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Rotator cuff injury often leads to shoulder pain and dysfunction. For the injured rotator cuff tendon without continuous interruption, conservative treatment is often used. However, the shoulder is used frequent in daily life, which makes that the rotator cuff injury generally shows gradual aggravation and eventually progresses to complete tear due to poor blood supply of the rotator cuff tendon tissue and weak repair ability. In order to reverse the pathophysiological changes after rotator cuff injury and promote the repair of injured rotator cuff tendon, a series of conservative treatments for rotator cuff injury have been explored. Extracorporeal shock wave therapy (ESWT) is one of the representative treatments, but its molecular biological mechanism in promoting rotator cuff repair is still unclear. Therefore, the authors review the progress of ESWT for rotator cuff injury from aspects of the molecular biological mechanism and clinical application status, so as to provide a reference for future researches and clinical application of ESWT.
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OBJECTIVE@#To compare clinical efficacy of platelet-rich plasma (PRP) and extracorporeal shock wave in treating chronic insertional Achilles tendinopathy.@*METHODS@#From February 2019 to August 2021, 42 patients with chronic insertional Achilles tendinopathy were selected and divided into PRP group(20 patients, 28 feet) and shock wave group (22 patients, 29 feet). In PRP group, there were 12 males and 8 females, aged 47.00(28.00, 50.75) years old, and the courses of disease ranged 7.00(6.00, 7.00) months;PRP injection was performed in the Achilles tendon stop area of the affected side. In shock wave group, there were 16 males and 6 females, aged 42.00(35.75, 47.25) years old;and the courses of disease was 7.00(6.00, 8.00) months;shock wave was performed in Achilles tendon stop area of the affected side and triceps surae area. Visual analogue scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) were applied to evaluate clnical effect before treatment, 1, 3 and 6 months after treatment, and satisfaction of patients was investigated.@*RESULTS@#VAS and VISA-A score in both groups were significantly improved at 1, 3 and 6 months after treatment than before treatment (P<0.05), VAS and VISA-A score in PRP group at 6 months after treatment were significantly higher than those at 1 and 3 months after treatment, and VAS and VISA-A score in shock wave group were lower than those at 1 and 3 months after treatment (P<0.05). There was no significant difference in VAS and VISA-A score between two groups before treatment, 1 and 3 months after treatment(P>0.05), while VAS and VISA-A score in PRP group were better than those in shock wave group at 6 months after treatment(P<0.05), and the satisfaction survey in PRP group was better than that in shock wave group(P<0.05).@*CONCLUSION@#PRP injection has a good clinical effect on chronic insertional Achilles tendinopathy with high patient satisfaction, and medium-and long-term effect of PRP injection for the treatment of chronic insertional Achilles tendinopathy is better than that of extracorporeal divergent shock wave.
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Male , Female , Humans , Middle Aged , Achilles Tendon , Tendinopathy/therapy , Treatment Outcome , Exercise Therapy , Platelet-Rich PlasmaABSTRACT
【Objective】 To investigate the effects of extracorporeal shock wave lithotripsy (ESWL) on procalcitonin (PCT), renal function and inflammatory index levels in patients with indinavir-induced urinary calculi so as to provide reference for clinical practice. 【Methods】 A total of 77 patients with urinary calculi admitted to the Department of Urology of our hospital from January 2017 to January 2021 were selected for retrospective analysis. They were divided into control group (38 cases, non-indinavir related urinary calculi) and observation group (39 cases, indinavir-related urinary calculi) according to the years of the disease. Before treatment and 7 days after treatment, the serum levels of PCT, CRP, Scr, UA, Kim1, VAS scores, and IgG, IgM, MDA, and SOD levels were compared between the two groups. 【Results】 The expressions of serum PCT and CRP at 7 days after treatment in the two groups were significantly lower than those before treatment, and the improvement degree of the observation group was significantly higher than that in the control group (P0.05), but the intraoperative blood loss and MAP 20 min after induction of anesthesia were significantly better than those in the control group. Seven days after treatment, GSH-Px and SOD were significantly better in the observation group than in the control group and before treatment (P<0.05). 【Conclusion】 ESWL treatment for patients with indinavir-induced urinary calculi can effectively reduce the expressions of serum PCT and CRP, improve renal function indexes, reduce intraoperative blood loss, and reduce the level of inflammatory indexes; the clinical effect is good.
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Objective:To observe any effect of combining extracorporeal shock wave stimulation with proprioceptive neuromuscular facilitation (PNF) on the lower limb motor function of stroke survivors with foot drop.Methods:Thirty-six stroke survivors with foot drop were randomly divided into an extracorporeal shock wave group, a PNF group and a combination group, each of 12. The extracorporeal shock wave group and PNF group were given those therapies alone, while the combination group was provided with both. The extracorporeal shock wave therapy protocol was 2000 times on each muscle at an intensity of 2.5 bar and a frequency of 10Hz, twice a week for 4 weeks, while the PNF was provided at least 3 times per week for 4 weeks. Before and after the intervention, all of the participants were evaluated using the modified Ashworth scale (MAS), the 10-metre walk test (10 MWT) and the Fugl-Meyer lower limb motor function scale (FMA). Active range of the ankle joint and toe out angle were also observed.Results:After the intervention the lower limb muscle tone had decreased significantly in 8 of the PNF group members and in 9 of those in the extracorporeal shock wave group, but it has decreased significantly in all 12 members of the combination group. And the average magnitude of the improvement was also significantly greater in the combination group than in the other two groups. Moreover, significant differences were observed in the active range of the ankle joint after the treatment in the combination group, but not in the other two groups. After the intervention the average 10 MWT times and FMA scores of the PNF and combination groups had improved significantly, but not those of the extracorporeal shock wave group, but significant improvement in toe out angles was observed in all three groups, though the average improvement in the combination group was significantly greater than in the other 2 groups.Conclusion:Combining extracorporeal shock waves with PNF can effectively improve the lower limb motor function of stroke survivors with foot drop.
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Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the common diseases in uroloandrology, which recurs easily after treatment. In recent years, the safety and efficacy of extracorporeal shock wave therapy (ESWT) for CP/CPPS has been widely demonstrated. Studies have shown satisfactory short-term (≤12 weeks) outcomes of ESWT, but lack long-term (>12 weeks) follow-up data. In addition, inconsistent indications and unexplained therapeutic mechanisms have limited the further clinical promotion of ESWT. This article summarizes the latest progress and potential mechanism of ESWT in the treatment of CP/CPPS in order to provide new insights for the standardized application of ESWT.
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The aim of this article is to assess the outcomes of a low-intensity extracorporeal shock wave therapy (LiESWT) protocol for the treatment of Peyronie's disease (PD). Patients treated for PD were prospectively recorded, and data were retrospectively reviewed. Age, characteristics of fibrous plaques, concomitant treatments, International Index of Erectile Function (IIEF-5), Lue score, and pain score on Likert scale were collected. Patients in acute phase of PD and an angulation of <40° were included. The protocol consisted of 6 weekly sessions of 4000 pulses each, applied from different directions, with a maximal power of 20 W and 8 Hz frequency. We included 39 patients (median age: 56.8 years, interquartile range [IQR]: 35.8-62.2 years). The median number of sessions received per patient was 7.2. After treatment, the median Lue score decreased from 6.8 initially to 3.3 (P = 0.003), the median Likert pain score dropped from 1.8 to 0.7 (P = 0.004), the median plaque size was reduced from 2 cm to 1.2 cm (P = 0.08), and the median penile curvature diminished from 31° to 17° (P = 0.07). On univariate and multivariate analysis, the only predictors of success were younger age (odds ratio [OR] = 0.95, P = 0.03 and OR = 0.91, P = 0.04, respectively) and concomitant use of phosphodiesterase-5 inhibitors (PDE5i; OR = 0.92, P = 0.02 and OR = 0.93, P = 0.01, respectively). LiESWT had a favorable impact on Lue score and notably penile pain, curvature, plaque size, and erectile function in patients treated for PD during the early inflammatory phase, with no side effects. Younger age and concomitant use of PDE5i were the only success predictors.
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Adult , Humans , Male , Middle Aged , Extracorporeal Shockwave Therapy , Penile Erection , Penile Induration/therapy , Penis , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVES@#Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients.@*METHODS@#From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups.@*RESULTS@#After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both P<0.05), and the combined group was lower than the control group (P<0.001); BBS and FMA-LE scores were higher than those before treatment (both P<0.05), and the combined group was higher than the control group (both P<0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all P<0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both P<0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all P<0.05), and were higher than those in control group (P<0.05 or P<0.001).@*CONCLUSIONS@#WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.
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Humans , Extracorporeal Shockwave Therapy , Gait , Hemiplegia/therapy , Muscle Spasticity/therapy , Stroke/complications , Stroke Rehabilitation/methods , Treatment Outcome , Vibration/therapeutic useABSTRACT
Objective:To observe any effect of supplementing continuous static stretching (CSS) with extracorporeal shock wave therapy (ESWT) in treating triceps surae spasm after a stroke.Methods:Sixty-four stroke survivors with triceps surae spasm were randomly divided into a conventional rehabilitation group, a shock wave group and a combined treatment group. In addition to conventional rehabilitation, the shock wave group received extracorporeal shock wave therapy twice a week and the combined treatment group received the shock waves during continuous static stretching. After 6 weeks of treatment all of the subjects were assessed using the Modified Ashworth Scale (MAS), the Fugl-Meyer Assessment (FMA) and Brunnstrom classification of their functional recovery stage.Results:Before treatment there was no significant difference among the three groups. After the 6 weeks of treatment the average triceps surae tension in all three groups had eased significantly. At that point the average MAS and FMA scores of the shock wave group and the combined treatment group were significantly better than those of the conventional group. The combined treatment group then showed significantly better therapeutic effect than the shock wave group.Conclusions:Applying extracorporeal shock waves during continuous static stretching can significantly improve the stretching′s ability to reduce spasticity and improve motor functioning, at least of the triceps surae. Combining shock waves with modern traction methods is recommended for clinical application.
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Objective:To compare the effect of local vibration and extracorporeal shock wave therapy (ESWT) on triceps spasticity and the walking ability of hemiplegic stroke survivors.Methods:Sixty-nine stroke survivors with hemiplegia were randomly divided into a control group, a vibration group and an ESWT group. The control group received 60 minutes of conventional Bobath rehabilitation treatment and motor relearning from Monday to Saturday for 4 weeks. For the vibration and ESWT groups, 10 minutes of that traditional therapy were replaced by either local vibration or extracorporeal shock wave treatment every Tuesday, Wednesday and Saturday. Before and after the treatment, the three groups were evaluated using the Comprehensive Spasticity Scale (CSS) and in terms of passive joint range of motion (PROM), ankle plantar flexion angle, 10m maximum walking speed, stride frequency, and stride length.Results:After the intervention the average CSS, PROM, and ankle plantar flexion angle were significantly better for all three groups than before the treatment. At that point the ESWT group′s averages were significantly better than those of the vibration group, and the vibration group′s averages were significantly superior to those of the control group. Walking speed, stride frequency and stride length had also improved significantly in all three groups, with those in the vibration and ESWT groups significantly outperforming the control group. There was no significant difference between the vibration and ESWT groups in terms of walking ability.Conclusions:Both local vibration and extracorporeal shock wave therapy improve triceps spasticity and the walking ability of hemiplegic stroke survivors. Shock waves are more effective for improving spasticity, but there is no significant difference between the therapies in terms of improving walking ability.
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Objective:To determine whether or not shock wave therapy promotes the repair of muscle injury by regulating insulin-like growth factor-1 (IGF-1) and/or the phosphorylation of protein kinase B (p-Akt).Methods:Sixty-six adult male Sprague-Dawley rats were randomly divided into a normal group, a model group and a treatment group. A custom-made striker was used to induce blunt contusion in the gastrocnemius muscles of the rats of the model and treatment groups. The normal and model groups were then not given any therapeutic intervention. Twenty-four hours later, the treatment group underwent 500-impulse shockwave treatment at 0.14mJ/mm 2 and 10Hz. That was repeated 4 days later. The injured muscle was sampled on the 1st, 3rd, 5th, and 7th day after modeling. Hematoxylin and eosin staining was applied to observe the arrangement of muscle fibers, and the expressions of myostatin, myogenic differentiation antigen 1 (MYOD1), IGF-1 and p-AKTs473 were detected by immunohistochemistry and western blotting. Results:(1) The staining showed that in the model group the space between the muscle cells was larger than in the normal group. In the treatment group there were more newly-formed mononuclear or multinucleated muscle tubes. The regeneration of skeletal muscle in the treatment group was superior to that in the model group at the same time points. (2) The average myostatin expression of the model group increased significantly compared with the normal group at all the time points, while that of the treatment group had decreased significantly compared with the model group. Moreover, no significant differences were found on the 7th day between the treatment and normal groups. (3) Western blotting showed that the expression of MyoD1 in the model group was significantly higher than that in the normal group on days 1 and 3, and the expression of MyoD1 in the treatment group was significantly higher than in the model group. The expression levels of IGF-1 and P-AKTS473 in the model group were higher than those in the normal group at the same time point, and the expression levels in the treatment group were significantly higher than those in the model group.Conclusion:Extracorporeal shock wave therapy can promote the regeneration and repair of skeletal muscle by regulating IGF-1 and p-AKT levels.
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Objective:To seek any effect of extracorporeal shockwave treatment on the expression of transforming growth factor-β1 (TGF-β1) and interleukin-1β (IL-1β) in the cartilage tissue of rabbits with knee osteoarthritis (OA), and its therapeutic mechanism.Methods:Fifty female New Zealand rabbits were randomly divided into a normal control group, a model group, and three shockwave groups A, B and C, each of 10. Except for the normal control group, an OA model was established in the other groups using Hulth′s method. The shockwave groups were given 2000 shocks in each weekly session over 4 weeks. The energy flow density in group A was 0.05mJ/mm 2; in B it was 0.11mJ/mm 2 and in C 0.22mJ/mm 2. The normal control and model groups were not shocked. All the rabbits were then sacrificed and their right knee cartilage tissue was sampled to observe any pathological changes and assign improved Mankin scores. Immunohistochemistry was used to count the number of TGF-β1 and IL-1β-positive cells in the cartilage. Western blotting and real-time fluorescence quantitative polymerase chain reactions were employed to determine the protein and mRNA expression of IL-1β and TGF-β1. Results:Compared with the normal group, degeneration of articular cartilage was observed in the model group. The average Mankin′s score of the model group was significantly higher than that of the normal control group. The average expression of TGF-β1 and IL-1β protein and mRNA in the model group had increased significantly compared with the normal control group. The average Mankin′s scores of the shock wave groups were all significantly lower than the model group′s average. Group C′s average expression levels of TGF-β1 and IL-1β protein and mRNA were significantly lower than the model group′s averages.Conclusions:Extracorporeal shockwave therapy can reduce the expression of TGF-β1 and IL-1β in the cartilage of an arthritic knee, at least in rabbits. Its therapeutic effect is positively correlated with the density of the energy flow, suggesting that shock waves may reduce the expression of inflammatory factor IL-1β by regulating the expression of TGF-β1. They should be applied in the prevention and treatment of osteoarthritis.
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Objective:To investigate the predictors of the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral calculi, and to evaluate the predictive value of the maximum ureteral wall thickness (UWT) in the treatment of ureteral calculi with ESWL.Methods:The clinical data of 138 patients with ureteral calculi treated with ESWL in the Second People's Hospital of Hefei from January 2020 to December 2020 were retrospectively analyzed. There were 91 males and 47 females. The age was (50.9±14.8) years old. The body mass index was (25.3±3.6) kg/m 2. The stones of 73 cases were located on the left side and 65 cases were on the right side. 70 cases had upper ureteral stones, 18 cases had middle ureteral stones, and 50 cases had lower ureteral stones. The median length of the stone was 8.5 (7.5, 10.5) mm. The CT value of the stone was 509 (343, 783) HU. The anteroposterior diameter of the renal pelvis was 12.0 (10.1, 16.0) mm, and UWT was (2.8 ± 0.8) mm. All patients underwent urinary non-contrast CT before lithotripsy, and the UWT of the stone bed was measured on the CT images. According to the stone removal situation 2 weeks after the operation, the patients were divided into a successful lithotripsy group and a failed lithotripsy group. Univariate analysis was used to compare the differences of various indicators between the two groups, and multivariate logistic regression was used to analyze the independent predictors of ESWL in the treatment of ureteral calculi for the indicators. The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) of each independent predictor, and the cut-off value, sensitivity and specificity were analyzed. Results:All operations were successfully completed, and the success rate of the first-stage lithotripsy was 71.7% (99/138). The results of univariate analysis showed that the stone length diameter, stone CT value, anteroposterior diameter of renal pelvis, stone skin distance, and UWT were significantly different between the successful lithotripsy group and the failure group ( P<0.05). There was no significant difference in age, gender, body mass index, stone side and stone location ( P>0.05). The results of multivariate logistic analysis showed that stone length ( OR=1.393, P=0.015), stone CT value ( OR=1.002, P=0.043) and UWT ( OR=17.997, P<0.001) were all for the efficacy of ESWL in the treatment of ureteral stones. The ROC curve was used to compare the three independent predictors. The area under the UWT curve was the largest (AUC=0.898, P<0.001), followed by the length of the stone (AUC=0.744, P<0.001), and the CT value of the stone (AUC=0.672, P= 0.002). The cut-off value for UWT was 3.19 mm, which had a sensitivity of 91.9% and a specificity of 71.8% for predicting the success of ESWL lithotripsy. When dividing the patients into thin wall group (UWT ≤3.19 mm) and thick wall group (UWT>3.19 mm) according to the cut-off value, the success rates of one-stage lithotripsy in the two groups were 89.2% (91 / 102) and 22.2% (8/36), respectively ( P<0.05). Conclusions:UWT, calculus length and calculus CT value are independent predictors of the efficacy of ESWL in the treatment of ureteral calculi, and UWT has the best predictive value. When UWT≤3.19 mm, the success rate of ESWL in the treatment of ureteral calculi is higher.
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Objective To establish a blast injury experimental model using a shock tube at lateral lying position of C57BL/6 mice, investigate biomechanical responses of macrophages/microglia cells in the heart, lung and brain tissues to mechanical damage by shock wave within 24 hours. Methods Shock tube was employed to generate a shock wave to C57BL/6 mice. Firstly, the weight changes of mice were measured at different time points after the shock. Then the cardiac, pulmonary and whole brain tissue samples were dissected after anesthesia. Pathological sections were stained with HE staining to detect structural damage; the TUNEL staining method was used to mark and count the proportion of dead cells in each tissue. Microglial cells were labeled with fluorescent antibody, while responses and changes of macrophages/microglia after shock loading were analyzed. Results The shock tube exerted 179 kPa overpressure shock wave upon sideway of the mouse, and lethal rate of the mouse was 3.33%. Compared with normal control group, the mice in experimental group had a significant weight loss within 24 hours after loading shock. Pathological sections showed rupture of lung tissues after shock, accompanied by alveolar protein deposition, pulmonary bulla and other diseases. Fluorescence staining showed that lung tissue was recruited and activated in a large amount within 24 hours. The proportion of dead cells cleared rebounded to normal level within 24 hours. The heart was highly tolerant to shock, and macrophages appeared near the large blood vessels. The brain showed unilateral aggregation of microglia due to the impact posture, mainly due to prolonged inflammation and a higher proportion of dead cells at the junction of gray and white matter. Conclusions A blast shock model at lateral lying position of the mouse was established. Within 24 hours, macrophages/microglia were recruited quickly to the injury site after being impacted, which mediated strong immune stress, and might participate in the immune response to trigger a second long-term inflammatory injury. The results of the study provide experimental basis for the evaluation of primary impact injury, such as dose-effect relationship and tissue damage difference.
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BACKGROUND: Studies have shown that the elasticity of the radial wrist flexor and ulnar wrist flexor muscles is related to the power of gripping, and the tension and stiffness directly affect the pinching force on the thumb side and the palm gripping ability. Extracorporeal shock waves have a definite effect on alleviating post-stroke limb spasm. OBJECTIVE: To observe the immediate effect of extracorporeal shock wave therapy on muscle tone, stiffness, and elasticity of flexor carpi radialis and flexor carpi ulnaris in stroke patients. METHODS: Twenty stroke patients with hemiplegia who met the inclusion criteria were given a single session of extracorporeal shock wave therapy on flexor carpi radialis and flexor carpi ulnaris. The oscillation frequency, logarithmic decrement, dynamic stiffness of flexor carpi radialis and flexor carpi ulnaris were detected using a muscle tone measurement device Myoton-3 before treatment and 5 minutes after treatment. At the same time, the Modified Tardieu Scale was used to evaluate spasticity of wrist flexor before and after treatment. The study protocol was implemented in accordance with the relevant ethical requirements of the First Affiliated Hospital of Guangdong Pharmaceutical University, and the enrolled patients and their families were fully informed of the whole trial. RESULTS AND CONCLUSION: After treatment, the oscillation frequency, logarithmic decrement, dynamic stiffness, and quality of muscle response of flexor carpi radialis and flexor carpi ulnaris were significantly reduced in all the patients (P < 0.01). The maximum passive range of motion of wrist extension and angle of catch following a fast velocity stretch wrist flexor were significantly higher than those before (P < 0.01). In conclusion, a single session of extracorporeal shock wave therapy can effectively reduce muscle tone and stiffness, and improve elasticity of flexor carpi radialis and flexor carpi ulnaris in stroke patients. And it can also improve the maximum passive range of motion of wrist extension.
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BACKGROUND: Research evidence shows hip arthroplasty has become the final treatment of osteonecrosis of femoral head, but early-and middle-stage osteonecrosis of femoral head or young patients often give priority to hip preservation treatment, including conservative treatment and surgical treatment. OBJECTIVE: To summarize the progress of hip preservation in the treatment of osteonecrosis of femoral head. METHODS: The literature about hip-preserving treatment of osteonecrosis of femoral head in PubMed, VIP, CNKI and Web of Science databases from 2010 to March 2020 was searched by computer. The key words were “osteonecrosis of femoral head, hyperbaric oxygen, pulsed electromagnetic fields, extracorporeal shock wave, hip arthroscopy, core decompression, stem cell transplantation, non-vascularized free bone grafting, vascularized free bone grafting, porous tantalum rod implantation, intertrochanteric osteotomy, medication”. A total of 197 articles were retrieved, and the full text was consulted. According to the inclusion criteria, 59 articles were included for result analysis. RESULTS AND CONCLUSION: (1) Drug therapy should be used cautiously because of its potential side effects and insufficient research. (2) Physiotherapy is effective for early lesions, and it has the advantages of non-invasion and convenient operation. (3) At present, there are different types of hip preservation surgery. Core decompression is the basic therapy for the treatment of osteonecrosis of femoral head, but it is seldom used alone. At present, it is often treated in combination with other hip preservation therapies. Osteotomy has higher requirements in the selection of patients’ indications and surgical skills, so it should be chosen carefully in clinic. There are some problems in porous tantalum rod implantation, such as long operation time, large blood loss and difficulty of hip replacement in the later stage. Stem cells and arthroscopic therapy show good results, and the research process should be accelerated. Vascularized bone grafting has a good effect on both middle-and late-stage patients.
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OBJECTIVE: Schwann cells can promote the regeneration of damaged peripheral nerves and serve as seed cells in the engineering repair of peripheral nerve tissue. The effective culture and purification of Schwann cells are the basis of clinical treatment for peripheral nerve injury. This paper summarized the literature of culture of Schwann cells in vitro in recent ten years and made a descriptive review on the research progress of Schwann cell culture and purification, in order to provide references for culture of Schwann cells in vitro. METHODS: Literature related to Schwann cell isolation, culture and purification was retrieved from PubMed, Web of Science, Medline databases, CNKI, Wanfang, VIP and other databases. The keywords included “Schwann cells; isolation; culture; purification”. All the papers obtained from the search were read, analyzed and judged, and finally 62 papers meeting the standards were included. RESULTS: The classical methods of Schwann cell culture include tissue block culture and enzyme digestion. Purification methods include mitosis resistance, immune selection, specific adhesion, pre degeneration, cold jet, differential adherent, laminin package, low serum, stimulating factor, fluorescence activated cell sorting or magnetic activated cell sorting, immunopanning, and extracorporeal shock wave treatment. CONCLUSION: Schwann cells can be cultured and purified in various ways in vitro, and each method has its advantages and disadvantages. How to obtain high-purity Schwann cells quickly and efficiently is still a challenge. Multiple methods can be combined for purification and affective factors can be controlled for Schwann cell proliferation as much as possible.
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Introduction: Extracorporeal shock-wave lithotripsy (ESWL)is an established non-invasive treatment modality for renaland ureteric stones. However, treatment outcome and efficacydepends on multiple factors like stone size, location and typeof machine used. We aimed to assess efficacy of ESWL asa primary treatment modality in renal and ureteric stones ina busy hospital setting having significant renal stone diseaseburden.Material and methods:1187 patients who underwent ESWLbetween January 2015 to December 2016 in our departmentwere included in the study. Patients with nephrolithiasis andureterolithiasis having functional kidney, without any absolutecontraindication to ESWL were included. Dornier Med TechCompact Delta 2 machines were used for all the patients.Stone localization was done using both fluoroscopic andultrasound- guided methods by same expert.Results: Out of 1187 patients,887 patients had solitary renalstones,170 had solitary ureteral calculus and 130 patients hadmultiple renal calculi. Stone size ranged from 8mm–20mm.Renal pelvic stones, upper calycial stones and proximalureteric stones had stone free rate of 84%,86% and 82.5%respectively. 89% and 84% of patients were stone free whensize of stone was between 8-12mm, it decreased to 77% and73% when size increased between 13-16mm for kidney andureteric stones respectively.Conclusions: ESWL is an effective primary treatmentmodality for appropriately selected patients with stone sizeless than 2 cm in favorable location with a normal functioningkidney. Use of both fluoroscopic and ultrasound imagingimproves localization of stones thus improving success. Itis an important modality in hands of urologist treating hugevolume of urolithiasis patients in busy hospitals with longwaiting list and with limited resources.
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ABSTRACT Objective: To evaluate the effectiveness of single-dose focal shockwave therapy in plantar fasciitis treatment. Methods: a primary, prospective study of a series of cases, conducted in the city of São Paulo, Brazil, by the Department of Orthopedics and Traumatology of the Universidade Federal de São Paulo, in Hospital São Paulo. All outcomes were measured at the time of inclusion of the patient in the study and at the post-intervention moments as it follows: three, six and twelve weeks. The VAS, AOFAS and SF-36 scales were applied by teams other than those who performed the SWT. Results: Data from 56 patients were collected during 2017 and 2018. There was improvement of the parameter evaluated (p < 0.005 and 95%CI) in all the periods in which the patients were reevaluated (3, 6 and 12 weeks), progressive improvement were observed in the three outcomes evaluated. Conclusion: Shock wave therapy was effective for plantar fasciitis treatment according to the proposed protocol considering pain, function and quality of life. Level of Evidence Ic, Case-series Study.
RESUMO Objetivo: Avaliar a eficácia da terapia de ondas de choque focais de dose única no tratamento de fasciíte plantar. Métodos: Um estudo primário e prospectivo de série de casos foi realizado na cidade de São Paulo, Brasil, pelo Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo, no Hospital São Paulo. Todos os desfechos foram medidos no momento da inclusão do paciente no estudo e nos momentos pós-intervenção da seguinte forma: 3, 6 e 12 semanas. As escalas VAS, AOFAS e SF-36 foram aplicadas por equipes diferentes daquelas que realizaram o tratamento. Resultados: Dados de 56 pacientes foram coletados durante 2017 e 2018. Houve melhora do parâmetro avaliado (p < 0,005 e IC95%) em todos os períodos de reavaliação dos pacientes (3, 6 e 12 semanas), sendo observada a melhora progressiva nos três desfechos avaliados. Conclusão: A terapia por ondas de choque foi eficaz no tratamento da fasciíte plantar de acordo com o protocolo proposto, considerando dor, função e qualidade de vida. Nível de evidência Ic, Estudo de série de casos.
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Blast wave can stimulate the sympathetic and parasympathetic nervous system, leading to the changes of autonomic nervous function. It can also damage the hypothalamus and pituitary, and activate the hypothalamic-pituitarytarget gland axis and the locus ceruleus-sympathetic-adrenal medulla axis, resulting in the changes of endocrine level. In addition, it can activate inflammatory cells, synthesize and release different inflammatory mediators, resulting in the changes of inflammatory response. This paper reviews the changes and interactions of autonomic nervous function, endocrine level and inflammatory response in blast wave injury, and further explains the injury mechanism of blase wave, providing references for the treatment of blast wave injury..
ABSTRACT
Objective:To observe the effect of extracorporeal shock wave therapy on tendon adhesion in late period after hand tendon repair. Methods:From July, 2017 to December, 2018, 40 patients with tendon adhesion after hand tendon repair more than three months were collected. They were randomly divided into control group (n = 20) and experimental group (n = 20). Two groups received routine therapy, and the experimental group added extracorporeal shock wave therapy. Before and two months after treatment, the total active movement (TAM) of the fingers and the grip strength were messured. Results:There was no significant difference in TAM of the fingers and the grip strength before treatment (P > 0.05). After treatment, TAM of the fingers and the grip strength significantly increased (|t| > 10.284,P < 0.001), and were higher in the experimental group than in the control group (t > 0.386,P < 0.001). Conclusion:Extracorporeal shock wave therapy could facilitate to improve the tendon slippage and hand function in patients with tendon adhesion after hand tendon repair.