Cardiac shock wave therapy for coronary heart disease: an updated meta-analysis

Abstract Introduction: The aim of this article is to study the efficacy and safety of cardiac shock wave therapy (CSWT) in the treatment of coronary heart disease (CAD). Methods: A comprehensive search of electronic databases and a manual search of conference papers and abstracts were performed until September 30, 2018. The studies using RevMan 5.3 and STATA 14.0 softwares were reviewed, and meta-analyses were performed on 13 indicators, such as a six-min walking distance test (6MWT), New York Heart Association (NYHA) functional class, Seattle Angina Questionnaire (SAQ) score, angina class (Canadian Cardiology Society [CCS]), etc. Results: A total of 26 articles were included. The total patient population was 855, of which 781 patients were treated with CSWT. Meta-analyses indicated that 6MWT (mean difference [MD] 75.64, 95% confidence interval [CI] 49.03, 102.25, P<0.00001) and NYHA (MD -0.70, 95% CI -0.92) in the CSWT group were comparable to those in the conventional revascularization group (MD -0.70, 95% CI -0.92, -0.49, P<0.00001). SAQ (MD 10.75, 95% CI 6.66, 14.83, P<0.00001), CCS (MD -0.99, 95% CI -1.13, -0.84, P<0.00001), nitrate dosage (MD -1.84, 95% CI -2.77, -1.12, P<0.00001), LVEF (MD 3.77, 95% CI 2.17, 5.37, P<0.00001), and SSS (MD -4.29, 95% CI -5.61, -2.96, P<0.00001), SRS (MD -2.90, 95% CI -4.85, -0.95, P=0.004), and the exercise test (standard mean difference 0.57, 95% CI 0.12, 1.02, P=0.01) all showed significant differences. Conclusion: CSWT may offer beneficial effects to patients with CAD, but more large-scale clinical studies are needed to further verify its therapeutic effect.

Utilização da terapia extracorpórea por ondas de choque em acidente vascular encefálico com espasticidade: estudo piloto / Use of extracorporeal shock wave therapy in patients with spasticity related to stroke: a pilot study

Introdução: O objetivo desta pesquisa é demonstrar a redução do tônus muscular utilizando a terapia extracorpórea por ondas de choque e promover o retorno dos movimentos normais. Métodos: Foram escolhidos 10 pacientes idosos que apresentavam espasticidade, faixa etária entre 50 e 80 anos. Este estudo piloto utilizou 3 métodos: a escala de Ashworth, goniometro digital e o deslocamento do ventre muscular, antes e após as aplicações das ondas de choque. Aplicou-se uma corrente de pulso para verificar o deslocamento do ventre muscular, por meio de um laser marca LTM 165 classe 2 Stanley. O deslocamento foi medido por um sensor a laser. O equipamento de ortolitotripsia foi a Direx Integra, cuja dose/intensidade foi entre 1000 ciclos por segundo e 0,030 mJ/mm de energia em 12 gpm. Resultados: Na escala de Ashworth os resultados foram significativos (= 0,05). Na goniometria digital a abdução do ombro evoluiu em média 35° em 7 pacientes e 15° em 3 pacientes. (p > 0,05). Conclusão: Observa se que as ondas de choque não deixam os músculos hipotônicos, mas com tônus adequado. Os pacientes que obtiveram pouca melhora (15° goniometria) apresentaram micro-encurtamentos e não apresentam história de participação na fisioterapia regularmente. (AU)

Introduction: This research aims to show the reduction of muscular tonus by using extracorporeal shock wave lithotripsy in order to recover normal movements. Methods: 10 patients over 50 and under 80 years of age presenting spasticity participated in this pilot study, which used three methods: 1) the Ashworth scale, 2) the digital goniometer and 3) the dislocation of muscle tissue, before and after the shock waves. To check the dislocation of muscle tissue, a current pulse was applied, measured by a LTM 165 class 2 Laser. This approach is similar and consists of measuring the dislocation on a laser sensor basis. The Ortho-lithotripsy equipment used was a Direx Integra. The dose/intensity was 1000 cps ­ 0.030 mJ/mm². Results: We also observed a better quality of muscle contraction (Scale Ashworth p=0.05). At digital goniometry, the shoulder abduction developed 35° in 7 of the patients and 15° in 3 of them (p<0.05). Conclusion: The muscles do not become hypotonic with the shock waves treatment, (they present an adequate tonus). The patients who presented micro-shortening and did not undergo to regular physiotherapy showed a minor improvement (15° goniometry). (AU)

Shockwave ou terapia por ondas de choque (TOC) em equinos atletas / Shockwave therapy in athlete horses / Shockwave o terapia por ondas de choque (TOC) en equinos atletas

A técnica de terapia por ondas de choque (TOC) ou shockwave, assim como outras técnicas reabilitativas, busca acelerar a recuperação de lesões do animal por meio de seus efeitos (terapêuticos e analgésicos), e consequentemente retornar o mesmo mais rapidamente à vida esportiva. O objetivo desta revisão é apresentar a eficácia desta técnica de reabilitação, reconhecer suas fases ocorrentes para que promova seus efeitos e entender seus benefícios para equinos atletas. As ondas de choque, basicamente são impulsos acústicos criados por um gerador e transmitidos para o corpo do animal, agindo nos tecidos. O mecanismo exato de como essas ondas age nos tecidos ainda não é completamente entendido, porém entende-se que quatro fases de reação são ocorrentes no corpo do animal. A fase física, onde ocorrem cavitações extracelulares (formação de cavidades ocas nos líquidos), ionização de moléculas e também um aumento de permeabilidade das membranas, já que os tecidos contraem-se e expandem-se à medida que as ondas são transmitidas aos tecidos biológicos, resultando assim em um movimento oscilatório de suas moléculas. A fase físico-química, onde ocorre uma interação entre os radicais difundidos e biomoléculas que são liberadas pelas células; a fase química, que é resultante disso, é caracterizada por reações intracelulares, e a fase biológica que somente é estabelecida caso as modificações ocorrentes na fase química persistam. A técnica é utilizada pelos seus efeitos terapêuticos e analgésicos no animal atleta. Em relação aos seus efeitos terapêuticos, pode-se destacar o aumento da produção de colágeno, a regeneração tecidual, a aceleração da remoção de metabólitos nociceptivos e o auxílio na restauração da mobilidade. Ao falar dos efeitos analgésicos, destaca-se a redução da tensão muscular, que consequentemente diminui a dor no local lesionado, e a diminuição do risco de edema. Por ser uma técnica considerada minimamente invasiva, a boa aceitação do tratamento por parte do animal é consequência. O equipamento também pode ser transportado facilmente, inclusive ser levado a eventos equestres, para que seja prestada assistência aos animais durante os intervalos de suas competições equestres. Portanto, a terapia por ondas de choque pode ser considerada uma técnica extremamente benéfica para a medicina esportiva de equinos.(AU)

The shockwave therapy technique, as well as other rehabilitative techniques, seeks to accelerate the recovery of injuries through its therapeutic and analgesic effects, and thus be able to return to sports life more quickly. The aim of this review is to present the effectiveness of this rehabilitation technique, recognize its phases to promote its effects and understand its benefits for equine athletes. Shock waves are basically acoustic pulses created by a generator and transmitted to the animal's body, acting on the tissues. The exact mechanism of how these waves act on tissues is not yet fully understood; however, it is understood that four reaction phases take place on the animal's body. The physical phase, where extracellular cavitations occur (hollow cavities in liquids), molecule ionization and increased membrane permeability, as tissues contract and expand while waves are transmitted to biological tissues, resulting in an oscillatory motion of its molecules. The physical-chemical phase, where there is an interaction between the diffused radicals and biomolecules that are released by the cells; the resulting chemical phase is characterized by intracellular reactions; and the biological phase is only established if the changes occurring in the chemical phase persist. The technique is used for its therapeutic and analgesic effects occurring in the athlete animal. Regarding its therapeutic effects, it is important to point out the increase of collagen production, tissue regeneration, the acceleration of nociceptive metabolite removal, and the aid in the restoration of mobility. In relation to its analgesic effects, the reduction in muscle tension, which consequently decreases the pain in the injured site, and the reduced risk of edema, can be observed. Since it is considered a minimally invasive technique, the animal accepts the treatment well. The equipment can also be easily transported, and can even be taken to equestrian events, so that the animals can be assisted during the breaks in their equestrian competitions. Therefore, shockwave therapy can be considered an extremely beneficial technique for equine sports medicine.(AU)

La técnica de terapia por ondas de choque (TOC) o shockwave, así como otras técnicas de rehabilitación, busca acelerar la recuperación de las lesiones del animal a través de sus efectos (terapéuticos y analgésicos) y, consecuentemente volver a la vida deportiva más rápidamente. El objetivo de esta revisión es presentar la efectividad de esta técnica de rehabilitación, reconocer las fases que ocurren para promover sus efectos y comprender sus beneficios para los equinos atletas. Las ondas de choque son básicamente impulsos acústicos creados por un generador y transmitidos al cuerpo del animal, actuando sobre los tejidos. El mecanismo exacto de cómo actúan estas ondas en los tejidos aún no se comprende completamente, pero se entiende que se están produciendo cuatro fases de reacción en el cuerpo del animal. La fase física, donde se producen cavitaciones extracelulares (formación de cavidades huecas en líquidos), ionización de moléculas y también mayor permeabilidad de la membrana, ya que los tejidos se contraen y se expanden a medida que las ondas se transmiten a los tejidos biológicos, resultando así en un movimiento oscilatorio de sus moléculas. La fase fisicoquímica, donde hay una interacción entre los radicales difusos y las biomoléculas que son liberadas por las células, la fase química que es resultante de eso, es caracterizada por reacciones intracelulares y la fase biológica que solo es establecida caso las modificaciones ocurrentes en la fase química persistan. La técnica es utilizada por sus efectos terapéuticos y analgésicos que ocurren en el animal atleta. En cuanto a sus efectos terapéuticos, se puede destacar el aumento de la producción de colágeno, la regeneración de tejidos, la aceleración de la eliminación de metabolitos nociceptivos y la ayuda en la restauración de la movilidad. Hablando de los efectos analgésicos, se destaca la reducción de la tensión muscular, que en consecuencia disminuye el dolor en el sitio lesionado, y el riesgo reducido de edema. Debido a que se considera una técnica mínimamente invasiva, la buena aceptación del tratamiento por parte del animal es consecuencia. El equipo también puede ser transportado fácilmente, incluso llevarlo a eventos ecuestres, para que los animales puedan ser asistidos durante los descansos de sus competiciones ecuestres. Por lo tanto, la terapia de ondas de choque puede ser considerada una técnica extremadamente beneficiosa para la medicina deportiva equina.(AU)

Predictors of success of shock wave lithotripsy for ureteral stones based on computed tomography scan parameters

Background: For shock wave lithotripsy has proven to be an effective, safe and truly minimally invasive option for the treatment of nephrolithiasis. Various technical factors as well as patient selection can impact the success of the procedure. Objective: The aim of this study was to identify the parameters on NCCT that may predict the success of shock wave lithotripsy (SWL) in ureteral stones. Patients and Methods: 102 patients who underwent SWL for ureteral stones at sayed Galal University Hospital from January 2015 to August 2018 diagnosed by non-contrasted computed tomography were studied. The failure was defined as remnant stones ﻞ4 mm. We assessed age, sex, body mass index, stone size, location, skin-to-stone distance (SSD), presence of JJ and the presence of secondary signs (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign). Results: 102 patients with success rate 61.8%, stone size, stone density were significantly associated with outcome of SWL. While SSD, JJ and secondary signs (hydronephrosis, perinephric fat stranding and tissue rim sign) were insignificant. On multivariate analysis, stone size and stone density were the independent factors affecting the outcome of SWL. Conclusions: The study demonstrated that stone size and density are significant and independent predictors of outcome in patients with upper ureteral stones. However SSD and signs of impaction still have to be evaluated

Seudoartrosis atrófica: Efecto de la aplicación de ondas de choque extracorpóreas en un modelo experimental en tibia de conejos / Atrophic pseudoartrosis. Effect of extracorporeal shock waves application in an experimental model in tibia of rabbits

Introducción: Los efectos de las ondas de choque extracorpóreas se han investigado en osteoblastos humanos, focos fracturarios, seudoartrosis y células periósticas. Los mejores resultados del tratamiento de la seudoartrosis con ondas de choque extracorpóreas se han documentado para seudoartrosis hipertróficas. El objetivo de este estudio fue investigar el efecto de la terapia con ondas de choque extracorpóreas sobre un foco de seudoartrosis "atrófica" generado en tibia de conejo. Métodos: Se establecieron tres grupos: A, fracturados sometidos a ondas de choque extracorpóreas; B ("control"), fracturados no sometidos a ondas de choque y C, no fracturados (pierna derecha). Se trataron 37 conejos (cuniculus NV) blancos y esqueléticamente maduros de Nueva Zelanda. Se practicó la cauterización del periostio con electrobisturí bipolar en una extensión de 20 mm, en ambos muñones óseos (proximal y distal). Luego se aplicaron ondas de choque extracorpóreas en una sola sesión. Se realizaron tinciones con hematoxilina-eosina. Se efectuó el análisis biomecánico con un método de carga a "3 puntos". Se estudiaron la carga máxima aplicada y el módulo de elasticidad para cada grupo. Resultados: El estudio histológico permitió registrar signos de consolidación -callo fracturario perióstico y endostal- considerablemente mayores en las tibias de los animales del grupo A (tratado con ondas de choque extracorpóreas) que en las del grupo B "control". Conclusión: En un modelo experimental original de seudoartrosis atrófica generada por electrocauterización en tibia de conejos, se registraron cambios significativos radiográficos e histológicos luego de la intervención del foco mediante ondas de choque extracorpóreas. Nivel de Evidencia: II

Introduction: The effects of extracorporeal shock wave therapy (ESWT) have been investigated in human osteoblasts, fracture foci, nonunion and periosteum cells. The best results of nonunion treatment with ESWT have been documented for hypertrophic type. The objective of this study was to investigate the effects of ESWT in an atrophic nonunion focus generated in a rabbit tibia model. Methods: Three groups were included: A, fractures receiving ESWT; B ("control"), fractures not receiving ESWT, and C, no fractures (right leg). A total of 37 New Zealand white and skeletally mature rabbits (cuniculus NV) were treated. Periosteum was cauterized using bipolar electrocautery at 20 mm in both bone stumps (proximal and distal). Then ESWT was applied in one session. Staining with hematoxylin-eosin was used. A biomechanical analysis with a 3-point loading system was performed. Maximum load and elastic modulus were evaluated in each group. Results: Histological study evidenced signs of union (periosteal and endosteal fracture callus) which were considerably larger in tibias of Group A (treated with ESWT) as compared to the control group (Group B). Conclusion: In an experimental model of atrophic pseudarthrosis caused by electrocautery in tibias of rabbits, significant radiographic and histological changes were observed after focus intervention with the application of ESWT. Level of Evidence: II

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

Long-Term Outcome and Factors Affecting Prognosis of Extracorporeal Shockwave Therapy for Chronic Refractory Achilles Tendinopathy

OBJECTIVE: To investigate the factors affecting prognosis of extracorporeal shockwave therapy (ESWT) for chronic refractory Achilles tendinopathy (AT). METHODS: Thirty-six patients (48 consecutive feet) with chronic AT (>6 months) and who underwent ESWT for ‘poor’ or ‘fair’ grade in Roles-Maudsley Score (RMS) after unsuccessful conservative treatment were included in the present study. A maximum of 12 sessions of ESWT were conducted until treatment success: RMS reached ‘good’ or ‘excellent’. Termination of ESWT for no response, or ‘poor’ or ‘fair’ grade was regarded as treatment failure. Immediate outcome, long-term outcome (telephone interview after mean 26 months), and factors affecting treatment success were analyzed. RESULTS: Numeric Rating Scale was significantly decreased at immediate and long-term follow-up. Success rate was 71.1% and 90.3%, respectively. Univariate logistic regression identified that immediate treatment success was associated with retrocalcaneal enthesophyte on X-ray (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.01–0.28), pretreatment abnormal ultrasonography echogenicity within Achilles tendon (OR, 18.89; 95% CI, 2.08–171.96), mean duration of ‘post-treatment soreness’ (OR, 0.55; 95% CI, 0.33–0.94), and duration of ‘post-treatment soreness after first ESWT’ (OR, 0.06; 95% CI, 0.01–0.34). The duration of ‘post-treatment soreness after first ESWT’ was found to be the only factor associated with long-term success (OR, 0.32; 95% CI, 0.10–0.99). CONCLUSION: ESWT appears to be effective in achieving long-term success in chronic refractory AT. Immediate success was associated with absence of retrocalcaneal enthesophyte on X-ray, presence of pretreatment abnormal ultrasonography echogenicity, shorter mean duration of ‘post-treatment soreness’, and shorter duration of ‘post-treatment soreness after first ESWT’. The shorter duration of ‘post-treatment soreness after first ESWT’ was identified as the only positive prognostic parameter in achieving long-term success.

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.

A retrospective study on the accuracy of sassone, lerner and IOTA simple rules in determining malignancy of ovarian masses in a tertiary hospital ob-gyn ultrasound diagnostics unit / Philippine Journal of Obstetrics and Gynecology

BACKGROUND: Ultrasonography has been established as one of the important diagnostic tools in detecting and classifying ovarian masses. Several studies have been made in determining the sensitivity and specificity of the different scoring systems as to determining the malignancy of ovarian masses. In a tertiary hospital ultrasound diagnostic unit, three scoring systems are utilized namely Lerner, Sassone and IOTA simple rules.OBJECTIVE: To determine and compare the sensitivity and specificity on the most utilized ultrasound scoring systems in determining malignancy of ovarian masses.METHODS: A single center observational, analytical, cross-sectional study utilizing review of the transvaginal or pelvic ultrasound results of women with ovarian masses that were scored using Sassone, Lerner and IOTA Simple Rules in a tertiary hospital ultrasound diagnostics unit from January 2013 to June 2016 was done. The sensitivity, specificity, positive and negative predictive values of each scoring system utilized was determined and compared with the histopathologic result.RESULTS: Out of the 111 ovarian masses that were included in the study, 44 ovarian masses were scored using Lerner Scoring system with a sensitivity, specificity, positive and negative predictive values of 100%, 65% 22.2% and 100%. 105 ovarian masses screened using Sassone Scoring System showed a sensitivity, specificity, positive and negative predictive values of 100%, 68%, 20.5% and 100%. A total of 33 out of the 111 ovarian masses were scored using the IOTA scoring system with a sensitivity, specificity, positive and negative predictive values of 100%, 85.6%, 55.5% and 100%.CONCLUSION: IOTA simple rules had a high sensitivity and specificity compared to Sassone or Lerner Scoring System. However, we cannot fully conclude that individual specificity will be better than combined tests since there is limited number of ovarian masses analyzed.

A retrospective study on the accuracy of sassone, lerner and IOTA simple rules in determining malignancy of ovarian masses in a tertiary hospital ob-gyn ultrasound diagnostics unit / Philippine Journal of Obstetrics and Gynecology

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Ultrasonography has been established as one of the important diagnostic tools in detecting and classifying ovarian masses. Several studies have been made in determining the sensitivity and specificity of the different scoring systems as to determining the malignancy of ovarian masses. In a tertiary hospital ultrasound diagnostic unit, three scoring systems are utilized namely Lerner, Sassone and IOTA simple rules.<br /><strong>OBJECTIVE</strong>: To determine and compare the sensitivity and specificity on the most utilized ultrasound scoring systems in determining malignancy of ovarian masses.<br /><strong>METHODS:</strong> A single center observational, analytical, cross-sectional study utilizing review of the transvaginal or pelvic ultrasound results of women with ovarian masses that were scored using Sassone, Lerner and IOTA Simple Rules in a tertiary hospital ultrasound diagnostics unit from January 2013 to June 2016 was done. The sensitivity, specificity, positive and negative predictive values of each scoring system utilized was determined and compared with the histopathologic result.<br /><strong>RESULTS</strong>: Out of the 111 ovarian masses that were included in the study, 44 ovarian masses were scored using Lerner Scoring system with a sensitivity, specificity, positive and negative predictive values of 100%, 65% 22.2% and 100%. 105 ovarian masses screened using Sassone Scoring System showed a sensitivity, specificity, positive and negative predictive values of 100%, 68%, 20.5% and 100%. A total of 33 out of the 111 ovarian masses were scored using the IOTA scoring system with a sensitivity, specificity, positive and negative predictive values of 100%, 85.6%, 55.5% and 100%.<br /><strong>CONCLUSION:</strong> IOTA simple rules had a high sensitivity and specificity compared to Sassone or Lerner Scoring System. However, we cannot fully conclude that individual specificity will be better than combined tests since there is limited number of ovarian masses analyzed.</p>

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.

Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein-2 and Osteoprotegerin in Osteoporotic Fracture in Rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Roughly focused extracorporeal shock waves therapy (ESWT) is characterized by a wide focal area, a large therapy zone, easy positioning, and less pain during treatment. The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin (OPG) and bone morphogenetic protein-2 (BMP-2) in osteoporotic fractures in rats.</p><p><b>METHODS</b>Seventy-two female Sprague-Dawley (SD) rats, 3 months old, were divided into sham-operated group (n = 6) and an ovariectomized (OVX) group (n = 66). Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation. The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm2, 60 doses/min, and 2000 pact quantities. The contralateral right tibia was left untreated and served as a control. Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry, real-time polymerase chain reaction (PCR), and Western blotting analysis.</p><p><b>RESULTS</b>Bone mineral density (BMD) at the proximal tibia, femur, and L5 spine was significantly reduced after ovariectomy. BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group. Meanwhile, bilateral oophorectomy resulted in a lower trabecular bone volume fraction (BV/TV) in the proximal tibia of the sham-OVX animals. Three months after bilateral oophorectomy, BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs (P < 0.001). These data showed that the SD rats became a suitable model of osteoporosis, 3 months after they were OVX. Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group. Compared with the contralateral controls, decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT, followed by a later increase at 7 days, was indicated by real-time PCR and Western blotting analysis. The OPG messenger RNA (mRNA) expression levels peaked at 6 weeks after the shock wave treatment, paired with a much earlier (at 4 weeks) increase of BMP-2, and declined close to normal at 8 weeks.</p><p><b>CONCLUSIONS</b>Roughly focused ESWT may promote the expression of OPG and BMP-2 in the osteoporotic fracture area in rats. BMP-2 and OPG may act synergistically and may lead to a significant enhancement of bone formation and remodeling.</p>

Effect of elastic strain rate ratio method and virtual touch tissue quantification on the diagnosis of breast masses / 中南大学学报(医学版)

OBJECTIVE@#To determine the effect of elastic strain rate ratio method and virtual touch tissue quantification (VTQ) on the diagnosis of breast masses.
@*METHODS@#Sixty female patients with breast cancer, who received surgical treatment in Daqing Oilfield General Hospital, were enrolled. All patients signed the informed consent paperwork and they were treated by routine ultrasound examination, compression elastography (CE) examination, and VTQ examination in turn. Strain ratio (SR) was checked by CE and shear wave velocity (SWV) value was measured by VTQ. The diagnostic values of different methods were evaluated by receiver operating characteristic (ROC) curves in the diagnosis of benign and malignant breast tumors.
@*RESULTS@#The maximum diameter and SWV value of the benign tumors were lower than those of the malignant tumors, and the SR ratio of benign masses was higher than that of malignant tumors (P<0.01). The AUC, sensitivity and specificity for elastic strain rate and VTQ for single or combined use were higher than those of conventional ultrasound (0.904, 97.5%, 69.2%; 0.946, 87.5%, 87.2%; 0.976, 90%, 97.4% vs 0.783, 85%, 61.5%). The AUC and specificity of VTQ were higher than those of the elastic strain rate (0.946, 87.2% vs 0.904, 69.2%), but the sensitivity of VTQ was higher than that of the latter (87.5% vs 97.5%). The AUC and specificity for combination of both methods were higher than those of single method, but the sensitivity was lower than that of the elastic strain rate. 
@*CONCLUSION@#Combination of elastic strain rate ratio method with VTQ possesses the best diagnostic value and the highest diagnostic accuracy in the diagnosis of breast mass than that used alone.

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.

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.

A 5 year retrospective review of pregnancy loss among women with polycystic ovarian morphology

BACKGROUND: Polycystic ovarian morphology is the most common ultrasound abnormality among women with recurrent pregnancy loss and as such, its presence has been postulated to have a relationship with a high rate of miscarriage among women conceiving spontaneously. Objective: The study aimed to determine the prevalence of pregnancy loss among women who have polycystic ovaries on ultrasound, at a tertiary hospital from January 2010 to December 2015.MATERIALS AND METHODS: A cross-sectional investigation involving a retrospective review of hospital records of 377 women who were diagnosed with polycystic ovaries on transvaginal ultrasound was performed. Their pregnancy outcomes were followed up by retrieving their medical charts at the outpatient department, consultants' clinics and the medical records section. Approval from the Independent Ethics Committee and Center for Clinical Epidemiology and Biostatistics was obtained.RESULTS: Of the 377 women with polycystic ovarian morphology, 280 (74.27%) met the 2003 Rotterdam criteria for polycystic ovary syndrome. The prevalence of pregnancy loss was 40.23%, while the live birth rate was 59.77% among the 377 women with polycystic ovaries on ultrasound. The majority of pregnancy loss occurred in the first trimester of pregnancy with a mean age of gestation of 8.9 ± 4.8 weeksCONCLUSION: The prevelance of pregnancy loss among women with polycystic ovarian morphology was 40.23%