Shock Wave Treatment Research Articles

The Effect of Radial Extracorporeal Shock Wave Therapy (rESWT) on the Skin Surface Temperature of the Longissimus Dorsi Muscle in Clinically Healthy Racing Thoroughbreds: A Preliminary Study

Radial extracorporeal shock wave therapy (rESWT) is increasingly being used to treat musculoskeletal injuries in horses. The aim of this study was to assess the influence of rESWT on the skin surface temperature of the longissimus dorsi muscle in clinically healthy racing horses. A total of 24 thoroughbreds were divided into a study group (n = 12) and an rESWT-sham group (n = 12). The study group underwent rESWT, whereas the rESWT-sham group had rESWT without probe activation in the treated area. Both groups underwent thermographic examination before and just after rESWT to determine and compare skin surface temperatures. Palpation examination was performed after the first and second thermography examination to assess longissimus dorsi muscle tone. Additionally, thermographic examination was repeated 10 min after the rESWT. In both groups, there was an increase in skin surface temperature just after rESWT, and a decrease 10 min after it to below the initial value. In the study group, the skin surface temperature just after rESWT was higher than in the rESWT-sham group. Additionally, in the study group the average muscle tone before rESWT was significantly higher than just after the procedure, whereas in the rESWT-sham group the average change in muscle tone was not significant. The results proved that rESWT increases skin surface temperature of the longissimus dorsi muscle in clinically healthy horses. Further research is necessary in order to configure shockwave treatment with appropriate parameters for effective and safe therapy.

Feasibility of Intravascular Lithotripsy for the Treatment of Calcified Supra-Aortic Vessels: A Case Report and Literature Review.

To report a case of coronary-subclavian steal syndrome (CSSS) due to a history of a left internal mammary artery (LIMA) to left anterior descending (LAD) artery coronary bypass (CABG) and a heavily calcified ostial left subclavian artery (LSA) occlusion, that was treated with intravascular lithotripsy (IVL) technique and to summarize the current trends of IVL treatment for supra-aortic vessels. A 64-year-old woman with progressive intermittent angina pectoris and a history of LIMA to LAD bypass underwent coronary angiography which demonstrated complete ostial occlusion of the LSA. Via brachial access, the patient underwent Shockwave IVL balloon treatment of the LSA and stent-graft implantation. At 9 months follow-up, the patient showed symptoms resolution, and duplex ultrasound (DUS) demonstrated a patent LSA. The Shockwave IVL system was demonstrated to be a feasible treatment and justified for selective cases of highly calcified lesions in supra-aortic vessels. The present case report and the literature review, in a total of 47 patients resulted in a high technical procedural success rate, with a low rate of complications. Future studies with larger cohorts are warranted to confirm these findings and standardize this technology in this particular vascular field. The present study exemplifies a case of recanalization of the left subclavian artery in a patient with coronary-subclavian steal syndrome with a heavily calcified ostial lesion treated with intravascular lithotripsy (IVL). In this paper, for the first time, a review of the contemporary literature on the use of IVL in supra-aortic vessels is reported, elucidating the feasibility of this technique in this vascular territory. Despite the heterogeneous features of the reported cases and the lack of a standardized protocol for the use of IVL in the management of highly calcified lesions of supra-aortic vessels, it was demonstrated to be a feasible technique, with a high technical success rate, being an advantageous tool for heavily calcified supra-aortic lesions.

A preliminary investigation into the impact of shock wave therapy and sonotherapy on postural control of stepping tasks in patients with Achilles tendinopathy.

The outcomes of physical therapy are commonly assessed with subjective scales and questionnaires. Hence, a continuous search to identify diagnostic tests that would facilitate objective assessment of symptom reduction in those patients with Achilles tendinopathy who undergo mechanotherapy. The main aim of this study was to evaluate and compare the effectiveness of shock wave and ultrasound treatments, using objective posturographic assessment during step-up and step-down initiation. The patients with non-insertional Achilles tendinopathy and pain lasting for more than 3 months were randomly assigned to one of the experimental groups, i.e., radial shock wave therapy (RSWT), ultrasound therapy, or placebo ultrasound. All groups also received deep friction massage as the primary therapy. The transitional locomotor task was performed with the affected and unaffected limb in random order, on two force platforms under two conditions (step-up and step-down). The recording of center of foot pressure displacements was divided into three phases: quiet standing before step-up/step-down, transit, and quiet standing until measurement completion. Pre-intervention measurements were performed and then short-term follow-ups at weeks 1 and 6 post-therapy. The three-way repeated measures ANOVA showed few statistically significant two-factor interactions between therapy type, time point of measurement and the type of the locomotor task. Significant increases in postural sway were observed in the entire study population throughout the follow-up period. Three-way ANOVAs revealed a group effect (shock wave vs. ultrasound) on almost all variables of the quiet standing phase prior to step-up/step-down initiation. Overall, postural stability before the step-up and step-down tasks appeared to be more efficient in patients who had undergone RSWT compared to the ultrasound group. Objective posturographic assessment during step-up and step-down initiation did not demonstrate therapeutic superiority of any of the three therapeutic interventions used in patients with non-insertional Achilles tendinopathy.Clinical Trial Registration: The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12617000860369; registration date: 9.06.2017).

Extracorporeal Shock Wave Combined with Warm Acupuncture for External Humeral Epicondylitis: A Randomized Clinical Trial.

The purpose of this study was to evaluate the clinical efficacy of extracorporeal shock wave combined with warm acupuncture for external humeral epicondylitis. Eighty-two patients with external humeral epicondylitis were randomly divided into an observation group and a control group. Patients in the control group were treated with extracorporeal shock waves while those in observation group with warm acupuncture on the basis of the control group. Patients in both groups were evaluated by Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) before and after treatment. The inflammatory factors such as IL-6, IL-10, TNF-ɑ and clinical outcomes were contrasted before and after treatment. There were statistically significant differences in VAS score, MEPS score and DASH score between the two groups before and after treatment (P<0.05), and the improvement of each score in the observation group was more obvious than that in the control group. After treatment, the inflammatory factors of the two groups were lower than those before treatment, and the difference was statistically significant (P<0.05). The decrease of inflammatory factors in the observation group was more obvious than that in the control group. The total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P<0.05). Extracorporeal shock wave combined with warm acupuncture could effectively improve the pain symptoms and dysfunction of external humeral epicondylitis and reduce the expression of inflammatory factors, and its effect may be better than that of extracorporeal shock wave treatment alone. ChiCTR2200066075.

The conservative management for improving Visual Analog Scale (VAS) pain scoring in greater trochanteric pain syndrome: a Bayesian analysis

BackgroundGreater trochanteric pain syndrome (GTPS) possesses a harmful influence on quality of life. Numerous conservative management modalities with varying success have been proposed for patients with GTPS. However, it is not clear which treatment is more effective for reducing pain. The purpose of this Bayesian analysis was to assess the current evidence for the effectiveness of conservative treatments on improving Visual Analog Scale (VAS) pain scoring of GTPS and to determine the most effective treatment protocol.MethodsA comprehensive study search was performed from inception until July 18, 2022, via the electronic databases PubMed, the Cochrane Library, and Web of Science for potential research. The risk of bias assessment for the included studies was independently performed based on the Cochrane Collaboration Risk of Bias Tool. Bayesian analysis was conducted by using ADDIS software (v1.16.5). The DerSimonian-Laird random effects model was used to perform the traditional pairwise meta-analysis.ResultsEight full-text articles with a total of 596 patients with GTPS were included in the analysis. In comparing ultrasound-guided platelet-rich plasma application (PRP-U) to ultrasound-guided corticosteroid injection (CSI-U), patients who received PRP therapy experienced reduced pain as the VAS decreased significantly (MD, -5.21; 95% CI, -6.24 to -3.64). VAS score in group of extracorporeal shockwave treatment (ESWT) was significant improved than that in exercise (EX) group (MD, -3.17; 95% CI, -4.13 to -2.15). There were no statistically significantly different VAS scores between the CSI-U group and the CSI under landmark (CSI-B) group. The treatment efficacy rankings of the different treatments on improving VAS scores showed that the most likely efficacious treatment was PRP-U (99%) followed by ESWT (81%), CIS-U (58%), usual care (48%), CIS-B (54%), and EX (84%).ConclusionBayesian analysis revealed that PRP injection and ESWT are relatively safe and effective in the treatment of GTPS. More multicenter high-quality randomized clinical trials with large sample sizes are still needed in the future to provide further evidence.

(053) Low Intensity Shockwave Therapy in Patients with Vulvas with Sexual Dysfunction

Abstract Introduction High intensity shockwave treatment has been used for kidney stone lithotripsy since the 1980’s; such devices generate an energy flux density (EFD) of approximately 0.9 mJ/mm2. Low intensity shockwave therapy (LiSWT) devices generate approximately one tenth of that EFD, 0.05 – 0.13 mJ/mm2. LiSWT was first used in sexual medicine in 2010 to treat erectile dysfunction (ED). In 2019 we began utilizing LiSWT for patients with vulvas with various sexual dysfunctions (SD). Objective To review our clinical uses of LiSWT as a non-hormonal, non-surgical treatment option for individuals with vulvas with various complaints of SD. Methods We have performed 324 total LiSWT treatment sessions, 1 to 17 total treatments per person, in 77 individuals with vulvas with SD; EFD (0.05 – 0.13 mJ/mm2), shocks (1800 – 4000/treatment), Hz 3, membrane pressure 1. The specific device used in our clinic, Softwave (TRT), is considered non-significant risk for human use by the FDA and cleared for pain amelioration, connective tissue activation, wound healing, and improved blood flow. This device has a parabolic reflective surface. For each underwater spark-gap discharge that generates a shockwave, there actually two shockwaves delivered: a primary unfocused shockwave and a secondary reflected focused shockwave. Each energy wave induces a variety of biologic reactions in tissues resulting from the mechanotransduction contraction/expansion forces produced. Results To date we have identified 4 clinical uses for LiSWT in our patients with vulvas (mean age 39 ± 21 years). Individuals with hormonally-mediated vestibulodynia (n = 12) or entrance dyspareunia associated with genitourinary syndrome of menopause (n = 13) have received a total of 61 (mean 5) and 64 (mean 5) vestibular treatment sessions, respectively. Positive outcomes from a sham-controlled randomized trial have been published for vestibulodynia. Our positive clinical experience in 60% (15/25) mirrors their data. This is especially important because not everyone is willing or able to undergo hormone treatment. Individuals with genito-pelvic dysesthesia from sacral radiculopathy (n = 22) have received 109 (mean 5) treatments directed to their lumbo-sacral region. These patients were either not candidates for spine surgery or continued to experience mild symptoms after spine surgery. LiSWT decreased or eliminated dysesthesia symptoms in 68% (15/22); a key predictor of success was the activation of radiculopathy symptoms (e.g. feet burning) during treatment. Finally, individuals who underwent LiSWT pre-operatively to reduce opioid use after complete vestibulectomy (n = 30) have received 90 (mean 3) vestibular treatments with a 65% reduction in opioid use with such prophylactic treatment. We have observed no serious and 2 transient adverse events, mild discomfort that resolved within several hours. Conclusions For individuals with vulvas with varying complaints of SD, LiSWT is a safe and effective non-hormonal, non-surgical treatment strategy. More research with LiSWT in this population is needed. A potential new clinical use for LiSWT is to manage stress/urge urinary incontinence (SUI) in a non-invasive, non-pharmacologic strategy. Disclosure No

Extracorporeal shock wave treatment for post‑surgical fracture nonunion: Insight into its mechanism, efficacy, safety and prognostic factors (Review).

Post-surgical fracture nonunion (PSFN) represents the failure to achieve cortical continuity at radiological examination after an orthopedic operation, which causes a considerable disease burden in patients with fractures. As one of the traditional treatment modalities, surgical therapy is associated with a high fracture union rate; however, post-surgical complications are not negligible. Therefore, less invasive therapies are needed to improve the prognosis of patients with PSFN. Extracorporeal shock wave treatment (ESWT) is a noninvasive method that presents a similar efficacy profile and favorable safety profile compared with surgical treatment. However, the application and detailed mechanism of ESWT in patients with PSFN remain unclear. The present review focuses on the mechanism, efficacy, safety and prognostic factors of ESWT in patients with PSFN, aiming to provide a theoretical basis for its application and improve the prognosis of these patients.

Erectile Dysfunction: Treatments, Advances and New Therapeutic Strategies.

Erectile dysfunction (ED) is the inability to get and maintain an adequate penile erection for satisfactory sexual intercourse. Due to its negative impacts on men's life quality and increase during aging (40% of men between 40 and 70 years), ED has always attracted researchers of different disciplines, from urology, andrology and neuropharmacology to regenerative medicine, and vascular and prosthesis implant surgery. Locally and/or centrally acting drugs are used to treat ED, e.g., phosphodiesterase 5 inhibitors (first in the list) given orally, and phentolamine, prostaglandin E1 and papaverine injected intracavernously. Preclinical data also show that dopamine D4 receptor agonists, oxytocin and α-MSH analogues may have a role in ED treatment. However, since pro-erectile drugs are given on demand and are not always efficacious, new strategies are being tested for long lasting cures of ED. These include regenerative therapies, e.g., stem cells, plasma-enriched platelets and extracorporeal shock wave treatments to cure damaged erectile tissues. Although fascinating, these therapies are laborious, expensive and not easily reproducible. This leaves old vacuum erection devices and penile prostheses as the only way to get an artificial erection and sexual intercourse with intractable ED, with penile prosthesis used only by accurately selected patients.

Shock waves as treatment of mouse myofascial trigger points.

An abnormal increase in spontaneous neurotransmission can induce subsynaptic knots in the myocyte called myofascial trigger points. The treatment of choice is to destroy these trigger points by inserting needles. However, 10% of the population has a phobia of needles, blood, or injuries. Therefore, the objective of this study is to verify the usefulness of shock waves in the treatment of myofascial trigger points. Two groups of mice have been developed for this: healthy muscles treated with shock waves; trigger points affected muscles artificially generated with neostigmine and subsequently treated with shock waves. Muscles were stained with methylene blue, PAS-Alcian Blue, and labeling the axons with fluorescein and the acetylcholine receptors with rhodamine. Using intracellular recording the frequency of miniature endplate potentials (mEPPs) was recorded and endplate noise was recorded with electromyography. No healthy muscles treated with shock waves showed injury. Twitch knots in mice previously treated with neostigmine disappeared after shock wave treatment. Several motor axonal branches were retracted. On the other hand, shock wave treatment reduces the frequency of mEPPs and the number of areas with endplate noise. Shock waves seem to be a suitable treatment for myofascial trigger points. In the present study, with a single session of shock waves, very relevant results have been obtained, both functional (normalization of spontaneous neurotransmission) and morphological (disappearance of myofascial trigger points). Patients with a phobia of needles, blood, or injuries who cannot benefit from dry needling may turn to noninvasive radial shock wave treatment.

Effective combination of biocompatible zinc oxide nanocrystals and high-energy shock waves for the treatment of colorectal cancer

BackgroundColorectal cancer (CRC) is the third most diagnosed tumor worldwide, with a very high mortality rate, second only to lung cancer. Current treatments, such as surgery, chemotherapy or radiotherapy, are not effective enough and show several limitations. Among the emerging strategies, nanomedicine offers very powerful tools in cancer treatment. Recently, the combination of nanoparticle antitumor effect with a triggering external stimulation was formulated to boost up the cytotoxic activity.ResultsIn this work, we show the synergistic effect of oleic acid-capped zinc oxide nanocrystals (ZnO NCs) and mechanical high-energy shock waves (SW) in the treatment for CRC cells, in vitro. We tested two different types of ZnO NCs synthetized in our laboratory, the basal undoped ZnO NCs and the iron-doped ones (Fe:ZnO NCs). The presence of the oleic acid capping and the further amino-propyl functionalization guarantee a high colloidal stability to both NCs, while the iron doping confers to Fe:ZnO NCs interesting magnetic properties useful for imaging applications in a clinical perspective. Thus, the iron-doped ZnO NCs are very attractive as potentially theranostic nanoparticles, allowing both stimuli-responsive therapy and magnetic resonance imaging.Importantly, two colon adenocarcinoma cell lines, the HT-29 and the Dukes’ type C Colo 320DM cells were tested, both showing a good bio-tolerance and internalization rates of NCs. With the aim of eradicating the CRC cells, the possible synergism between the undoped/iron-doped ZnO NCs and an external physical stimulus, i.e., high-energy SW, was then here investigated in vitro. We demonstrated that the combined treatment resulted in an augmentation of the antitumor activity, especially for Colo 320DM cells, when compared to controls. Moreover, a repeated and sequenced SW treatment (three times/day, 3SW) after ZnO NCs exposure resulted in a further increased mortality of CRC cells.ConclusionOur work proposes the combination of the cytotoxic activity of ZnO NCs with the SW external stimulation to obtain a booster of the antitumor activity, which warrants further investigation in vivo on CRC as well as on other tumors.Graphical

Clinical Results of Decortication with Bone Grafting Method versus Extracorporeal Shock Wave Treatment in Long-Bone Pseudoarthrosis.

BACKGROUND Despite advanced treatment methods, the treatment of pseudoarthrosis still poses a significant challenge for orthopedists. In this study, we aimed to assess the clinical results of decortication and bone grafting and extracorporeal shock wave treatment (ESWT) in long-bone pseudoarthrosis. MATERIAL AND METHODS Between 2007 and 2015, 68 fractures of 66 patients treated for long-bone pseudoarthrosis were evaluated retrospectively. ESWT was used in 36 extremities and decortication and iliac bone grafting was used in 32. The treatment results of these patients were evaluated and compared with rates in the literature. RESULTS The mean patient age was 43.9 years (range, 21-69). The mean interval between the occurrence of the fracture and treatment with bone grafting or ESWT was 8.6 months and the mean interval between the procedure and achievement of union was 6.9 months. The patients were followed up for a mean period of 25.2 months. After the mean follow-up period, bone union had occurred in all 32 patients (100%) in the decortication and bone grafting group and in 28 (78%) of the 36 patients in the ESWT group (P=0.023). CONCLUSIONS This study shows that extracorporeal shock wave treatment should be considered the first option in treatment of pseudoarthrosis as it is a non-invasive method and also provides good rates of union. In patients that do not heal with ESWT, decortication and bone grafting remains the criterion standard therapy.

Low-Intensity Extracorporeal Shock Wave Treatment (LI-ESWT) efficacy treating a cohort of real-life patients with erectile dysfunction

Low-Intensity Extracorporeal Shock Wave Treatment (LI-ESWT) efficacy treating a cohort of real-life patients with erectile dysfunction

Management of Persistent Erectile Dysfunction after COVID-19 Infection: An 18-Month Follow-Up Case Report

The coronavirus disease 2019 (COVID-19) is an emerging pandemic caused by a novel coronavirus (SARS-CoV-2). Since December 2019 the new virus has spread all over the world and has become a major health problem also because of the public measures that could affect people’s sexual activity. We report a case of a 35-year-old married male admitted to the andrology outpatient clinic in July 2021 because of sudden onset erectile dysfunction (ED). The diagnostic workup showed no risk factor for ED, normal levels of testosterone, increased levels of endothelial dysfunction markers, such as CRP (C-Reactive Protein) and Endothelin-1, and reduced Vitamin D (VD) levels. Dynamic penile duplex ultrasound (D-PDU) revealed dysfunctional penile arterial flow. The five-item International Index of Erectile Function (IIEF-5) and the Short-Form Health Survey (SF-36) showed a reduction in all domain scores. The patient, initially unresponsive to the high dose oral phosphodiesterase 5 inhibitors (PDE-5is), was treated with vitamin-D and then submitted to LI-SWT (low intensity shockwave treatment), with a progressive clinical benefit at the 12-month follow-up. After 18 months, hormone levels persisted in normal ranges, with a consistent reduction in CRP and Endothelin-1. Additionally, IIEF-5, SF-36 and arterial flow significantly improved over the follow-up period. Thus far, the erectile function was restored and the patient is no more treated with PDE-5i.

Homeopathy as a saviour for urolithiasis: A narrative review shading light on pathophysiology of renal stones and homeopathy drugs

Kidney stone disease is a crystal concretion formed generally within the kidneys. It is an accumulative urological disorder of human health, affecting about 12% of the world population. Higher risk of kidney failure which has been associated with end stage renal failure. Calcium oxalate, which forms at Randall's plaque on the renal papillary surfaces, is the most common type of kidney stone. Stone formation is highly prevalent, with rates of up to 14.8% and increasing, and a recurrence rate of up to 50% within the first 5 years of the initial stone incident. The formation of the stone is a complex process which results from numerous physiochemical events such as, super saturation, nucleation, growth, aggregation, and retention of urinary stone constituents within tubular cells. Several therapies are being performed for kidney stone treatment, including thiazide diuretics, allopurinol, painkillers, dietary changes, shock-wave treatment, ureterenooscopic and percutaneous nephrolithotomy, and ureterenooscopic and percutaneous nephrolithotomy in severe cases. However, the side effects that these treatments possess and reoccurrence of the disease have motivated researchers to search for better and safer options. Homeopathic drugs as well as several medicinal plants display antiurolithiatic activity and thus perform an important role in treatment of kidney stone disease. Therefore, the present review thereby wants to bring to the attention the wonderful results that homeopathy is offering in cases of urolithiasis in a very non-invasive and economical way which is not yet popularized.

Comparison of Radial Pressure Waves and Focused Extracorporeal Shock Waves in Treatment of Osteoarthritis of the Knee

Objective: The aim of this study is to investigate and compare the clinical efficacy of radial pressure waves and focused external shock wave therapy for knee osteoarthritis (KOA). Materials and Methods: From October 2020, 90 patients aged 45–65 years old with Kellgren and Lawrence classification (K-L) stage I and II of KOA were selected in our hospital or randomly assigned to 3 groups with 30 cases in each group. One group was treated with antiinflamatory medication. The other two groups received one course of treatment (once a week, 4 times in total) performed by using radial focused shock waves respectively, and follow-up was conducted by telephone and outpatient review 3, 6, and 9 months after the treatment. Visual Analog Scale (VAS) and Western Ontario McMaster Osteoarthritis Index (WOMAC) osteoarthritis score were used before and after treatment. Results: (1) VAS, WOMAC, and evaluation indexes of both treated groups were better than those of the control group (oral drug group); (3) The score of the radial group was significantly different from that of the focused group (P &gt; 0.05). Conclusion: (1) Focused and radial pressure waves (RPW) have good clinical therapeutic effect on early KOA (2) Comparison of long-term effect: focused shock waves are more significant than radial (3) Radial pressure waves area good indication in relatively young patients, short course of disease (within 1 year), and K-L stage I an II. (4) In older patients, with more than a year of symptoms and K-L stages II and III, focal waves are more effective than radial waves. (5) Patients with acute onset and night pain or accompanied by obvious effusion can first take nonsteroidal drugs orally continuously for a week, and the treatment effect is better. During treatment, the drugs can be continued or stopped according to the specific conditions. When synovial edema and effusion of the joint decreased, the conventional parameters were used for treatment. Keywords: Knee osteoarthritis, Extracorporeal shock wave therapy, Radial Pressure Waves

Simulation of Mechanical Processes at the Contact Region of a Dental Implant with Bone Tissues Under Shock Wave Treatment

Dental implants are becoming an increasingly important part of modern dental treatment. Developing an optimal implant surface design can improve osseointegration. Promising to increase the rate of osseointegration is the use of external shock wave therapy, which has proven itself for the treatment of fractures, bone defects, and bone tissue regeneration during surgery and arthroplasty. This work aims at a numerical investigation of the effects of low-energy shock wave therapy of various ranges on the mechanical behaviour of bone tissues, taking into account the physiological characteristics in the area of dental implant placement. Modelling was carried out using the method of movable cellular automata. Using computer simulation, it was found that the conditions for the regeneration of bone tissues at the near-contact zone with the implant of the jaw segment are created by a shock wave with an intensity of greater than 0.1 mJ/mm2.

Oxalic acid incorporated acetamide single crystal growth dynamics, characterization, NLO and antimicrobial activities via shock wave treatment

Shock waves are applied to non-linear optical materials, particularly organic materials, due to their fast responsein electro-optic switchesand high nonlinearefficiency. At room temperature, an acetamide-doped oxalic acid single crystal has been grown using the slow evaporation method among other crystal growth techniques. Single crystal oxac applies to shock waves in steps of 50 and 100 shock waves to the tail or the material properties without altering the original crystal system. The grown and shock wave treated crystals of OXAC were structurally identified by X-ray diffraction and Fourier transform infrared spectroscopy,UV–Visible and Photoluminescence spectral analysis, nonlinear optical activity (NLO) studies. The antimicrobial studies such as antibacterial and antifungal activities of the grown crystals of oxalic acid, OXAC and OXAC with 50 and 100 shocks were performed and the obtained results were discussed. From we declared results, we state that the post shock wave induced OXAC crystal is enhancing properties of NLO, antimicroibial studies relatively pre shock wave induced OXAC crystal and reflected in structural and optical studies.

Peyronie hastalığı: Cerrahi dışı tedavi yaklaşımları

Peyronie’s disease is a condition characterized by progressive fibrosis in the tunica albuginea, resulting in deformities such as penile shortening and curvature. This situation not only causes sexual problems, but also can cause an increase in sexual performance anxiety, difficulty in relationship and depression. The course of the disease consists of two periods, acute and chronic. In the acute phase and in the stable disease period, while non-surgical treatments are used to relieve symptoms and regress fibrosis, surgical treatments are on the agenda, especially after serious deformities develop. Non-surgical treatment methods are oral treatments, intralesional injection treatments, topical treatments, vacuum and traction devices and shock wave treatments. Intralesional clostridium histolyticum collagenase treatment has been approved by the US-FDA and it’s indicated in patients with noncalcified plaques. For multimodal treatments, there is no clear consensus yet. Keywords: Peyronie’s disease, penil curvature, medical therapy, vacuum device

Dramatic Clinical and Ultrasound Outcomes Post PlateletRich Plasma for Recalcitrant Chronic Mid-Portion Achilles Tendinopathy: Case Report

Chronic Achilles tendinosis with or without tendon tear is a common form of tendon degenerative pathology that is hard to treat with traditional approaches including oral anti-inflammatory medicine, physical therapy, and shock-wave treatment. corticosteroid injection could lead to tendon rupture, thus if conservative management fails then surgery is a last resort. This article presents a middle-female, who suffered Achilles tendinopathy symptoms for over 20 years, affecting her daily activity and sports life. She had tendon nodule clinically. Ultrasound scan (USS) showed diffuse thickening of the Achilles tendon at the mid-portion of the maximal sagittal diameter of 10 mm without a tendon tear. She failed conservative management, physiotherapy, and shock wave therapy. She elected for a single trial of investigational USS-guided platelet-rich plasma (PRP) therapy. She improved gradually by returning to completely normal daily activities and running/sprinting after one year of PRP therapy. Her tendon nodule resolved clinically, and a repeat USS showed reduced diffuse thickening of the Achilles tendon at the midportion of the maximal sagittal diameter down to 7mm suggestive of the healing process. Thanks to the regenerative restoration power of the growth factors and signalling proteins in platelets that stimulate the internal mesenchymal stem cells to promote the healing process. We recommend a comprehensive randomized control trial to approve those findings and standardization of the PRP technique, trusting regenerative medicine to develop as a mainstream therapy in several musculoskeletal pathologies, particularly in degenerative conditions and resistant injuries.

High Energy Focused Extracorporeal Shock Wave therapy for early and mid stage femoral head necrosis: A single center Retrospective Cohort Study

Background: Research has shown that extracorporeal shock wave therapy has a certain therapeutic effect on the osteonecrosis of the femoral head (ONFH). However, the sample sizes are relatively small. The aim of this study is to evaluate and investigate the clinical efficacy and safety of high-energy extracorporeal shock wave treatment (ESWT) in the management of early and mid-stage ONFH by observing a large size clinical sample. Materials &amp; Methods: 453 patients with stage I–III ONFH treated ESWT in our hospital between June 2019 to August 2021, are included. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. Results: The mean follow-up was 39.81±7.94 months (range 26 to 50 months). The mean VAS decreased from 5.54 ± 1.19 before ESWT treatment to 1.92 ± 0.43 points at the 12 months follow-up (p &lt; 0.001). The mean Harris hip score improved from 75.51 ± 5.14 before ESWT treatment, to 92.21 ± 4.53 at the 12 months follow-up (p &lt; 0.001). The clinical success(improvement) was observed in 85.71% of ARCO stage I patients, 48.09% of ARCO stage II patients, and 49.15% of ARCO stage III patients. Imaging success (no worsening of clinical images) was observed in 12.38% stage I hips, 28.37% of stage II hips, and 27.12% of stage III hips, respectively. The hip joint survival rate of stage Ⅱ and stage Ⅲ patients was 86.51% and 77.97% (P&lt;0.05). Conclusions: The result of the current study suggests that ESWT definitely represents an effective, reliable, and safe therapeutic method for early and middle stages of ONFH with bone marrow edema syndrome (BMES), and should be recommended as a therapeutic option. Keywords: High-energy extracorporeal shock wave therapy, Osteonecrosis, Femoral head, Bone marrow edema.