneration period of three weeks, SSP tendon was reconstructed transosseously. Rats were randomly assigned into three groups (n = 16 per group): control (noSW); intraoperative shockwave treatment (IntraSW); intra- and postoperative shockwave treatment (IntraPostSW). Eight weeks after SSP repair, all rats were sacrificed and underwent bone microstructure analysis as well as histological and immunohistochemical analyses.ResultsWith exception of cortical porosity at the tendon area, bone microstructure analyses revealed no significant differences between the three study groups regarding cortical and trabecular bone parameters. Cortical Porosity at the Tendon Area was lowest in the IntraPostSW (p≤0.05) group. Histological analyses showed well-regenerated muscle and tendon structures in all groups. Immunohistochemistry detected augmented angiogenesis at the musculo-tendinous transition zone in both shockwave groups indicated by CD31 positive stained blood vessels.ConclusionIn conclusion, bone microarchitecture changes are not responsible for previously described improved biomechanical results after shockwave treatment in rotator cuff repair in rodents. Immunohistochemical analysis showed neovascularization at the musculo-tendinous transition zone within ESWT-treated animals. Further studies focusing on neovascularization at the musculo-tendinous transition zone are necessary to explain the enhanced biomechanical and functional properties observed previously.Clinical relevanceIn patients treated with a double-row SSP tendon repair, an improvement in healing through ESWT, especially in this area, could prevent a failure of the medial row, which is considered a constantly observed tear pattern.

Is Li-ESWT effective in diabetic patients with severe erectile dysfunction?

Noninvasive low-intensity extracorporeal shockwave treatment (Li-ESWT) has been widely used to treat erection disorders. There is no clear information regarding either the selection of patients for the treatment or the treatment protocol. In this study, we aimed to investigate the efficacy of extracorporeal shockwave therapy in diabetic patients with severe erectile dysfunction (International Index of Erectile Function-5 [IIEF-5] scores of 5 to 7). Sixty-three diabetes mellitus patients with erectile dysfunction having IIEF-5 scores of 5 to 7 and not showing a recovery of potency despite phosphodiesterase type 5 inhibitor therapy for the past 6 months were included in the study. The patients were evaluated based on their IIEF-5 scores and Erection Hardness Scale scores. The IIEF-5 score (mean ± standard deviation [s.d.]) increased from 5.29 ± 1.67 to 5.56 ± 1.85, with a difference of 0.27 ± 0.18 (P > 0.05). The Erection Hardness Scale scores (mean ± s.d.), on the other hand, increased from 1.46 ± 0.50 to 1.48 ± 0.50, with a difference of 0.02 ± 0 (P > 0.05). In conclusion, the response to phosphodiesterase type 5 inhibitors did not change after extracorporeal shockwave treatment in diabetes mellitus patients with severe erectile dysfunction (IIEF-5 scores of 5 to 7).

Radial shockwave treatment promotes chondrogenesis in human growth plate and longitudinal bone growth in rabbits.

The process of longitudinal bone growth occurs at the growth plate where the chondrocytes undergo apparent structural and molecular changes to promote growth. Recent reports suggest that radial shockwave treatment (rSWT) stimulates bone length in cultured fetal rat metatarsals. Therefore, we investigated if rSWT has similar growth promoting effects on cultured human growth plate fragments and addressed the same in a preclinical in vivo rabbit model by subjecting their growth plates to rSWT. Short-term effects of high-energy rSWT were evaluated in a unique model of cultured human growth plate cartilage (n=5) wherein samples exposed to rSWT were assessed for chondrogenic markers at 24h in comparison to unexposed samples obtained from the same limb. Local in vivo effects were studied in six-week-old rabbits who had their distal femurs exposed to four weekly sessions of rSWT at low- and high-energy levels (n=4 each). At sacrifice, histomorphometric and immunohistochemistry analyses were performed. For effect on longitudinal growth, proximal tibiae of 22-week-old rabbits (n=12) were asymmetrically exposed to rSWT; the contralateral side served as untreated controls. At sacrifice, the final bone length was measured. In the ex vivo model of cultured human growth plate cartilage, rSWT exposure upregulated SOX9 and COL2A1 compared to control. In the immature rabbit model, an increased number of proliferative chondrocytes and column density was seen for both the energy levels. In the adolescent rabbits, an increase in tibial length was observed after the fourth session of high-energy rSWT and until six-weeks after rSWT compared to the untreated limb. Our preliminary experimental results suggest that rSWT may serve as a non-invasive treatment and possibly a safe strategy to stimulate longitudinal bone growth. However, further studies are needed to assess the in vivo effects of rSWT in models of disturbed bone growth.