Clinical efficacy of acupuncture combined with extracorporeal shock wave therapy in the treatment of piriformis syndrome / 中国基层医药

Objective:To evaluate the clinical efficacy of acupuncture combined with extracorporeal shock wave therapy in the treatment of piriformis syndrome.Methods:Eighty patients with piriformis syndrome who received treatment in Huaihe Energy Occupational Disease Prevention Hospital Rehabilitation Medicine Center from February 2021 to December 2022 were included in this study. They were divided into a treatment group ( n = 40) and a control group ( n = 40) according to different treatment methods using a retrospective cohort study design. The treatment group was treated with acupuncture combined with extracorporeal shock wave therapy, once every 7 days for 3 consecutive weeks. The control group was treated with extracorporeal shock wave therapy alone once every 7 days for 3 consecutive weeks.Pre- and post-treatment visual analogue scale scores and clinical efficacy were compared between the two groups. Results:There was no significant difference in baseline data between the two groups (all P > 0.05). After treatment, the visual analogue scale score decreased in each group. After adjusting for covariates, there was no significant difference in visual analogue scale score between the two groups ( F = 112.38, P < 0.001). After adjusting the pre-treatment visual analogue scale score, the post-treatment visual analogue scale score in the treatment group was lower than that in the control group [1.417 (95% CI: 1.151-1.683)]. The total response rate in the treatment group was 97.5% (39/40), which was significantly higher than 82.5% (33/40) in the control group ( Z = -2.03, P = 0.042). Conclusion:Acupuncture combined with extracorporeal shock wave therapy is highly effective on piriformis syndrome.

Effects of qianlieshutong capsule combined with extracorporeal shock wave therapy on inflammatory factors and immune function in patients with chronic prostatitis / 中国医师进修杂志

Objective:To investigate the effects of qianlieshutong capsule combined with extracorporeal shock wave therapy on inflammatory factors and immune function in patients with chronic prostatitis (CP).Methods:The clinical data of 100 patients with CP in Yingcheng People′s Hospital from September 2019 to September 2020 were retrospectively analyzed. Among them, 50 cases were treated with extracorporeal shock wave therapy (control group), and 50 cases were treated with qianlieshutong capsule combined with extracorporeal shock wave therapy (observation group). The National Institutes of Healthy chronic prostatitis symptom index (NIH-CPSI), interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, T lymphocyte subsets, small particle of lecithin (SPL) and prostate specific antigen (PSA) before and after treatment were compared between 2 groups. The adverse reactions and efficacy were compared between 2 groups.Results:The total effective rate in observation group was significantly higher than that in control group: 88.0% (44/50) vs. 70.0% (35/50), and there was statistical difference ( χ2 = 4.88, P<0.05). There were no significant differences in NIH-CPSI respective scores and total score before treatment between 2 groups ( P>0.05); the NIH-CPSI respective scores of pain and discomfort, urination, symptoms, quality of life and total score after treatment in observation group were significantly lower than those in control group: (4.15±1.04) scores vs. (6.72±1.13) scores, (1.23±0.39) scores vs. (1.88±0.48) scores, (1.31±0.39) scores vs. (1.91±0.35) scores, (1.68±0.34) scores vs. (2.35±0.32) scores and (8.37±1.02) scores vs. (12.86±1.33) scores, and there were statistical differences ( P<0.01). There were no statistical differences in the prostatic fluid and serum IL-6, IL-8 and TNF-α before treatment between 2 groups ( P>0.05); the prostatic fluid and serum IL-6, IL-8 and TNF-α after treatment in observation group were significantly lower than those in control group, and there were statistical differences ( P<0.01). There were no statistical difference in CD 3+, CD 4+, CD 8+ and CD 4+/CD 8+ before treatment between 2 groups ( P>0.05); there were no statistical difference in CD 3+, CD 4+ and CD 8+ after treatment between 2 groups ( P>0.05), the CD 4+/CD 8+ after treatment in observation group was significantly higher than that in control group (1.48±0.33 vs. 1.35±0.28), and there was statistical difference ( P<0.05). There were no statistical differences in SPL and PSA before treatment between 2 groups ( P>0.05); the SPL after treatment in observation group was significantly higher than that in control group: (33.25±4.08) μg/L vs. (20.96±4.13) μg/L, the PSA was significantly lower than that in control group: (0.81±0.23) μg/L vs. (0.97±0.29) μg/L, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of adverse reactions between 2 groups ( P>0.05). Conclusions:Qianlieshutong capsule combined with extracorporeal shock wave therapy has a significant efficacy in patients with CP. It can effectively reduce the levels of inflammatory factors in prostate fluid and improve the immune function.

Ondas de choque eletromagnéticas na Dermatologia: análise microscópica de sua interação com a possível redução do tecido adiposo em indivíduos obesos / Electromagnetic shock wave therapy in dermatology: Microscopic analysis of its interaction with the possible reduction of adipose tissue in obese individuals

Introdução: a obesidade é uma doença que afeta a saúde pública em nível mundial devido a suas comorbidades e ao risco de morte prematura. Diante disso, a tecnologia de terapia de ondas de choque extracorpóreas (ESWT) pode ser útil em seu tratamento e na prevenção de suas comorbidades. Objetivos: o objetivo foi avaliar se a ESWT é capaz de estimular a lipólise e/ou apoptose da célula adiposa de indivíduos obesos. Métodos: trata-se de um estudo comparativo de intervenção baseado em análises imuno- -histoquímicas de um conjunto de amostras de tecido subcutâneo de mulheres com obesidade, submetidas ao tratamento ESWT. O material biológico foi coletado no momento da cirurgia bariátrica. Resultados: 14 mulheres obesas foram incluídas na pesquisa. Foi evidenciada positividade na expressão de Casp3 (p<0,0001), cCasp3 (p<0,0024), macrófagos CD68+ (p<0,0001), HSL (p<0,0001) e adipofilina (p<0,0013) na amostra intervenção quando comparada ao controle. Conclusões: a ESWT estimula a apoptose com consequente lipólise do tipo autofágica no tecido adiposo de mulheres obesas. Assim, a ESWT pode ser considerada uma terapia adjuvante útil, segura e promissora para redução do tecido adiposo e, consequentemente, para prevenção e/ou tratamento de obesidade

Introduction: Obesity is a disease that affects public health worldwide due to its comorbidities and premature death risk. Therefore, extracorporeal shock wave therapy (ESWT) technology can help treat and prevent its comorbidities. Objective: This study aims to assess whether ESWT can stimulate lipolysis and/or apoptosis of the fat cells of obese individuals. Methods: This is a comparative interventional study based on immunohistochemical analyzes of a set of subcutaneous tissue samples from women with obesity submitted to ESWT treatment. The biological material was collected at the time of bariatric surgery. Results: The survey included 14 obese women. Positivity was shown in the expression of Casp3 (p<0.0001), cCasp3 (p<0.0024), CD68+ macrophages (p<0.0001), HSL (p<0.0001), and adipophilin (p<0.0013) in the intervention sample compared to the control. Conclusions: We conclude that ESWT stimulates apoptosis with consequent autophagic lipolysis in the adipose tissue of obese women. Thus, ESWT can be considered useful, safe, and promising adjuvant therapy for reducing adipose tissue and, consequently, for preventing and/or treating obesity.

Pancreatitis aguda como complicación infrecuente de litotricia extracorpórea por ondas de choque. Comunicación de un caso / Acute pancreatitis as an unusual complication of extracorporeal shock wave lithotripsy. A case report / Pancreatite aguda como complicação pouco frequente de litotrícia extracorpórea por ondas de choque. Comunicação de um caso

Resumen: La litotricia extracorpórea por ondas de choque para el tratamiento de la urolitiasis es un tratamiento ampliamente aceptado, pero no exento de complicaciones. La pancreatitis aguda que se desencadena inmediatamente posterior a este procedimiento es infrecuente, pero puede ser una complicación grave que amenaza la vida del paciente. La aparición aguda de dolor abdominal y vómitos en las horas posteriores al procedimiento, deben hacer al médico tratante sospechar esta complicación. Presentamos el caso de un paciente joven que luego de someterse a una sesión de litotricia para el tratamiento de una litiasis renal derecha instaló una pancreatitis aguda que requirió ingreso a terapia intensiva y que se suma a los escasos informes de casos publicados en la literatura médica.

Summary: Extracorporeal shock wave lithotripsy to treat urolithiasis is a widely aceptable treatment, although it may involve complications. Acute pancreatitis immediately after the procedures is rather unusual, but it may result in a serious life-threatening complication for patients. The appearance of severe pain and vomits a few hours after the procedure should make physicians suspicious of this complication. The study presents the case of a young patient who developed acute pancreatitis after undergoing lithotripsy to treat lithiasis in the right kidney, requiring his admission to the intensive care unit. This will add up to the scarce reports published in the medical literature.

Resumo: A litotrícia extracorpórea por ondas de choque para o tratamento da urolitíase é um tratamento amplamente aceito, mas não isento de complicações. A pancreatite aguda que se desencadeia imediatamente depois deste procedimento não é frequente, porém pode ser uma complicação grave que ameaça a vida do paciente. O surgimento súbito de dor abdominal e vómitos nas horas seguintes ao procedimento devem induzir à suspeita desta complicação. Apresentamos o caso de um paciente jovem que depois de uma sessão de litotrícia para o tratamento de uma litíase renal direita apresentou uma pancreatite aguda com posterior admissão a terapia intensiva; este caso se agrega aos poucos publicados na literatura médica.

The characteristics of synovitis under energy Doppler ultrasonography in knee osteoarthritis patients / 中华风湿病学杂志

Objective To investigate the correlation between synovial inflammatory changes (synovial blood signals,synovial thickness,joint effusion) and cartilage injury,meniscus prominence of knee osteoarthritis (KOA) under energy Doppler ultrasound and further to assess the value of ultrasound for prognostic judgment in KOA.Methods A total of 291 KOA patients from our hospital from 2016 to 2018 were collected.The patients with rheumatoid arthritis (RA) with knee joints involved were recruited as control group.The data that conform to the normal distribution were expressed by mean±SD,and others were represented by M (P25,P75).The t test,the rank test and Chi-square test were used between the two groups,and ANOVA or K-W test was used to compare the data between the multiple groups,Spearman correlation analysis was used for correlation analysis.Results ① The proportion of synovial blood flow signal in KOA group was lower than RA group (19.6％ vs 47.7％,x2=286.2,P＜0.01),as well as the typical synovial thickness [2.6(0,3.95) mm vs 3.43 (1.85,6) mm,Z=-3.674,P＜0.01] and popliteal cyst (11.5％ vs 18.5％,x2=4.484,P=0.04).② In KOA group,no significant difference was found between ESR and hs-CRP among different synovial blood signals (H=7.213,H=0.883,all P＞0.05).ESR from KOA group were both significantly lower than controls but the synovial blood signals was the same except for power Doppler signal-2 group (Z=-8.414,Z=-4.991,t=-3.428,all P＜0.05);hs-CRP from KOA group were both significantly lower than controls but the synovial blood signals was the same.③ A total of 489 knee joints were detected in 291 patients with KOA,of which synovial blood flow signals were found in 96 joints,the power Doppler signal-I group was the most frequent in KOA (80/96,83.3％).In addition,joint effusion and synovial thickening were positively correlated with the synovial blood signals,(r=0.277,r=0.411,all P＜0.05).④ At last,the degrees of ultrasound blood flow signal in KOA group was positively associated with the WOMAC score,the Lequsne index and US-1 score (r=0.352,r=0.424,r=0.59,all P＜0.05).Conclusion Energy Doppler ultrasonography can be used to detect the KOA synovitis.Synovitis is not rare in KOA patients,and which is associated with disease activity.However,KOA and RA cannot be differentiated by energy Doppler ultrasonography.

Comparison of clinical efficacy of proximal medial gastrocnemius release and shock wave for treating unilateral chronic plantar fasciitis / 国际外科学杂志

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).In control group,VAS,AOFAS and dorsal extension angle of ankle joint were (6.1 ± 0.7) scores,(49.1 ± 2.8) scores and (11.8 ± 3.6) ° before treatment,while VAS,AOFAS and dorsal extension range of ankle joint were (3.8 ± 1.2) scores,(56.0 ± 3.6) scores and (12.2 ± 3.2) ° at 3 months after treatment.There were significant differences in VAS between pre-treatment and 3 months after treatment (P ＜ 0.05).There were no significant differences in AOFAS and dorsal extension angleof ankle joint between pre-treatment and 3 months after treatment (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 gronp 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.

Effect of different energy of extracorporeal shock waves on diabetic neuralgia in rats / 中华麻醉学杂志

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.

Efficacy of extracorporeal shock wave therapy combined with traditional Chinese medicine iontophoresis in elderly patients with knee osteoarthritis / 中华老年医学杂志

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.

Terapia de ondas de choque focal para osteoartrose de joelho: um ensaio clínico randomizado duplo-cego / Focused extracorporeal shockwave therapy (f-ESWT) for knee osteoarthritis: a double-blind randomized clinical trial

Objetivo: Avaliar eficácia da terapia de ondas de choque focal (f-ESWT) comparada ao placebo para dor e incapacidade em pacientes com osteoartrose de joelho (OA). Métodos: Ensaio clínico randomizado, duplo-cego, placebo controlado, pacientes com OA primária de joelhos realizaram exercícios (alongamentos de isquiotibiais e fortalecimento de quadríceps) e randomizados em f-ESWT ou placebo. Todos os pacientes foram submetidos a 4 sessões semanais de 7.000 pulsos, e no grupo f-ESWT a energia foi de até 0.15mJ/mm2. O desfecho primário foi a escala analógica visual (VAS) para dor em 1 mês. Os desfechos secundários foram WOMAC, TUG, Lequesne e índice de resposta OMERACT-OARSI em 1 e 3 meses; bem como VAS aos 3 meses e eventos adversos (EAs). O teste de Mann-Whitney U e o teste exato Fisher foram utilizados com alfa = 5% e poder = 80% em uma análise de intenção de tratar. Os desfechos contínuos foram relatados como média ± desvio padrão. Resultados: 18 pacientes (9 em cada grupo), idade de 60.6±8.7 com 33.3% homens. Não houve diferença significativa entre grupos em qualquer variável. F-ESWT não foi superior ao placebo em 1 mês: VAS = -2,97 ± 3,18 e -2,68 ± 2,33 cm, respectivamente, p = 0,96. Somente o TUG no 1º mês foi significativo: 9.09 ± 2.30 e 11.01 ± 2.85 seg, p = 0.01. Conclusão: f-ESWT não foi superior ao placebo para osteoartrose de joelhos. Este estudo foi insuficiente para detectar diferenças. Novos estudos devem usar WOMAC A (subescala dor) como desfecho primário e recrutar 92 pacientes.

Objective: To assess the efficacy of focused extracorporeal shockwave therapy (f-ESWT) when compared to placebo for pain and disability in patients with knee osteoarthritis (OA). Methods: Randomized, parallel, double-blind, placebo-controlled clinical trial. Patients with primary knee OA were given a set of exercises (hamstring stretching and quadriceps strengthening) and randomized into f-ESWT or placebo (sham probe). All patients were submitted to 4 weekly sessions of 7,000 pulses, and in the f-ESWT group energy was up to 0.15mJ/mm2. Primary outcome was visual analog scale (VAS) for pain at 1 month. Secondary outcomes were WOMAC, TUG, Lequesne's index and OMERACT-OARSI responder index at 1 and 3 months; as well as VAS at 3 months and adverse events (AEs). Both patients and outcome assessors were blinded. Mann-Whitney U test and Fisher's exact test were used with alpha=5% and power=80% in an intention-to-treat analysis. Continuous outcomes were reported as mean± standard deviation. Results: 18 patients were included (9 in each group), aging 60.6±8.7, with 33.3% males. There was no significant difference at baseline across groups in any variables. f-ESWT was not superior to placebo at 1 month: VAS=-2.97±3.18 and -2.68±2.33cm, respectively, p=0.96. TUG at 1 month had significant differences: 9.09±2.30 and 11.01±2.85sec, p=0.01. No serious AEs were observed. Conclusions: f-ESWT was not superior to placebo for knee OA. This RCT was underpowered to detect differences in this study. New RCTs should use WOMAC A (pain subscale) as primary outcome and recruit at least 92 patients.

Tratamento por ondas de choque extracorpórea na síndrome do estresse tibial: uma revisão da literatura / Treatment of medial tibial stress syndrome with extracorporeal shockwave treatment: a literature review

A síndrome do estresse tibial medial é uma lesão comum devido a sobrecarga mecânica, principalmente em atletas, devido a inflamação local e estresse ósseo. A terapia de ondas de choque (TOC) vem sendo utilizada como tratamento para esta patologia por seus efeitos analgésicos e anti-inflamatórios. Objetivo: Avaliar a eficácia da TOC no tratamento analgésico da síndrome do estresse tibial medial e medidas de funcionalidade. Métodos: Foi realizada uma revisão da literatura, sendo incluídos estudos clínicos em humanos. Resultados: 3 artigos preencheram os critérios de inclusão, incluindo 166 pacientes. Os trabalhos trouxeram uma ampla variedade de intervenções, tipos de aparelhos, frequência e energia utilizada, além de diferenças nas quantidades de sessões e tipos de ondas de choque utilizado no tratamento. Conclusão: Ainda não há evidências consistentes quanto ao uso da TOC no tratamento conservador da síndrome do estresse tibial medial, com estudos pequenos, de qualidade metodológica baixa. Os estudos inclusos no trabalho não relataram efeitos colaterais significativos

Medial tibial stress syndrome is a common injury due to mechanical overload, especially in athletes due to local inflammation and bone stress. Shockwave therapy (ESWT) has been used as a treatment for this pathology due to its analgesic and anti-inflammatory effects. Objective: To evaluate the effectiveness of ESWT in the analgesic treatment of medial tibial stress syndrome and measures of functionality. Methods: A review of the literature was conducted, with clinical studies in humans included. Results: 3 articles fulfilled the inclusion criteria, including 166 patients. The trials involved a wide variety of interventions, types of devices, frequency and energy used, as well as differences in the number of sessions and types of shock waves used in treatment. Conclusion: There is still no consistent evidence regarding the use of ESWT in the conservative treatment of medial tibial stress syndrome, with small studies of low methodological quality. Studies included in this review did not report significant side effects

Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone

PURPOSE: To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates. MATERIALS AND METHODS: The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4–20 mm diameter radiopaque calculus were included in the study. RESULTS: The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841–0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995–0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005–1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368–0.988, p=0.043) were significantly associated with one-session success. CONCLUSION: Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone.

Effective Site for the Application of Extracorporeal Shock-Wave Therapy on Spasticity in Chronic Stroke: Muscle Belly or Myotendinous Junction

OBJECTIVE: To compare the effect of extracorporeal shock-wave therapy (ESWT) applied at the muscle belly and myotendinous junction on spasticity in the upper and lower limbs of chronic stroke patients. METHODS: Of the 151 patients, a total of 80 patients with stroke-induced spasticity on the elbow flexor and 44 patients on the knee flexor were enrolled for a prospective, randomized clinical trial. The patients were divided into control, muscle belly, and myotendinous junction groups, and a total of three ESWT sessions (0.068–0.093 mJ/mm², 1,500 shots) were conducted at one per week. A Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) were collected at the baseline and at 1 week after each session. RESULTS: After interventions, the MAS and MTS of both the belly and the junction groups showed positive effects from the ESWT on spasticity in the elbow and knee flexors, but the control group did not. The results also tended to improve after each session until the entire intervention was completed. However, there was no significant difference between the belly and junction groups. CONCLUSION: ESWT could be effective for treating chronic spasticity after stroke when applied to muscle belly or myotendinous junction.

Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis

OBJECTIVE: To evaluate and compare the effects and outcomes of extracorporeal shock wave therapy (ESWT) and intra-articular injections of hyaluronic acid (HA) in patients with knee osteoarthritis (OA). METHODS: Of the 78 patients recruited for the study, 61 patients met the inclusion criteria. The enrolled patients were randomly divided into two groups: the ESWT group and the HA group. The ESWT group underwent 3 sessions of 1,000 shockwave pulses performed on the affected knee with the dosage adjusted to 0.05 mJ/mm² energy. The HA group was administered intra-articular HA once a week for 3 weeks with a 1-week interval between each treatment. The results were measured with the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, 40-m fast-paced walk test, and stair-climb test (SCT). A baseline for each test was measured before treatment and then the effects of the treatments were measured by each test at 1 and 3 months after treatment. RESULTS: In both groups, the scores of the VAS, WOMAC, Lequesne index, 40-m fast-paced walk test, and SCT were significantly improved in a time-dependent manner (p0.05). CONCLUSION: The ESWT can be an alternative treatment to reduce pain and improve physical functions in patients with knee OA.

Advances in study of extracorporeal shock wave therapy for chronic overuse disease of shoulder joint / 中华创伤骨科杂志

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.

Ultrasound cavitation enhances ethanol ablation of rabbit liver / 中华医学超声杂志（电子版）

Objective To explore the effect of low intensity ultrasound (LUS) and microbubble enhanced ultrasound cavitation (MEUS), alone or in combination, on ethanol ablation (EA) of rabbit liver and observe the changes of liver perfusion and liver function. Methods Sixty-two healthy New Zealand rabbits were randomized to five groups: LUS group (n=6), EA group (n=14), LUS + EA group (n=14), MEUS + EA group (n=14), MEUS + LUS + EA group (n=14). For LUS, pulsed low intensity focused ultrasound emission was adopted (focal distance, 15 cm; duty cycle, 0.036%-0.22%;therapy duration, 5-6 min). According to the experiment design, surgically exposed left lobe of the liver was treated. In the LUS, MEUS + EA, and MEUS + LUS + EA groups, quantitative parameters were calculated and compared between the experimental and control liver lobes after different treatments. Three rabbits in each of the EA, LUS + EA, MEUS + EA, and MEUS + LUS + EA groups were used to detect the contents of alanine aminotransferase (ALT) and aspartate transaminase (AST) in arterial blood at five different time points (before treatment, 1 h, 48 h, 5 d, and 7 d after treatment). The livers of the remaining rabbits were harvested for measurement of ethanol ablation volume by drainage method or examination of the histological changes by HE staining 48 h after treatment. Results In the LUS group, the peak intensity (PI) and the area under the curve (AUC) were higher in the experiment lobe than in the control lobe, but there was no significant difference. In the MEUS + EA and MEUS+LUS+EA groups, the PI and AUC values were significantly lower in the experiment lobe than in the control lobe(PI:51.65±16.90 vs 101.09±14.41,44.08±8.46 vs 113.40±9.35;AUC:2183.06±501.13 vs 4258.54±841.21,1900.39±352.59 vs 4385.55±1198.16;t=9.059,16.835,9.630,7.932,P<0.001 for all). In the LUS group, no necrosis was observed, and the necrosis volume was 0 ml. The necrosis volumes caused by ethanol ablation in the EA, LUS+EA, MEUS+EA, and MEUS+LUS+EA groups were (0.84±0.27) ml, (2.42±1.11) ml, (3.52±1.34) ml, and (4.01±1.45) ml. The ethanol ablation volume was significantly lower in the EA group than in the other three groups (u=-13.800, -20.400, -23.400, P<0.05 for all),although there were no significant difference between any two of the latter three groups. No pathological changes were observed in the ultrasound exposed liver of the LUS group. In contrast, a wide range of coagulation necrosis area was noted in the other four groups. Compared with pre-treatment values, ALT and AST levels in all groups showed a slight rise after treatment, peaked at 48 h, and gradually returned to the pretreatment levels after seven days. The tendency of changes in ALT and AST levels with time was similar among the four groups (F=0.256, P=0.855; F=0.517, P=0.686). Conclusion LUS and MEUS, alone or in combination, could significantly increase the ethanol ablated volume of rabbit liver without aggravating liver function.

Terapia por Ondas de Choque Extracorpórea e Laser na redução da dor de indivíduos com fasciíte plantar: revisão sistemática / Extracorporeal Shock Wave Therapy and Laser in pain reduction of individuals with plantar fasciitis: a systematic review

Objetivo: Avaliar a efetividade da Terapia por Ondas de Choque Extracorpórea (ESWT) e do Laser na redução da dor de indivíduos com fasciíte plantar. Métodos: Foram feitas buscas de ensaios clínicos randomizados nas bases de dados MEDLINE, LILACS e Cochrane até novembro de 2016, nos idiomas inglês e português. Foram incluídos estudos que tinham como forma de tratamento as ESWT ou Laser, comparados com outros métodos, e que avaliaram a dor com a escala visual analógica. Foi utilizada a escala de PEDro para avaliação da qualidade metodológica dos estudos. Resultados: Foram encontrados 131 artigos. Destes, 106 foram excluídos após a leitura de seus títulos e resumos e 15 após sua leitura na íntegra, restando oito que tiveram como forma de tratamento as ESWT e dois o Laser. Conclusão: Dos dez artigos encontrados seis apresentaram resposta estatisticamente significativa em relação à dor, sendo dois sobre Laser e quatro sobre ESWT.

Purpose: To evaluate the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) and Laser in pain reduction of individuals with plantar fasciitis. Methods: Searches were made of randomized trials in MEDLINE, LILACS and Cochrane until November 2016, in English and Portuguese. They included studies that had as a treatment ESWT or the Laser, compared with other methods, and assessed pain with a visual analogue scale. It used the PEDro scale to assess the methodological quality of the studies. Results: We found 131 articles. Of these, 106 were excluded after reading their titles and abstracts and 15 after reading in full, leaving eighy who had as a treatment the ESWT and two the Laser. Conclusion: Of the 10 articles found six showed statistically significant response in relation to pain, two on Laser and six on ESWT.

Benefício da terapia de ondas de choque no tratamento de úlceras cutâneas: uma revisão da literatura / Benefits of extracorporeal shockwave in the treatment of skin ulcers: a literature review

A terapia de ondas de choque (TOC) extracorpórea possui ação analgésica e anti-inflamatória. Com a evolução e compreensão de seus mecanismos físicos e biológicos, foi se estudando a sua aplicação em outras patologias, principalmente em afecções ósseas e musculo-tendíneas. Recentemente, estudos em modelos animais demonstraram a sua capacidade angiogênica e maior taxa de re-epitelização local. Estas pesquisas levaram ao início do uso de TOC radial de baixa energia no tratamento e manejo de diversas lesões de pele de difícil tratamento. As úlceras cutâneas possuem diversas etiologias, variando desde úlceras de pressão, queimaduras, úlceras venosas ou arteriais e também úlceras diabéticas. Seu tratamento é um desafio, devido ao seu tempo prolongado de tratamento (resultando em dificuldades quanto ao seguimento clínico) e também elevados custos. Objetivo: Avaliar a eficácia da TOC na cicatrização de úlceras de diversas etiologias: diabéticas, por pressão, queimaduras, pós-traumáticas, vasculares venosas e arteriais, por meio de uma revisão da literatura. Métodos: Foi realizada uma revisão da literatura, sendo incluídos estudos clínicos em humanos Resultados: 9 artigos preencheram os critérios de inclusão. Os estudos inclusos compreenderam 788 pacientes. Os manuscritos trouxeram uma variedade de padrão de intervenções diferentes. Houve heterogeneidade no tempo de intervenção, número de pulsos e na frequência de sessões, bem como na quantidade de sessões, densidade de energia aplicada, e também no tipo de ondas de choque utilizados nas terapias. Alguns dos trabalhos descritos encontraram uma maior taxa na cicatrização e fechamento completo de lesões em pacientes com lesões crônicas, que não responderam ao tratamento conservador. Porém, há poucos estudos na literatura com qualidade metodológica adequada. Conclusão: A TOC surge como uma alternativa promissora para pacientes que não respondem bem à terapia conservadora. Os resultados são promissores porém com evidências limitadas quanto a diminuição do tempo de cicatrização e na aceleração do fechamento de lesões. Os estudos selecionados não relataram efeitos colaterais significativos, sendo uma terapia segura

Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolution and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small studies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs. Objective: To review the literature and evaluate the efficacy of ESWT in caring for skin ulcers of various etiologies: diabetic ulcers, pressure ulcers, burns, post-traumatic ulcers, venous and arterial ulcers. Method: A literature review was made, with only human trials included. Results: 9 articles were selected that fulfilled the eligibility criteria. The studies included evaluations of 788 patients. The manuscripts demonstrated a large variability regarding the interventions made. There was heterogeneity regarding intervention time, number of pulses, frequency of sessions, and also the number of sessions, energy density used, and the type of shock wave used in therapies. Some of the included trials found a higher rate of complete wound healing and faster epithelization in patients with chronic lesions, unresponsive to the traditional measures. However, there were few studies in the literature with proper methodological quality. Conclusion: ESWT is a promising alternative for the treatment of patients unresponsive to conventional measures. The results are promising, although the evidence regarding wound healing and acceleration of wound healing is still limited. The studies selected did not report any significant side effects

Effects of Extracorporeal Shockwave Therapy in Chronic Stroke Patients With Knee Osteoarthritis: A Pilot Study

OBJECTIVE: To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA). METHODS: A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm² on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height). RESULTS: The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT. CONCLUSION: It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site.

Effectiveness of Lower Energy Density Extracorporeal Shock Wave Therapy in the Early Stage of Avascular Necrosis of the Femoral Head

OBJECTIVE: To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head. METHODS: Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm²) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm²). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months. RESULTS: In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05). CONCLUSION: Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.

Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome

OBJECTIVE: To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome. METHODS: In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed. RESULTS: VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were -1.69±1.90 and -0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were -1.60±1.74 and -0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were -1.61±1.73 and -0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05). CONCLUSION: rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.