TISU: Extracorporeal shockwave lithotripsy, as first treatment option, compared with direct progression to ureteroscopic treatment, for ureteric stones: study protocol for a randomised controlled trial.

PubMed

McClinton, Samuel; Cameron, Sarah; Starr, Kathryn; Thomas, Ruth; MacLennan, Graeme; McDonald, Alison; Lam, Thomas; N'Dow, James; Kilonzo, Mary; Pickard, Robert; Anson, Ken; Keeley, Frank; Burgess, Neil; Clark, Charles Terry; MacLennan, Sara; Norrie, John

2018-05-22

Urinary stone disease is very common with an estimated prevalence among the general population of 2-3%. Ureteric stones are associated with severe pain as they pass through the urinary tract and have significant impact on patients' quality of life due to the detrimental effect on their ability to work and need for hospitalisation. Most ureteric stones can be expected to pass spontaneously with supportive care. However, between one-fifth and one-third of cases require an intervention. The two standard active intervention options are extracorporeal shockwave lithotripsy (ESWL) and ureteroscopic stone retrieval. ESWL and ureteroscopy are effective in terms of stone clearance; however, they differ in terms of invasiveness, anaesthetic requirement, treatment setting, complications, patient-reported outcomes (e.g. pain after intervention, time off work) and cost. There is uncertainty around which is the most clinically effective in terms of stone clearance and the true cost to the NHS and to society (in terms of impact on patient-reported health and economic burden). The aim of this trial is to determine whether, in adults with ureteric stones, judged to require active intervention, ESWL is not inferior and is more cost-effective compared to ureteroscopic treatment as the initial management option. The TISU study is a pragmatic multicentre non-inferiority randomised controlled trial of ESWL as the first treatment option compared with direct progression to ureteroscopic treatment for ureteric stones. Patients aged over 16 years with a ureteric stone confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) will be randomised to either ESWL or ureteroscopy. The primary clinical outcome is resolution of the stone episode (no further intervention required to facilitate stone clearance) up to six months from randomisation. The primary economic outcome is the incremental cost per quality-adjusted life years (QALYs) gained at six months from

Pressure-release versus rigid reflector for extracorporeal shockwave lithotripsy.

PubMed

Loske, Achim M; Prieto, Fernando E

2002-06-01

To evaluate the advantages and disadvantages of using a pressure-release reflector instead of a rigid reflector to concentrate shockwaves for extracorporeal shockwave lithotripsy (SWL). As in all electrohydraulic lithotripters, shockwaves were generated by electrical breakdown of water between two electrodes, located at the focus (F1) closest to a paraellipsoidal reflector. A pressure-release reflector, made out of polyurethane foam, was constructed and tested on a research lithotripter using kidney stone models. Fragmentation data and pressure measurements were compared with those of a conventional rigid reflector tested on the same device. The weight of stone model fragments remaining after shockwave exposure was less with the pressure-release reflector after screening through a 3.0 x 3.0-mm mesh. The residual fragment weight was less with the rigid reflector using 1.0 x 1.0- and 0.6 x 0.6-mm meshes. Pressure-release reflectors may maintain acceptable stone fragmentation while offering improved patient safety and should be considered for SWL.

Development and Preclinical Testing of Laser-Generated Shockwave Therapy for Infected Wounds

NASA Astrophysics Data System (ADS)

Francis, Nathan Craig

The goal of this thesis is to translate laser-generated shockwave (LGS) therapy from a bench-top, research system into a portable, clinical system for in vivo animal trials. Prior research along this topic was completed using a benchtop system, in a physical setup dissimilar to the clinical setup. So the technology required re-engineering in order to apply it to animal studies. This began with the construction of a portable LGS therapy system, mobile enough to transport from laboratory to clinical settings. Included in the portable system is a 2D scanning system to consistently treat wound areas of varying geometries with shockwaves of 3 mm diameter spot sizes. The shockwaves generated by the portable laser system were characterized, along with the varying shockwave-generating substrates possible for clinical application. A final material selection of black polyimide was chosen because of its complete absorption of laser light and its ability to conform to tight wound geometries. Since shockwaves have never been demonstrated to delaminate biofilm from a tissue surface, a proof-of-concept study was completed successfully delaminating Staphylococcus epidermidis from wounded ex vivo pigskin. Through false-colored SEM imaging, biofilm area reduction between treated and non-treated samples were calculated. A 53% reduction in biofilm area and signifcant biofilm fragmentation was seen. An in vivo safety study was conducted next to observe potential physiological effects of LGS on healthy dermal tissue. Treated subjects were observed over a 3 day period, and no physiological or inflammatory effects were seen in the histological analysis. Finally, a pilot wound healing study was com- pleted on excisional wound healing model in rats, with S. epidermidis as the infectious agent, to measure the effect of LGS on wound healing area and rate compared to other treatments. After 9 days of wound healing, no treatment or controls showed a significant difference in wound healing rate

Shockwave treatment for medial tibial stress syndrome in military cadets: A single-blind randomized controlled trial.

PubMed

Gomez Garcia, Santiago; Ramon Rona, Silvia; Gomez Tinoco, Martha Claudia; Benet Rodriguez, Mikhail; Chaustre Ruiz, Diego Mauricio; Cardenas Letrado, Francia Piedad; Lopez-Illescas Ruiz, África; Alarcon Garcia, Juan Maria

2017-10-01

Medial tibial stress syndrome (MTSS) is a common injury in athletes and soldiers. Several studies have demonstrated the effectiveness of extracorporeal shockwave treatment (ESWT) in athletes with MTSS. To assess whether one session of focused ESWT is effective in the treatment of military cadets with MTSS. A randomized, prospective, controlled, single-blind, parallel-group clinical study. Ib. Military School of Cadets of the Colombian Army. Forty-two military cadets with unilateral chronic MTSS were randomly assigned to either one session of focused electromagnetic ESWT (1500 pulses at 0.20 mJ/mm 2 ) plus a specific exercise programme (muscle stretching and strengthening exercises) or the exercise programme alone. The primary endpoint was change in asymptomatic running test (RT) duration at four weeks from baseline. Secondary endpoints were changes in the visual analogue scale (VAS) after running and modified Roles and Maudsley (RM) score also at four weeks from baseline. ESWT patients were able to run longer. Mean RT after four weeks was 17 min 33 s (SE: 2.36) compared to 4 min 48 s (SE: 1.03) in the exercise-only group (p = 0.000). Mean VAS after running was 2.17 (SE: 0.44) in the ESWT group versus 4.26 (SE: 0.36) in the exercise-only group (p = 0.001). The ESWT group had a significantly higher RM score, with excellent or good results for 82.6% of patients vs. 36.8% in the exercise-only group (p = 0.002). No significant adverse effects of ESWT were observed. A single application of focused shockwave treatment in combination with a specific exercise programme accelerates clinical and functional recovery in military cadets with MTSS. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

The effect of antibacterial acting extracorporeal shockwaves on bacterial cell integrity.

PubMed

Horn, Carsten; Mengele, Karin; Gerdesmeyer, Ludger; Gradinger, Reiner; Gollwitzer, Hans

2009-12-01

Antibacterial effects of extracorporeal shockwaves (ESWs) have been demonstrated in vitro against bacteria under static and dynamic growth conditions. This study assessed the effects of ESWs on the cell wall integrity of bacteria. Standardized suspensions of Staphylococcus aureus were exposed to various shockwave impulses (2000-12,000) of different energy flux densities (EFD, 0.38-0.96 mJ/mm(2)). Bacterial suspensions of equal concentration that had been permeabilized (to >99%) with isopropanol were used as positive controls. The bacteria of all groups were stained with Sytox Green nucleic acid stain. The fluorescence of the shockwave-treated, permeabilized, and untreated suspensions was measured and compared for bacterial survival, quantified by colony-forming units after plating. Although ESWs showed a significant energy-dependent antibacterial effect that reduced CFUs in the treated suspensions by between 56% and 99%, only maximum energies (4000 impulses at 0.96 mJ/mm(2) and 12,000 impulses at 0.59 mJ/mm(2)) were followed by a significant increase in fluorescence compared with the untreated control (p<0.05). However, the fluorescence of these treated groups was still far less than that of the alcohol-permeabilized positive control groups (p<0.05). Lower energies and impulse rates did not show increased intracellular uptake of the fluorescent dye (p>0.05). This is the first study to assess bacterial cell wall permeability after ESW treatment. It was found that the permeabilization of bacterial cells after ESW treatment was far less than expected due to the corresponding antibacterial effect. Other mechanisms, such as intracellular effects, might be involved in bacterial killing after ESWs and still must be elucidated.

Shockwave Consolidation of Nanostructured Thermoelectric Materials

NASA Technical Reports Server (NTRS)

Prasad, Narasimha S.; Taylor, Patrick; Nemir, David

2014-01-01

Nanotechnology based thermoelectric materials are considered attractive for developing highly efficient thermoelectric devices. Nano-structured thermoelectric materials are predicted to offer higher ZT over bulk materials by reducing thermal conductivity and increasing electrical conductivity. Consolidation of nano-structured powders into dense materials without losing nanostructure is essential towards practical device development. Using the gas atomization process, amorphous nano-structured powders were produced. Shockwave consolidation is accomplished by surrounding the nanopowder-containing tube with explosives and then detonating. The resulting shock wave causes rapid fusing of the powders without the melt and subsequent grain growth. We have been successful in generating consolidated nano-structured bismuth telluride alloy powders by using the shockwave technique. Using these consolidated materials, several types of thermoelectric power generating devices have been developed. Shockwave consolidation is anticipated to generate large quantities of nanostructred materials expeditiously and cost effectively. In this paper, the technique of shockwave consolidation will be presented followed by Seebeck Coefficient and thermal conductivity measurements of consolidated materials. Preliminary results indicate a substantial increase in electrical conductivity due to shockwave consolidation technique.

Interaction of lithotripter shockwaves with single inertial cavitation bubbles.

PubMed

Klaseboer, Evert; Fong, Siew Wan; Turangan, Cary K; Khoo, Boo Cheong; Szeri, Andrew J; Calvisi, Michael L; Sankin, Georgy N; Zhong, Pei

2007-01-01

The dynamic interaction of a shockwave (modelled as a pressure pulse) with an initially spherically oscillating bubble is investigated. Upon the shockwave impact, the bubble deforms non-spherically and the flow field surrounding the bubble is determined with potential flow theory using the boundary-element method (BEM). The primary advantage of this method is its computational efficiency. The simulation process is repeated until the two opposite sides of the bubble surface collide with each other (i.e. the formation of a jet along the shockwave propagation direction). The collapse time of the bubble, its shape and the velocity of the jet are calculated. Moreover, the impact pressure is estimated based on water-hammer pressure theory. The Kelvin impulse, kinetic energy and bubble displacement (all at the moment of jet impact) are also determined. Overall, the simulated results compare favourably with experimental observations of lithotripter shockwave interaction with single bubbles (using laser-induced bubbles at various oscillation stages). The simulations confirm the experimental observation that the most intense collapse, with the highest jet velocity and impact pressure, occurs for bubbles with intermediate size during the contraction phase when the collapse time of the bubble is approximately equal to the compressive pulse duration of the shock wave. Under this condition, the maximum amount of energy of the incident shockwave is transferred to the collapsing bubble. Further, the effect of the bubble contents (ideal gas with different initial pressures) and the initial conditions of the bubble (initially oscillating vs. non-oscillating) on the dynamics of the shockwave-bubble interaction are discussed.

Improving the antioxidant functionality of Citrus junos Tanaka (yuzu) fruit juice by underwater shockwave pretreatment.

PubMed

Kuraya, Eisuke; Nakada, Shina; Touyama, Akiko; Itoh, Shigeru

2017-02-01

Citrus junos Tanaka (yuzu) has a strong characteristic aroma, and hence, yuzu juice is used in a number of Japanese foods. We herein evaluated the functional compounds of yuzu juice to investigate whether underwater shockwave pretreatment affects its functionality. Employing the shockwave pretreatment at an increased discharge and energy of 3.5kV and 4.9kJ, respectively, resulted in an increase in the flavanone glycoside content and oxygen radical absorbance capacity (ORAC). The ORAC value of yuzu juice cultivated in Rikuzentakata increased approximately 1.7 times upon underwater shockwave pretreatment. The treatment method proposed herein exhibited reliable and good performance for the extraction of functional and antioxidant chemicals in yuzu fruits, and was comparable with traditional squeezing methods. The high applicability and reliability of this technique for improving the antioxidant functionality of yuzu fruit juice was demonstrated, confirming the potential for application to a wide range of food extraction processes. Copyright © 2016 Elsevier Ltd. All rights reserved.

1D GAS-DYNAMIC SIMULATION OF SHOCK-WAVE PROCESSES VIA INTERNET

DOE Office of Scientific and Technical Information (OSTI.GOV)

Khishchenko, K. V.; Levashov, P. R.; Povarnitsyn, M. E.

2009-12-28

We present a Web-interface for 1D simulation of different shock-wave experiments. The choosing of initial parameters, the modeling itself and output data treatment can be made directly via the Internet. The interface is based upon the expert system on shock-wave data and equations of state and contains both the Eulerian and Lagrangian Godunov hydrocodes. The availability of equations of state for a broad set of substances makes this system a useful tool for planning and interpretation of shock-wave experiments. As an example of simulation with the system, results of modeling of multistep shock loading of potassium between polytetrafluoroethylene and stainlessmore » steel plates are presented in comparison with experimental data from Shakhray et al.(2005).« less

Effectiveness of extracorporeal shockwave therapy in three major tendon diseases.

PubMed

Carulli, Christian; Tonelli, Filippo; Innocenti, Matteo; Gambardella, Bonaventura; Muncibì, Francesco; Innocenti, Massimo

2016-03-01

Extracorporeal shockwave therapy is a conservative treatment for several painful musculoskeletal disorders. The aim of the study was the assessment of the relief from pain by the shockwave therapy in a population of consecutive patients affected by specific pathologies. A group of consecutive patients were studied and treated. They were affected by calcific tendonitis of the shoulder (129 patients), chronic Achilles tendinopathy (102 patients), and lateral epicondylitis of the elbow (80 subjects). Each patient had 3 applications with a monthly interval, and was followed up at 1, 6, and 12 months after treatment. Results were evaluated by the numeric rating scale (NRS) in all cases, the Constant Murley Score for the assessment of the shoulder function, the American Orthopaedic Foot and Ankle Society Score for subjects affected by chronic Achilles tendinopathy, and the Oxford Elbow Score for those affected by a lateral epicondylitis of the elbow. One year after treatment, the results were considered satisfactory with an almost complete resolution of symptoms. There were statistically significant results at the 12-month follow-ups regarding the mean NRS score (from 6.25 to 0.2), the Constant Murley Score (from 66.7 to 79.4), the Oxford Elbow Score (from 28 to 46), and the AOFAS (from 71 to 86). Extracorporeal shockwave therapy may be considered a safe, economic, and effective treatment for several chronic musculoskeletal disorders, allowing satisfactory pain relief and improvement of function ability. Level IV.

Explosively driven two-shockwave tools with applications

NASA Astrophysics Data System (ADS)

Buttler, W. T.; Oró, D. M.; Mariam, F. G.; Saunders, A.; Andrews, M. J.; Cherne, F. J.; Hammerberg, J. E.; Hixson, R. S.; Monfared, S. K.; Morris, C.; Olson, R. T.; Preston, D. L.; Stone, J. B.; Terrones, G.; Tupa, D.; Vogan-McNeil, W.

2014-05-01

We present the development of an explosively driven physics tool to generate two mostly uniaxial shockwaves. The tool is being used to extend single shockwave ejecta models to account for a second shockwave a few microseconds later. We explore techniques to vary the amplitude of both the first and second shockwaves, and we apply the tool experimentally at the Los Alamos National Laboratory Proton Radiography (pRad)facility. The tools have been applied to Sn with perturbations of wavelength λ = 550 μm, and various amplitudes that give wavenumber amplitude products of kh in {3/4,1/2,1/4,1/8}, where h is the perturbation amplitude, and k = 2π/λ is the wavenumber. The pRad data suggest the development of a second shock ejecta model based on unstable Richtmyer-Meshkov physics.

Tissue reactions under piezoelectric shockwave application for the fragmentation of biliary calculi.

PubMed Central

Ell, C; Kerzel, W; Heyder, N; Rödl, W; Langer, H; Mischke, U; Giedl, J; Domschke, W

1989-01-01

The tissue reactions that occurred during piezoelectric shockwaves for the fragmentation of biliary calculi were investigated in 10 surgically removed stone containing human gall bladders and in acute (six dogs) and chronic (six dogs) animal experiments. Before and after shockwave (500, 1500 or 3000) in the anaesthetised dogs, computed tomography (CT), magnetic imaging (MRI) and laboratory tests were done; treatment was carried out under continuous ultrasonographic control. Shockwave applications to the human gall bladders resulted in disintegration of the stones with no macroscopically or microscopically detectable tissue changes. In acute animal experiments, small haematomas were observed in all six animals at surfaces, but also inside the liver and gall bladder (max diameter 25 mm). Perforation or intra-abdominal or pleural bleeding did not occur. In chronic experiments, no macroscopic, and only slight microscopic residual lesions (haemosiderin deposits) were seen three weeks after shockwave. In almost all instances, the lesions were detected by CT, MRI, and ultrasonography, while laboratory tests were negative. Images Fig 1 Figs. 2-4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 PMID:2731762

Superconductivity of Cu/CuOx interface formed by shock-wave pressure

NASA Astrophysics Data System (ADS)

Shakhray, D. V.; Avdonin, V. V.; Palnichenko, A. V.

2016-11-01

A mixture of powdered Cu and CuO has been subjected to shock-wave pressure of 350 kbar with following quenching of the vacuum-encapsulated product to 77 K. The ac magnetic susceptibility measurements of the samples have revealed metastable superconductivity with Tc ≈ 19 K, characterized by glassy dynamics of the shielding currents below Tc . Comparison of the ac susceptibility and the DC magnetization measurements infers that the superconductivity arises within the granular interfacial layer formed between metallic Cu and its oxides due to the shock-wave treatment.

Interaction of lithotripter shockwaves with single inertial cavitation bubbles

PubMed Central

Klaseboer, Evert; Fong, Siew Wan; Turangan, Cary K.; Khoo, Boo Cheong; Szeri, Andrew J.; Calvisi, Michael L.; Sankin, Georgy N.; Zhong, Pei

2008-01-01

The dynamic interaction of a shockwave (modelled as a pressure pulse) with an initially spherically oscillating bubble is investigated. Upon the shockwave impact, the bubble deforms non-spherically and the flow field surrounding the bubble is determined with potential flow theory using the boundary-element method (BEM). The primary advantage of this method is its computational efficiency. The simulation process is repeated until the two opposite sides of the bubble surface collide with each other (i.e. the formation of a jet along the shockwave propagation direction). The collapse time of the bubble, its shape and the velocity of the jet are calculated. Moreover, the impact pressure is estimated based on water-hammer pressure theory. The Kelvin impulse, kinetic energy and bubble displacement (all at the moment of jet impact) are also determined. Overall, the simulated results compare favourably with experimental observations of lithotripter shockwave interaction with single bubbles (using laser-induced bubbles at various oscillation stages). The simulations confirm the experimental observation that the most intense collapse, with the highest jet velocity and impact pressure, occurs for bubbles with intermediate size during the contraction phase when the collapse time of the bubble is approximately equal to the compressive pulse duration of the shock wave. Under this condition, the maximum amount of energy of the incident shockwave is transferred to the collapsing bubble. Further, the effect of the bubble contents (ideal gas with different initial pressures) and the initial conditions of the bubble (initially oscillating vs. non-oscillating) on the dynamics of the shockwave–bubble interaction are discussed. PMID:19018296

Uniformity of cylindrical imploding underwater shockwaves at very small radii

NASA Astrophysics Data System (ADS)

Yanuka, D.; Rososhek, A.; Bland, S. N.; Krasik, Ya. E.

2017-11-01

We compare the convergent shockwaves generated from underwater, cylindrical arrays of copper wire exploded by multiple kilo-ampere current pulses on nanosecond and microsecond scales. In both cases, the pulsed power devices used for the experiments had the same stored energy (˜500 J) and the wire mass was adjusted to optimize energy transfer to the shockwave. Laser backlit framing images of the shock front were achieved down to the radius of 30 μm. It was found that even in the case of initial azimuthal non-symmetry, the shock wave self-repairs in the final stages of its motion, leading to a highly uniform implosion. In both these and previous experiments, interference fringes have been observed in streak and framing images as the shockwave approached the axis. We have been able to accurately model the origin of the fringes, which is due to the propagation of the laser beam diffracting off the uniform converging shock front. The dynamics of the shockwave and its uniformity at small radii indicate that even with only 500 J stored energies, this technique should produce pressures above 1010 Pa on the axis, with temperatures and densities ideal for warm dense matter research.

Minimizing masses in explosively driven two-shockwave physics applications

NASA Astrophysics Data System (ADS)

Buttler, William; Cherne, Frank; Furlanetto, Michael; Payton, Jeremy; Stone, Joseph; Tabaka, Leonard; Vincent, Samuel

2015-06-01

We have experimentally investigated different two-shockwave high-explosives (HE) physics package designs to maximize the variability of the second shockwave peak stress, while minimizing the total HE load of the physics tool. A critical requirement is to also have a large radial diameter of the second shockwave to maintain its value as an HE driven two-shockwave drive. We have previously shown that we could vary the peak-stress of the second-shockwave with a 76 mm diameter HE lens driving different composite boosters of PBX 9501 and TNT. Here we report on our results with a 56- and 50-mm diameter HE lens driving Baritol. The results indicate that the 56-mm diameter HE lens works well, as does the Baritol, giving total HE loads of about 250 mg TNT equivalent explosives.

Shockwave Interaction with a Cylindrical Structure

NASA Astrophysics Data System (ADS)

Mulligan, Phillip

2017-06-01

An increased understanding of the shockwave interaction with a cylindrical structure is the foundation for developing a method to explosively seal a pipe similar to the Deepwater Horizon accident in the Gulf of Mexico. Shockwave interactions with a cylindrical structure have been a reoccurring focus of energetics research. Some of the most notable contributions of non-destructive tests are described in ``The Effects of Nuclear Weapons'' (Glasstone, 1962). The work presented by Glasstone examines shockwave interaction from a 20-megaton bomb with a cylindrical structure. However, the data is limited to a peak overpressure of less than 25 psi, requiring several miles between the structure and the charge. The research presented in the following paper expands on the work Glasstone described by examining the shockwaves from 90, 180, and 270-gram C-4 charges interacting with a 6-inch diameter cylindrical structure positioned 52-inches from the center of the charge. The three charge weights that were tested in this research generated a peak overpressures of approximately 15, 25, and 40 psi, respectively. This research examines the peak pressure and total impulse from each charge acting on the cylindrical structure as well as the formation of vortices on the ``backside'' of the cylinder surface. This paper describes the methodology and findings of this study as well as examines the causality and implications of its results on our understanding of the shockwave interaction with a cylindrical structure.

Deformation behavior and spall fracture of the Hadfield steel under shock-wave loading

NASA Astrophysics Data System (ADS)

Gnyusov, S. F.; Rotshtein, V. P.; Polevin, S. D.; Kitsanov, S. A.

2011-03-01

Comparative studies of regularities in plastic deformation and fracture of the Hadfield polycrystalline steel upon quasi-static tension, impact failure, and shock-wave loading with rear spall are performed. The SINUS-7 accelerator was used as a shock-wave generator. The electron beam parameters of the accelerator were the following: maximum electron energy was 1.35 MeV, pulse duration at half-maximum was 45 ns, maximum energy density on a target was 3.4·1010 W/cm2, shock-wave amplitude was ~20 GPa, and strain rate was ~106 s-1. It is established that the failure mechanism changes from ductile transgranular to mixed ductile-brittle intergranular one when going from quasi-static tensile and Charpy impact tests to shock-wave loading. It is demonstrated that a reason for the intergranular spallation is the strain localization near the grain boundaries containing a carbide interlayer.

Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial.

PubMed

Newman, Phil; Waddington, Gordon; Adams, Roger

2017-03-01

Up to 35% of runners develop medial tibial stress syndrome (MTSS) which often results in lengthy disruption to training and sometimes affects daily activities. There is currently no high quality evidence to support any particular intervention for MTSS. This study aims to investigate the effect of shockwave therapy for MTSS. A randomized, sham-controlled, pilot trial in a university-based health clinic including 28 active adults with MTSS. Intervention included standard dose shockwave therapy for the experimental group versus sham dose for the control group, delivered during Week 1-3, 5 and 9. Main outcome measures were pain measured during bone and muscle pressure as well as during running using a numerical rating scale (0-10) and running was measured as pain-limited distance (m), at Week 1 (baseline) and Week 10 (post-intervention). Self-perception of change was measured using the Global Rating of Change Scale (-7 to +7) at Week 10 (post-intervention). Pain (palpation) was reduced in the experimental group by 1.1 out of 10.0 (95% CI -2.3 to 0.0) less than the control group. There were no other statistically significant differences between the groups. Standard dose shockwave therapy is not more effective than sham dose at improving pain or running distance in MTSS. However, the sham dose may have had a clinical effect. Further investigation including a no intervention control is warranted to evaluate the effect of shockwave therapy in the management of MTSS. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Extracorporeal shockwaves versus ultrasound-guided percutaneous lavage for the treatment of rotator cuff calcific tendinopathy: a randomized controlled trial.

PubMed

Del Castillo-González, Federico; Ramos-Alvarez, Juan J; Rodríguez-Fabián, Guillermo; González-Pérez, José; Jiménez-Herranz, Elena; Varela, Enrique

2016-04-01

Extracorporeal shockwave treatment (ESWT) and ultrasound-guided percutaneous lavage (UGPL) are two effective ways of treating rotator cuff calcific tendinopathy (RCCT). The aim of the present study was to compare the effectiveness of these techniques in the treatment of RCCT. Prospective, randomized, controlled trial. Patients treated in our sports medicine and rehabilitation center (Centro Médico Deyre, Madrid. Spain) between January 2007 and December 2013. This randomized study compares the results achieved with these techniques over one year following their use to treat the above condition. Eighty patients received ESWT and 121 received UGPL. A visual analogue scale was used to measure pain, and ultrasound to determine the extent of calcification, at 3, 6, and 12 months after treatment. Pain and the amount of calcification were significantly reduced by both techniques at 3, 6 and 12 months (P<0.001 for each), but significantly more so by UGPL (P<0.001). Both techniques are valid for the treatment of RCCT, although UGPL is associated with a greater reduction of calcification and greater reduction in pain. The results obtained applying UGPL, the low cost and the lack of complications should therefore make the treatment of choice in centers that are appropriately equipped and staffed.

[The results of the combined application of extracorporeal shock-wave therapy and radon baths during the rehabilitative treatment of the patients presenting with gonarthrosis].

PubMed

Razumov, A N; Puriga, A O; Yurova, O V

2015-01-01

Osteoarthritis (OA) is one of the leading diseases of the musculoskeletal system and the main cause of arthritic joint damage. The objective of the present study was to evaluate the effectiveness of the combined application of radon baths and shock-wave therapy in the patients suffering from knee OA. The study involved 75 patients at the age of 35 to 62 years with the confirmed diagnosis of stage II and III gonarthrosis; they were divided into 3 groups. The patients of the main group received the combined treatment including extracorporeal shock-wave therapy and radon baths The patients comprising the group of comparison were given the course of radon therapy alone while those in the control group were offered the standard treatment including physiotherapy, magnetic therapy, and NSAIDs. The study has demonstrated the high effectiveness of the combined application of the radon baths and extracorporeal shock-wave therapy for the rehabilitation of the patients with deforming arthrosis of the knee that was apparent from the substantial decrease of pain syndrome, the increase of the range of motions in the knee joints, and the overall improvement of the quality of life. These beneficial changes persisted for a period of up to 6 months. The results of the present study give reason to recommend the proposed method of the remedial treatment for the wide practical application as a component in the framework of the medical rehabilitation programs.

Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial.

PubMed

Chew, Kelvin Tai Loon; Leong, Darren; Lin, Cindy Y; Lim, Kay Kiat; Tan, Benedict

2013-12-01

To evaluate the efficacy of autologous conditioned plasma (ACP) compared with extracorporeal shockwave (ESWT) and conventional treatments for plantar fasciitis. Randomized trial. Sports medicine center in a tertiary care hospital. Fifty-four subjects (age range, 29-71 years) with unilateral chronic plantar fasciitis with more than 4 months of symptoms. Subjects randomized to 3 groups: 19 to ACP and conventional treatment (ACP group), 19 to ESWT and conventional treatment (ESWT group), and 16 to conventional treatment alone. Conventional treatment included stretching exercises and orthotics if indicated. Outcomes were pain-Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, and ultrasound plantar fascia thickness assessed at baseline before treatment and at 1 month, 3 months, and 6 months after treatment. VAS, AOFAS ankle-hindfoot scale, and plantar fascia thickness improved in all groups. Significant VAS pain score improvements in the ACP group compared with conventional treatment at month 1 (P = .037) and for the ESWT group compared with conventional treatment at months 1, 3, and 6 (P = .017, P = .022, and P = .042). The AOFAS ankle-hindfoot scale score improved in the ACP group at months 3 and 6 (P = .004 and P = .013) and, for the ESWT group, at months 1 and 3 (P = .011 and P = .003) compared with conventional treatment. Significant improvements in plantar fascia thickness were seen in the ACP group at months 1 and 3 compared with conventional treatments (P = .015 and P = .014) and at months 3 and 6 compared with the ESWT group (P = .019 and P = .027). No adverse events reported. Treatment of plantar fasciitis with ACP or ESWT plus conventional treatments resulted in improved pain and functional outcomes compared with conventional treatment alone. There was no significant difference between ACP and ESWT in terms of VAS and AOFAS ankle-hindfoot scale improvements, although the ACP group demonstrated greater

Shockwave-Loading-Induced Enhancement of T c in Superconducting Bi 2Sr 2CaCu 2O 8+δ

DOE PAGES

Liu, Tiansheng; He, Chao; Wang, Fengying; ...

2017-07-27

Here, we report a shockwave method for altering the properties of the superconductor material Bi 2Sr 2CaCu 2O 8+δ (Bi2212). We find that the superconducting transition temperature (T c) increases from 84 K for the pristine sample to 94 K for the sample treated at a temperature and pressure of ~1200 K and ~31 GPa, respectively. X-ray diffraction and transmission electron microscopy characterizations indicate that this T c enhancement arises from a phase transition from pristine Bi2212 to a mixture of superconducting Bi2212 and semiconducting Bi 2Sr 2CuO 6+δ (Bi2201) during the shockwave treatment. The shockwave-treated sample exhibits n-type semiconductormore » properties (with an on-off ratio ~5), in contrast to the pure metallic pristine sample. This study offers an alternative route for modifying the superconducting properties via a shockwave treatment. Furthermore, this method may provide a new approach for studying other temperature- and pressure-sensitive materials.« less

Developing Multimedia Courseware for the Internet's Java versus Shockwave.

ERIC Educational Resources Information Center

Majchrzak, Tina L.

1996-01-01

Describes and compares two methods for developing multimedia courseware for use on the Internet: an authoring tool called Shockwave, and an object-oriented language called Java. Topics include vector graphics, browsers, interaction with network protocols, data security, multithreading, and computer languages versus development environments. (LRW)

Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit)

PubMed Central

Malliaropoulos, Nikos; Jury, Rosanna; Pyne, Debasish; Padhiar, Nat; Turner, Jennifer; Korakakis, Vasileios; Meke, Maria; Lohrer, Heinz

2016-01-01

Introduction Stenosing tenosynovitis that is characterized by the inability to flex the digit smoothly, usually leads to prolonged rehabilitation or surgery. Study design This case series is a retrospective cohort study. Purpose The aim of this case series was to evaluate the effectiveness of radial extracorporeal shockwave therapy (rESWT) for the treatment of stenosing tenosynovitis of the digital flexor tendon (trigger digit). Methods A retrospective analysis of 44 patients (49 fingers) treated with an individually adapted rESWT protocol was conducted. Trigger digit pain and function were evaluated at baseline and 1-, 3-, and 12-months posttreatment. Recurrence and pretreatment symptom duration were analyzed. Results Significant reductions in pain scores and functional improvement were found between baseline and all follow-up assessments (P<0.001). Pretreatment symptom duration was significantly correlated with the number of rESWT sessions required (r=0.776, P<0.001) and 1-year posttreatment pain score (r=0.335, P=0.019). Conclusion This study provides initial evidence that rESWT is an effective treatment for trigger digit, but randomised controlled trials are required to provide further evidence of this effect. PMID:27843364

Extracorporeal shockwave lithotripsy of distal ureteral calculi.

PubMed

Miller, K; Bubeck, J R; Hautmann, R

1986-01-01

To date, the use of extracorporeal shockwave lithotripsy (ESWL) has been limited to renal calculi and ureteral calculi above the pelvic brim. Modifying the position of the patient on the support of the Dornier lithotripter HM3, we were able to localize and treat distal ureteral calculi. Until April 1986, 43 patients with stones in the lower ureter underwent contact-free lithotripsy. Treatment was successful in 39 patients (90%), 2 of these requiring 2 sessions. In 4 patients treatment failed and stone removal was accomplished using ureteroscopy or open surgery. No complications or adverse side effects were encountered in the whole series. ESWL is now the method of choice for the treatment of distal ureteral calculi in our department.

Shockwaves Cause Synaptic Degeneration in Cultured Neurons

DTIC Science & Technology

2009-11-02

constructed of delrin. A piezoresistive pressure sensor (Endevco Model 8530C) was mounted flush with the plate, coaxial with the center of the gene gun ...biolostic gene gun to deliver shockwaves to cultured hippocampal or cortical neurons. These cultured cells form abundant synapses in vitro, and after a 24-48...neurons, we used a biolostic gene gun to deliver shockwaves to cultured hippocampal or cortical neurons. These cultured cells form abundant synapses in

Underwater Shockwave Pretreatment Process to Improve the Scent of Extracted Citrus junos Tanaka (Yuzu) Juice

PubMed Central

Touyama, Akiko; Nakada, Shina; Higa, Osamu; Itoh, Shigeru

2017-01-01

Citrus junos Tanaka (yuzu) has a strong characteristic aroma and thus its juice is used in various Japanese foods. Herein, we evaluate the volatile compounds in yuzu juice to investigate whether underwater shockwave pretreatment affects its scent. A shockwave pretreatment at increased discharge and energy of 3.5 kV and 4.9 kJ, respectively, increased the content of aroma-active compounds. Moreover, the underwater shockwave pretreatment afforded an approximate tenfold increase in the scent intensity of yuzu juice cultivated in Rikuzentakata. The proposed treatment method exhibited reliable and good performance for the extraction of volatile and aroma-active compounds from the yuzu fruit. The broad applicability and high reliability of this technique for improving the scent of yuzu fruit juice were demonstrated, confirming its potential for application to a wide range of food extraction processes. PMID:28761874

The effects of extracorporeal shockwave on acute high-energy long bone fractures of the lower extremity.

PubMed

Wang, Ching-Jen; Liu, Hao-Chen; Fu, Te-Hu

2007-02-01

High-energy long bone fractures of the lower extremity are at risk of poor fracture healing and high rate of non-union. Extracorporeal shockwave was shown effective to heal non-union of long bone fracture. However, the effect of shockwave on acute fractures is unknown. The purpose of this study was to investigate the effects of shockwave on acute high-energy fractures of the lower extremity. Between January and October 2004, 56 patients with 59 acute high-energy fractures were enrolled in this study. Patients were randomly divided into two groups with 28 patients with 28 fractures in the study group and 28 patients with 31 fractures in the control group. Both groups showed similar age, gender, type of fracture and follow-up time. Patients in the study group received open reduction and internal fixation and shockwave treatment immediately after surgery on odd-numbered days of the week, whereas, patients in the control group received open reduction and internal fixation without shockwave treatment on even-numbered days of the week. Postoperative managements were similarly performed in both groups including crutch walking with non-weight bearing on the affected limb until fracture healing shown on radiographs. The evaluation parameters included clinical assessments of pain score and weight bearing status of the affected leg and serial radiographs at 3, 6 and 12 months. The primary end-point is the rate of non-union at 12 months, and the secondary end point is the rate of fracture healing at 3, 6 and 12 months. At 12 months, the rate of non-union was 11% for the study group versus 20% for the control group (P < 0.001). Significantly, better rate of fracture healing was noted in the study group than the control group at 3, 6 and 12 months (P < 0.001). Extracorporeal shockwave is effective on promoting fracture healing and decreasing the rate of non-union in acute high-energy fractures of the lower extremity.

Meso-scale Computational Investigation of Polyurea Microstructure and Its Role in Shockwave Attenuation/dispersion

DTIC Science & Technology

2015-07-01

grained simulations of the formation of meso-segregated microstructure and its interaction with the shockwave is analyzed in the present work. It is...help identify these phenomena and processes, meso-scale coarse-grained simulations of the formation of meso-segregated microstructure and its...of shockwave-induced hard-domain densification. Keywords: Polyurea; Meso-scale; Coarse-grained simulations ; Shockwave attenuation; shockwave

Safety and efficacy of low intensity shockwave (LISW) treatment in patients with erectile dysfunction

PubMed Central

Ruffo, A.; Capece, M.; Prezioso, D.; Romeo, G.; Illiano, E.; Romis, L.; Lauro, G. Di; Iacono, F.

2015-01-01

ABSTRACT The primary goal in the management strategy of a patient with ED would be to determine its etiology and cure it when possible, and not just to treat the symptoms alone. One of the new therapeutic strategies is the use of low intensity extracorporeal shockwave (LISW) therapy. The mechanism of shockwave therapy is not completely clear. It is suggested that LISW induces neovascularization and improvement of cavernosal arterial flow which can lead to an improvement of erectile function by releasing NO, VEGF and PCNA. Materials and Methods: 31 patients between February and June 2013 with mild to severe ED and non-Phosphodiesterase 5 inhibitors responders were enrolled. Patients underwent four weekly treatment sessions. During each session 3600 shocks at 0.09mJ/ mm2 were given, 900 shocks at each anatomical area (right and left corpus cavernosum, right and left crus). Improvement of the erectile function was evaluated using the International Index of Erectile Function (IIEF-EF), the Sexual Encounter Profile (SEP) diaries (SEP-Questions 2 and 3) and Global Assessment Questions (GAQ-Q1 and GAQ-Q2). Results: At 3-month follow-up IIEF-EF scores improved from 16.54±6.35 at baseline to 21.03±6.38. Patients answering ‘yes’ to the SEP-Q2 elevated from 61% to 89% and from 32% to 62% in the SEP-Q3. A statistically significant improvement was reported to the Global Assessment Questions (GAQ-Q1 and GAQ-Q2). Conclusion: In conclusion, we can affirm that LISW is a confirmed therapeutic approach to erectile dysfunction that definitely needs more long-term trials to be clarified and further verified. PMID:26689523

Shockwave dynamics: a comparison between stochastic and periodic porous architectures

NASA Astrophysics Data System (ADS)

Branch, Brittany; Ionite, Axinte; Clements, Bradford; Montgomery, David; Schmalzer, Andrew; Patterson, Brian; Mueller, Alexander; Jensen, Brian; Dattelbaum, Dana

Polymeric foams are used extensively as structural supports and load mitigating materials in which they are subjected to compressive loading at a range of strain rates, up to the high strain rates encountered in blast and shockwave loading. To date, there have been few insights into compaction phenomena in porous structures at the mesoscale, and the influence of structure on shockwave localization. Of particular interest is when the properties of the inherent mesoscopic, periodic structure begin to emerge, versus the discrete behavior of the individual cell. Here, we illustrate, for the first time, modulation of shockwave dynamics controlled at micron-length scales in additively manufactured periodic porous structures measured using in situ, time-resolved x-ray phase contrast imaging at the Advanced Photon Source. Further, we demonstrate how the shockwave dynamics in periodic structures differ from stochastic foams of similar density and we conclude that microstructural control in elastomer foams has a dramatic effect on shockwave dynamics and can be tailored towards a variety of applications. Laboratory Directed Research and Development (LDRD) program at Los Alamos National Laboratory (project# 20160103DR) and DOE/NNSA Campaign 2.

Study of the effects of Shockwaves on Nano fluids

NASA Astrophysics Data System (ADS)

Shreekhar; Akhil, Mohan; Ram, Sai; Gopaiah, Venkata; Koundinya, Sandeep; Nagaraja, S. R.

2018-02-01

Nanofluids are fluids with nanoparticles dispersed in them. Due to the presence of Nano particles, these fluids exhibit unique properties that can used in various applications such as heat exchangers and in medical fields. However, due to agglomeration, the size of these particle increases, reducing their efficiency. In order to break the agglomeration, we are passing shockwaves in the fluid. Shockwaves theoretically carry energy which can be used to break the agglomerating particles. In this paper, silver nanoparticles were synthesized using silver nitrate. Tri sodium citrate was used as the reducing agent. Shock waves were passed to the fluid containing silver Nano particles. The changes in the Nano fluid was measured by a UV-Vis Spectrophotometer. With each shock passed, the fluid’s absorbance and wavelength peak was measured and compared with Nano fluid without shock.

Update on the efficacy of extracorporeal shockwave treatment for myofascial pain syndrome and fibromyalgia.

PubMed

Ramon, Silvia; Gleitz, Markus; Hernandez, Leonor; Romero, Luis David

2015-12-01

Chronic muscle pain syndrome is one of the main causes of musculoskeletal pathologies requiring treatment. Many terms have been used in the past to describe painful muscular syndromes in the absence of evident local nociception such as myogelosis, muscle hardening, myalgia, muscular rheumatism, fibrositis or myofascial trigger point with or without referred pain. If it persists over six months or more, it often becomes therapy resistant and frequently results in chronic generalized pain, characterized by a high degree of subjective suffering. Myofascial pain syndrome (MPS) is defined as a series of sensory, motor, and autonomic symptoms caused by a stiffness of the muscle, caused by hyperirritable nodules in musculoskeletal fibers, known as myofascial trigger points (MTP), and fascial constrictions. Fibromyalgia (FM) is a chronic condition that involves both central and peripheral sensitization and for which no curative treatment is available at the present time. Fibromyalgia shares some of the features of MPS, such as hyperirritability. Many treatments options have been described for muscle pain syndrome, with differing evidence of efficacy. Extracorporeal Shockwave Treatment (ESWT) offers a new and promising treatment for muscular disorders. We will review the existing bibliography on the evidence of the efficacy of ESWT for MPS, paying particular attention to MTP (Myofascial Trigger Point) and Fibromyalgia (FM). Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

High-speed imaging optical techniques for shockwave and droplets atomization analysis

NASA Astrophysics Data System (ADS)

Slangen, Pierre R.; Lauret, Pierre; Heymes, Frederic; Aprin, Laurent; Lecysyn, Nicolas

2016-12-01

Droplets atomization by shockwave can act as a consequence in domino effects on an industrial facility: aggression of a storage tank (projectile from previous event, for example) can cause leakage of hazardous material (toxic and flammable). As the accident goes on, a secondary event can cause blast generation, impacting the droplets and resulting in their atomization. Therefore, exchange surface increase impacts the evaporation rate. This can be an issue in case of dispersion of such a cloud. The experiments conducted in the lab generate a shockwave with an open-ended shock tube to break up liquid droplets. As the expected shockwave speed is about 400 m/s (˜Mach 1.2), the interaction with falling drops is very short. High-speed imaging is performed at about 20,000 fps. The shockwave is measured using both overpressure sensors: particle image velocimetry and pure in line shadowgraphy. The size of fragmented droplets is optically measured by direct shadowgraphy simultaneously in different directions. In these experiments, secondary breakups of a droplet into an important number of smaller droplets from the shockwave-induced flow are shown. The results of the optical characterizations are discussed in terms of shape, velocity, and size.

Second shock ejecta measurements with an explosively driven two-shockwave drive

NASA Astrophysics Data System (ADS)

Buttler, W. T.; Oró, D. M.; Olson, R. T.; Cherne, F. J.; Hammerberg, J. E.; Hixson, R. S.; Monfared, S. K.; Pack, C. L.; Rigg, P. A.; Stone, J. B.; Terrones, G.

2014-09-01

We develop and apply an explosively driven two-shockwave tool in material damage experiments on Sn. The two shockwave tool allows the variation of the first shockwave amplitude over range 18.5 to 26.4 GPa, with a time interval variation between the first and second shock of 5 to 7 μs. Simulations imply that the second shock amplitude can be varied as well and we briefly describe how to achieve such a variation. Our interest is to measure ejecta masses from twice shocked metals. In our application of the two-shockwave tool, we observed second shock ejected areal masses of about 4 ± 1 mg/cm2, a value we attribute to unstable Richtmyer-Meshkov impulse phenomena. We also observed an additional mass ejection process caused by the abrupt recompression of the local spallation or cavitation of the twice shocked Sn.

Radiofrequency Thermal Lesioning and Extracorporeal Shockwave Therapy: A Comparison of Two Methods in the Treatment of Plantar Fasciitis.

PubMed

Ozan, Fırat; Koyuncu, Şemmi; Gürbüz, Kaan; Öncel, Eyyüp Sabri; Altay, Taşkın

2017-06-01

We compared the results of radiofrequency thermal lesioning (RTL) and extracorporeal shockwave therapy (ESWT) in patients with chronic plantar fasciitis. This prospective study included 56 patients diagnosed with plantar fasciitis who had complaints for ≥6 months: 40 (group 1) underwent ESWT and 16 (group 2) underwent RTL. The presence of calcaneal spurs was investigated with imaging studies. All patients were followed up clinically at baseline and 1, 3, and 6 months after treatment. Clinical evaluations were performed by the visual analog scale (VAS) and the modified Roles-Maudsley (RM) scoring system. There was no significant difference in the age, sex, body mass index, and side of involvement between the groups (all P > .05). Radiographic evaluation showed calcaneal spurs in 22 patients (55%) in group 1 and 7 patients (43%) in group 2. There was no significant difference in the baseline and posttreatment values between the groups; however, group 2 had significantly different RM values at 1 month than group 1 ( P < .05). In both groups, the VAS scores significantly decreased at 1, 3, and 6 months after treatment ( P < .05). The RM scores at 1, 3, and 6 months after treatment significantly decreased in both groups, except for the RM values at 1 month after treatment in group 1 ( P < .05). Our study results suggest that RTL and ESWT are safe and effective treatments in patients with chronic plantar fasciitis. Level II: Therapeutic study.

Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels.

PubMed

Ioppolo, Francesco; Tattoli, Maria; Di Sante, Luca; Attanasi, Carmine; Venditto, Teresa; Servidio, Marila; Cacchio, Angelo; Santilli, Valter

2012-11-01

Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treatment of people with supraspinatus calcifying tendinitis (SCT), but there is limited evidence for the useful range of ESWT doses. The aim of this study was to compare 2 different ranges of energy flux density in treatment of SCT with ESWT. This study was designed as a single-blind randomized clinical trial. This study was performed in a university hospital. Forty-six patients with SCT were randomly assigned to 2 groups that received different therapeutic energy doses of ESWT: (1) group A received ESWT at an energy level of 0.20 mJ/mm², and (2) group B received ESWT at an energy level of 0.10 mJ/mm². The treatment protocol consisted of 4 sessions performed once a week. The change in mean Constant Murley Scale (CMS) scores at 3 and 6 months was the primary endpoint. The change in the mean visual analog scale (VAS) scores from baseline to 3 and 6 months after the intervention and radiographic change in size of calcium deposits were evaluated as secondary endpoints. At 12 months, pain relief was assessed using a numeric rating scale. Significant clinical improvement based on mean CMS scores was observed after 6 months in group A (X=79.43, SD=10.33) compared with group B (X=57.91, SD=6.53). Likewise, after 6 months, a significant decrease in VAS scores was found in group A (X=2.09, SD=1.54) compared with group B (X=5.36, SD=0.78). Calcific deposits disappeared in the same percentage of patients in both groups. The small sample size and lack of a control group were limitations of the study. In ESWT for SCT, an energy level of 0.20 mJ/mm² appears to be more effective than an energy level of 0.10 mJ/mm² in pain relief and functional improvement.

Enhanced High-Rate Shockwave Lithotripsy Stone Comminution in an In Vivo Porcine Model Using Acoustic Bubble Coalescence.

PubMed

Alavi Tamaddoni, Hedieh; Roberts, William W; Duryea, Alexander P; Cain, Charles A; Hall, Timothy L

2016-12-01

Cavitation plays a significant role in the efficacy of stone comminution during shockwave lithotripsy (SWL). Although cavitation on the surface of urinary stones helps to improve fragmentation, cavitation bubbles along the propagation path may shield or block subsequent shockwaves (SWs) and potentially induce collateral tissue damage. Previous in vitro work has shown that applying low-amplitude acoustic waves after each SW can force bubbles to consolidate and enhance SWL efficacy. In this study, the feasibility of applying acoustic bubble coalescence (ABC) in vivo was tested. Model stones were percutaneously implanted and treated with 2500 lithotripsy SWs at 120 SW/minute with or without ABC. Comparing the results of stone comminution, a significant improvement was observed in the stone fragmentation process when ABC was used. Without ABC, only 25% of the mass of the stone was fragmented to particles <2 mm in size. With ABC, 75% of the mass was fragmented to particles <2 mm in size. These results suggest that ABC can reduce the shielding effect of residual bubble nuclei, resulting in a more efficient SWL treatment.

Effect of laser generated shockwaves 1 on ex-vivo pigskin.

PubMed

Ramaprasad, Vidyunmala; Navarro, Artemio; Patel, Shahzad; Patel, Vikash; Nowroozi, Bryan N; Taylor, Zach D; Yong, William; Gupta, Vijay; Grundfest, Warren S

2014-10-01

Persistent bacterial infection prolongs hospitalizations, leading to increased healthcare costs. Treatment of these infections costs several billion dollars annually. Biofilm production is one mechanism by which bacteria become resistant. With the help of biofilms, bacteria withstand the host immune response and are much less susceptible to antibiotics. Currently, there is interest in the use of laser-generated shockwaves (LGS) to delaminate biofilm from infected wound surfaces; however, the safety of such an approach has not yet been established. Of particular concern are the thermal and mechanical effects of the shockwave treatment on the epidermis and the underlying collagen structure of the dermis. The present study is a preliminary investigation of the effect of LGS on freshly harvested ex vivo porcine skin tissue samples. Tissue samples for investigation were harvested immediately post-mortem and treated with LGS within 30 minutes. Previous studies have shown that laser fluences between 100 and 500 mJ/pulse are capable of delaminating biofilms off a variety of surfaces, thus our preliminary investigation focused on this range of laser energy. For each sample, LGS were produced via laser irradiation of a thin layer (0.5 µm) of titanium sandwiched between a 50 and 100 µm thick layer of water glass and a 0.1 mm thick sheet of Mylar. The rapid thermal expansion of the irradiated titanium film generates a transient compressive wave that is coupled through a liquid layer to the surface of the ex vivo pigskin sample. Shocked samples were immediately fixed in formalin and prepared for histological analysis. A blinded pathologist evaluated and scored each section on the basis of its overall appearance (O) and presence of linear/slit-like spaces roughly parallel to the surface of the skin (S). The scores were given on a scale of 0-3. The present investigation revealed no visible difference between the tissue sections of the control sample and those that

Laser-generated shockwave for clearing medical device biofilms.

PubMed

Kizhner, Victor; Krespi, Yosef P; Hall-Stoodley, Luanne; Stoodley, Paul

2011-04-01

This study aimed to evaluate a laser method of biofilm interruption from the surface of various common medical devices and from surgically removed sinus tissue with adherent biofilms in a timely manner. Biofilm has emerged as a new threat not amenable to most antibiotic treatments. Biofilms, as opposed to planktonic bacteria, develop an extracellular polymeric slime matrix to facilitate adherence to host tissue or a prosthetic surface and to form a protective shield. A laser-induced biofilms disruption concept was previously described. Biofilms were grown in the laboratory on metallic and plastic medical device surfaces such as stents. Attempts to remove the biofilms with a laser were undertaken three times for each device. Q-switched Nd:YAG laser-generated shockwaves affecting Pseudomonas aeruginosa biofilms expressing yellow fluorescent protein (YFP) biofilm coating were applied with biologically safe parameters utilizing a fiber delivery system and a special probe. A confocal microscope was used to identify the biofilm structure prior to, during, and after laser application. The amount of biofilm removed from the medical devices in time was measured by quantifying green fluorescence. The biofilm fluctuated and eventually broke off the surface as shock waves neared the target. The time to remove 97.9 ± 0.4% (mean ± 1SD, n = 3) the biofilm from the surface of a Nitinol (NiTi) stent ranged from 4 to 10 s. The detached biofilm was observed floating in fluid media in various microscopic size particles. A new treatment modality using laser-generated shockwaves in the warfare against biofilms growing on surgical devices was demonstrated. Q-switched laser pulses stripped biofilm from the surface it adhered to, changing the bacteria to their planktonic form, making them amenable to conventional treatment. This therapeutic modality appears to be rapid, effective, and safe on metallic and plastic medical device surfaces.

Efficacy Management of Urolithiasis: Flexible Ureteroscopy versus Extracorporeal Shockwave Lithotripsy.

PubMed

Tauber, Volkmar; Wohlmuth, Martin; Hochmuth, Andreas; Schimetta, Wolfgang; Schimetta, Wofgang; Krause, F Steffen

2015-01-01

To evaluate the efficacy of flexible ureterscopy (fURS) and extracorporal shockwave lithotripsy (SWL) in the treatment of urolithiasis, complemented by a subgroup analysis of lower pole calyx. Retrospective analysis of patients treated by fURS or SWL was performed by independent variables such as gender, age, nephrolith size, double-J stent (DJ stent) and stone localisation. Out of 326 patients, 165 were treated by SWL and 161 by fURS. Complete stone removal was achieved by fURS in 83.2% and by SWL in 43.0% (p < 0.001). Asymptomatic behaviour (88-89%) and complication rate (10-11%) were nearly the same in both methods. A higher retreatment rate for SWL was necessary; otherwise, an auxillary DJ stent was performed more often preoperative before fURS. The subgroup analysis of lower pole calyx confirmed these evaluations. Complete stone-free removal was almost 8 times higher after fURS compared to SWL. The efficacy of fURS in treatment of urolithiasis is substantially higher than the efficacy of SWL. © 2015 S. Karger AG, Basel.

Sharp plasma pinnacle structure based on shockwave for an improved laser wakefield accelerator

NASA Astrophysics Data System (ADS)

Fang, Ming; Zhang, Zhijun; Wang, Wentao; Liu, Jiansheng; Li, Ruxin

2018-07-01

We created a sharp plasma pinnacle structure for localized electron injection and controlled acceleration in a laser wakefield accelerator. The formation of this shockwave-based pinnacle structure was investigated using aerodynamic theory. Details and scaling laws for the shockwave angle, shock position, shock width, and density ratio were experimentally and theoretically presented. Such work is crucial to yielding an expected plasma density distribution in a laser–plasma experiment but has had little discussion in the literature. Compared with the commonly used shock downramp structure, the particle-in-cell simulations demonstrated that the e beam injected in the created pinnacle structure could be accelerated to higher energy with much smaller root-mean-square relative energy spread. Moreover, this study indicated that the beam charge and transverse emittance can be tuned by the shock angle.

Shockwave lithotripsy with music: Less painful and more satisfactory treatment.

PubMed

Ordaz Jurado, D G; Budia Alba, A; Bahilo Mateu, P; Trassierra Villa, M; López-Acón, D; Boronat Tormo, F

2017-11-01

The objective of this study was to determine whether listening to music during a session of extracorporeal shockwave lithotripsy (ESWL) improves patients' pain. A simple, blind randomisation was undertaken of patients with kidney and ureter stones attending an ESWL session of 7,000 waves for the first time, between September and December 2014. One group was given music and the other was not. The age, gender, location of stones (kidney/ureter) were recorded and 2questionnaires: pre ESWL (questionnaire A) and postESWL (questionnaire B). Each questionnaire contained a question about anxiety and another question on pain on the Likert scale (0-10). Questionnaire B also had a question on satisfaction and comfort (Likert 0-10). Other variables included heart rate, respiratory rate, systolic and diastolic blood pressure on wave 2,000, 5,000 and 7,000, reason for halting the procedure, total pethidine (mg), secondary analgesia, energy (J) and frequency (Hz). Bivariate analysis using the Student's t-test, X 2 /Fisher test and a multiple linear regression model. The sample comprised 95 patients, with a mean age of 52 (±13) years, 35 (36.84%) females, 60 (63.2%) males. A total of 25 (26.3%) ureter stones and 70 (73.7%) kidney stones. A number of 42 (44.2%) patients were given music. There were no differences between the demographic variables or questionnaire A scores. Satisfaction and pain were better on questionnaire B with music. Music can reduce pain and improve patient satisfaction in ESWL treatment. More studies are required to confirm this effect. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Working mechanism of extracorporeal shockwave therapy in non-urological disciplines

NASA Astrophysics Data System (ADS)

Schaden, Wolfgang

2005-04-01

For 32 years of extracorporeal shockwave lithotripsy (ESWL) only the mechanical strength of shockwaves were of clinical interest. For use in orthopaedics, the absence of dangerous long term effects (malignant degeneration, etc.) is the only important message. The mechanical model tries to explain the effect of shock waves by the provocation of microleasions in the tissue stimulating repairing processes. First doubts on this mechanical model came up when Schaden (2001) could show, that less energy is more efficient in the treatment of non-unions. Due to the basic research of the last years knowledge increased about the microbiological effects. Under the influence of shock waves the change of permeability of cell membranes and the liberation of free radicals was reported. Also the production of nitric oxide (NO) and different growth factors like vascular endothelial growth factor (VEGF), bone morphogenetic proteins (BMP), transforming growth factor-beta 1 (TGF-b1), insulin-like growth factor-I (IGF-I) etc. was observed. The biological model tries to explain the effect of shock waves by stimulating the ingrowth of blood vessels and liberation of growth factors. Under the influence of shock waves, biological tissues seem to be able to produce important substances to initiate healing processes.

Treatment of mid- and lower ureteric calculi: extracorporeal shock-wave lithotripsy vs laser ureteroscopy. A comparison of costs, morbidity and effectiveness.

PubMed

Bierkens, A F; Hendrikx, A J; De La Rosette, J J; Stultiens, G N; Beerlage, H P; Arends, A J; Debruyne, F M

1998-01-01

To determine the efficacy and costs of extracorporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid- and lower ureteric calculi. The records of patients treated primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients (42 men and 21 women, mean age 52 years, range 23-78, 19 mid- and 44 lower ureteric calculi). All patients received 4000 shock waves at a mean energy setting of 18.1 kV. URS was used in 105 patients, with a 7.2 F miniscope or the 7.1 F flexible scope. Stones were fragmented with a pulsed-dye laser lithotripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 microns fibre. All ureteroscopies were performed with the patient under general (n = 17) or spinal (n = 87) anaesthesia in a mean treatment duration of 34 min. Stones were located in the mid-ureter in 24 patients and in the lower ureter in 80. The outcome was assessed by stone-free rates, re-treatment rates, time to become stone-free, complication and costs. ESWL for mid- and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, compared with 96% and 99% for URS. However, patients treated with URS were stone-free within 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were achieved with stones of < 50 mm2. The costs of URS were higher than those for ESWL. ESWL provides a noninvasive, simple and safe option for the management of mid- and lower ureteric calculi, provided that the stones are < 50 mm2; larger stones are best treated by URS.

Focused extracorporeal shockwave therapy in Dupuytren's disease--a hypothesis.

PubMed

Knobloch, Karsten; Kuehn, Marie; Vogt, Peter M

2011-05-01

Dupuytren's disease is a progressive disease due to unknown causal agents or genetics. An epidemiological analysis of 566 cases in North Germany estimated that around 1.9 million Germans are suffering from Dupuytren's disease. Beside Dupuytren's disease, there are a number of further less common forms of progressive fibromatosis, such as knuckle pads, plantar fibromatosis or Peyronie's disease. Surgery in plantar fasciectomy yields to a 60% recurrence rate depending on the extent of the plantar fasciectomy. Peyronie's disease of the penis affects middle-aged men between 40 and 60 years with penile pain, curvature during erection and potential erectile dysfunction. In a clinical randomized-controlled trial in Peyronie's disease 2000 focused extracorporeal shock waves reduced pain significantly and improved erectile function and quality of life. We hypothesize that focused extracorporeal shock wave therapy is able to reduce Dupuytren's contracture, a fibromatosis of the palm and improve function. Given the fact that recurrence rate in Dupuytren's disease is high und unpredictable extracorporeal shockwave therapy as a non-invasive tool might be applicable both, in primary and secondary prevention of the progression as well as for treatment. As such we have planned a randomized-controlled trial (ClinicialTrials.gov, NCT01184586) studying the effect of high-energy focused extracorporeal shockwave therapy on patients suffering Dupuytren's disease with patient-related outcome measures such as the DASH score and the Michigan Hand Outcome Questionnaire (MHQ) as primary outcome parameters. Copyright © 2011 Elsevier Ltd. All rights reserved.

Controlling shockwave dynamics using architecture in periodic porous materials

DOE PAGES

Branch, Brittany; Ionita, Axinte; Clements, Bradford E.; ...

2017-04-07

Additive manufacturing (AM) is an attractive approach for the design and fabrication of structures capable of achieving controlled mechanical response of the underlying deformation mechanisms. While there are numerous examples illustrating how the quasi-static mechanical responses of polymer foams have been tailored by additive manufacturing, there is limited understanding of the response of these materials under shockwave compression. Dynamic compression experiments coupled with time-resolved X-ray imaging were performed to obtain insights into the in situ evolution of shockwave coupling to porous, periodic polymer foams. We further demonstrate shock wave modulation or “spatially graded-flow” in shock-driven experiments via the spatial controlmore » of layer symmetries afforded by additive manufacturing techniques at the micron scale.« less

Extended asymmetric hot region formation due to shockwave interactions following void collapse in shocked high explosive

NASA Astrophysics Data System (ADS)

Shan, Tzu-Ray; Wixom, Ryan R.; Thompson, Aidan P.

2016-08-01

In both continuum hydrodynamics simulations and also multimillion atom reactive molecular dynamics simulations of shockwave propagation in single crystal pentaerythritol tetranitrate (PETN) containing a cylindrical void, we observed the formation of an initial radially symmetric hot spot. By extending the simulation time to the nanosecond scale, however, we observed the transformation of the small symmetric hot spot into a longitudinally asymmetric hot region extending over a much larger volume. Performing reactive molecular dynamics shock simulations using the reactive force field (ReaxFF) as implemented in the LAMMPS molecular dynamics package, we showed that the longitudinally asymmetric hot region was formed by coalescence of the primary radially symmetric hot spot with a secondary triangular hot zone. We showed that the triangular hot zone coincided with a double-shocked region where the primary planar shockwave was overtaken by a secondary cylindrical shockwave. The secondary cylindrical shockwave originated in void collapse after the primary planar shockwave had passed over the void. A similar phenomenon was observed in continuum hydrodynamics shock simulations using the CTH hydrodynamics package. The formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.

Extracorporeal shockwave therapy versus exercise program in patients with low back pain: short-term results of a randomised controlled trial.

PubMed

Notarnicola, A; Maccagnano, G; Gallone, M F; Mastromauro, L; Rifino, F; Pesce, V; Covelli, I; Moretti, B

2018-01-01

The physiotherapy treatment of low back pain (LBP) with physical stimulation offers different possibilities of application. Until now, the physical therapies used in LBP are laser therapy, ultrasonotherapy and currents. We conducted a clinical trial in order to verify whether shockwave therapy, which is very effective in treating tendinopathies and fracture consolidation delays, leads to clinical and electromyographic improvement in patients affected by LBP. We randomized thirty patients affected by LBP treated with shock waves (shockwave group) or a standard protocol characterized by rehabilitative exercises (control group). At one and three months, the patients treated with shockwave therapy showed clinical improvement measured by VAS scales (p=0.002; p= 0.02), and disability evaluated with Roland scales (p=0.002; p=0.002) and Oswestry (p=0.002; p=0.002). At three months, the patients treated with shock waves, showed a significant improvement in terms of values of amplitude of the sensory nerve conduction velocity (SNCV) of the plantar medialis nerve (left: p=0.007; right: p=0.04), the motor nerve muscular conduction (MNCV) of the deep peroneal nerve (left: p=0.28; right: p=0.01) and recruitment of motor units of finger brevis extensor (left: p = 0.02; right: p=0.006). In the control group, there was a trend to increase the clinical and electromyographic results without statistical significance. The preliminary results suggest a good applicability of shockwave therapy in the treatment of LBP, in accordance with the antiinflammatory, antalgic, decontracting effects and remodeling of the nerve fiber damage verified in previous studies conducted on other pathological models. Future research will allow us to verify the integration of this therapy into a rehabilitation protocol combined with other physical therapies.

Al 1s-2p Absorption Spectroscopy of Shock-Wave Heating and Compression in Laser-Driven Planar Foil

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sawada, H.; Regan, S.P.; Radha, P.B.

Time-resolved Al 1s-2p absorption spectroscopy is used to diagnose direct-drive, shock-wave heating and compression of planar targets having nearly Fermi-degenerate plasma conditions (Te ~ 10–40 eV, rho ~ 3–11 g/cm^3) on the OMEGA Laser System [T. R. Boehly et al., Opt. Commun. 133, 495 (1997)]. A planar plastic foil with a buried Al tracer layer was irradiated with peak intensities of 10^14–10^15 W/cm^2 and probed with the pseudocontinuum M-band emission from a point-source Sm backlighter in the range of 1.4–1.7 keV. The laser ablation process launches 10–70 Mbar shock waves into the CH/Al/CH target. The Al 1s-2p absorption spectra weremore » analyzed using the atomic physic code PRISMSPECT to infer Te and rho in the Al layer, assuming uniform plasma conditions during shock-wave heating, and to determine when the heat front penetrated the Al layer. The drive foils were simulated with the one-dimensional hydrodynamics code LILAC using a flux-limited (f =0.06 and f =0.1) and nonlocal thermal-transport model [V. N. Goncharov et al., Phys. Plasmas 13, 012702 (2006)]. The predictions of simulated shock-wave heating and the timing of heat-front penetration are compared to the observations. The experimental results for a wide variety of laser-drive conditions and buried depths have shown that the LILAC predictions using f = 0.06 and the nonlocal model accurately model the shock-wave heating and timing of the heat-front penetration while the shock is transiting the target. The observed discrepancy between the measured and simulated shock-wave heating at late times of the drive can be explained by the reduced radiative heating due to lateral heat flow in the corona.« less

Shock-wave facility at Tokyo Institute of Technology

NASA Astrophysics Data System (ADS)

Sawaoka, A.; Kondo, K.

1982-04-01

The shock-wave facility at the Tokyo Institute of Technology is described. Two double-stage light-gas guns are used to studying material science and technology. Recently construction has begun for a new type of rail gun combined with a double-stage light-gas gun.

Extended asymmetric hot region formation due to shockwave interactions following void collapse in shocked high explosive

DOE PAGES

Shan, Tzu -Ray; Wixom, Ryan R.; Thompson, Aidan P.

2016-08-01

In both continuum hydrodynamics simulations and also multimillion atom reactive molecular dynamics simulations of shockwave propagation in single crystal pentaerythritol tetranitrate (PETN) containing a cylindrical void, we observed the formation of an initial radially symmetric hot spot. By extending the simulation time to the nanosecond scale, however, we observed the transformation of the small symmetric hot spot into a longitudinally asymmetric hot region extending over a much larger volume. Performing reactive molecular dynamics shock simulations using the reactive force field (ReaxFF) as implemented in the LAMMPS molecular dynamics package, we showed that the longitudinally asymmetric hot region was formed bymore » coalescence of the primary radially symmetric hot spot with a secondary triangular hot zone. We showed that the triangular hot zone coincided with a double-shocked region where the primary planar shockwave was overtaken by a secondary cylindrical shockwave. The secondary cylindrical shockwave originated in void collapse after the primary planar shockwave had passed over the void. A similar phenomenon was observed in continuum hydrodynamics shock simulations using the CTH hydrodynamics package. Furthermore, the formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.« less

Extended asymmetric hot region formation due to shockwave interactions following void collapse in shocked high explosive

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shan, Tzu -Ray; Wixom, Ryan R.; Thompson, Aidan P.

In both continuum hydrodynamics simulations and also multimillion atom reactive molecular dynamics simulations of shockwave propagation in single crystal pentaerythritol tetranitrate (PETN) containing a cylindrical void, we observed the formation of an initial radially symmetric hot spot. By extending the simulation time to the nanosecond scale, however, we observed the transformation of the small symmetric hot spot into a longitudinally asymmetric hot region extending over a much larger volume. Performing reactive molecular dynamics shock simulations using the reactive force field (ReaxFF) as implemented in the LAMMPS molecular dynamics package, we showed that the longitudinally asymmetric hot region was formed bymore » coalescence of the primary radially symmetric hot spot with a secondary triangular hot zone. We showed that the triangular hot zone coincided with a double-shocked region where the primary planar shockwave was overtaken by a secondary cylindrical shockwave. The secondary cylindrical shockwave originated in void collapse after the primary planar shockwave had passed over the void. A similar phenomenon was observed in continuum hydrodynamics shock simulations using the CTH hydrodynamics package. Furthermore, the formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.« less

Structural Changes in Alloys of the Al-Cu-Mg System Under Ion Bombardment and Shock-Wave Loading

NASA Astrophysics Data System (ADS)

Ovchinnikov, V. V.; Gushchina, N. V.; Romanov, I. Yu.; Kaigorodova, L. I.; Grigor'ev, A. N.; Pavlenko, A. V.; Plokhoi, V. V.

2017-02-01

To confirm the hypothesis on the shock-wave nature of long-range effects upon corpuscular irradiation of condensed media presumably caused by emission and propagation of post-cascade shock waves, comparative experiments on ion beam modification and mechanical shock-wave loading of specimens of VD1 and D16 alloys of the Al-Cu-Mg system are performed. Direct analogy between the processes of microstructural change of cold-deformed VD1 and D16 alloys under mechanical shock loading and irradiation by beams of accelerated Ar+ ions (E = 20-40 keV) with low fluences (1015-1016 cm-2) is established. This demonstrates the important role of the dynamic long-range effects that have not yet been considered in classical radiation physics of solids.

Low-energy versus middle-energy extracorporeal shockwave therapy for the treatment of snapping scapula bursitis

PubMed Central

Acar, Nihat

2017-01-01

Objective: Extracorporeal shockwave therapy (ESWT) has been used successfully in treatment of musculoskeletal disorders. Our objective was to assess the effectiveness of low versus middle-energy ESWT on snapping scapula bursitis. Methods: Thirty-five patients, divided into two groups, group (L), received low-energy ESWT, group (M) received middle-energy ESWT. Groups were evaluated at 1,3,6 and 12 months using the Visual Analogue Scale (VAS), the Constant-Murley scoring (CMS) and the Roles and Maudsley criteria. Results: In groups (L) and (M), VAS average values after 1,3,6 months and one year were (43±5.17, 38±4.33, 28±4.18 and 19±3.39) and (37±4.85, 26±4.74, 21±4.45 and 7±3.42) respectively. At six and twelve months, statistical difference was detected, P (0.034, 0.026) respectively. After one year of completing the treatment, the average values of CMS were (83.5±6.44 and 91±5.33) respectively, P=0.046. Roles and Maudsley criteria demonstrated that, patients in group (L), 6 (35%) excellent, 5 (29%) good, 4 (24%) acceptable and 2 (12%) had poor results. Whereas, patients in group (M), 11 (61%) excellent, 3 (17%) good, 3 (17%) acceptable and 1 (5%) had poor results. Conclusion: Although low-energy ESWT showed good early-term results, but middle-energy ESWT protocol demonstrated better early-term, Mid-term, and late-term results. PMID:28523033

A passive acoustic device for real-time monitoring of the efficacy of shockwave lithotripsy treatment.

PubMed

Leighton, T G; Fedele, F; Coleman, A J; McCarthy, C; Ryves, S; Hurrell, A M; De Stefano, A; White, P R

2008-10-01

Extracorporeal shockwave lithotripsy (ESWL) is the preferred modality for the treatment of renal and ureteric stone disease. Currently X-ray or ultrasound B-scan imaging are used to locate the stone and to check that it remains targeted at the focus of the lithotripter during treatment. Neither imaging modality is particularly effective in allowing the efficacy of treatment to be judged during the treatment session. A new device is described that, when placed on the patient's skin, can passively monitor the acoustic signals that propagate through the body after each lithotripter shock, and which can provide useful information on the effectiveness of targeting. These acoustic time histories are analyzed in real time to extract the two main characteristic peak amplitudes (m(1) and m(2)) and the time between these peaks (t(c)). A set of rules based on the acoustic parameters was developed during a clinical study in which a complete set of acoustic and clinical data was obtained for 30 of the 118 subjects recruited. The rules, which complied with earlier computational fluid dynamics (CFD) modeling and in vitro tests, allow each shock to be classified as "effective" or "ineffective." These clinically-derived rules were then applied in a second clinical study in which complete datasets were obtained for 49 of the 85 subjects recruited. This second clinical study demonstrated almost perfect agreement (kappa = 0.94) between the number of successful treatments, defined as >50% fragmentation as determined by X-ray at the follow-up appointment, and a device-derived global treatment score, TS(0), a figure derived from the total number of effective shocks in any treatment. The acoustic system is shown to provide a test of the success of the treatment that has a sensitivity of 91.7% and a specificity of 100%. In addition to the predictive capability, the device provides valuable real-time feedback to the lithotripter operator by indicating the effectiveness of each shock, plus

Mesoscale simulations of shockwave energy dissipation via chemical reactions.

PubMed

Antillon, Edwin; Strachan, Alejandro

2015-02-28

We use a particle-based mesoscale model that incorporates chemical reactions at a coarse-grained level to study the response of materials that undergo volume-reducing chemical reactions under shockwave-loading conditions. We find that such chemical reactions can attenuate the shockwave and characterize how the parameters of the chemical model affect this behavior. The simulations show that the magnitude of the volume collapse and velocity at which the chemistry propagates are critical to weaken the shock, whereas the energetics in the reactions play only a minor role. Shock loading results in transient states where the material is away from local equilibrium and, interestingly, chemical reactions can nucleate under such non-equilibrium states. Thus, the timescales for equilibration between the various degrees of freedom in the material affect the shock-induced chemistry and its ability to attenuate the propagating shock.

Al 1s-2p absorption spectroscopy of shock-wave heating and compression in laser-driven planar foil

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sawada, H.; Regan, S. P.; Radha, P. B.

Time-resolved Al 1s-2p absorption spectroscopy is used to diagnose direct-drive, shock-wave heating and compression of planar targets having nearly Fermi-degenerate plasma conditions (T{sub e}{approx}10-40 eV, {rho}{approx}3-11 g/cm{sup 3}) on the OMEGA Laser System [T. R. Boehly et al., Opt. Commun. 133, 495 (1997)]. A planar plastic foil with a buried Al tracer layer was irradiated with peak intensities of 10{sup 14}-10{sup 15} W/cm{sup 2} and probed with the pseudocontinuum M-band emission from a point-source Sm backlighter in the range of 1.4-1.7 keV. The laser ablation process launches 10-70 Mbar shock waves into the CH/Al/CH target. The Al 1s-2p absorption spectramore » were analyzed using the atomic physic code PRISMSPECT to infer T{sub e} and {rho} in the Al layer, assuming uniform plasma conditions during shock-wave heating, and to determine when the heat front penetrated the Al layer. The drive foils were simulated with the one-dimensional hydrodynamics code LILAC using a flux-limited (f=0.06 and f=0.1) and nonlocal thermal-transport model [V. N. Goncharov et al., Phys. Plasmas 13, 012702 (2006)]. The predictions of simulated shock-wave heating and the timing of heat-front penetration are compared to the observations. The experimental results for a wide variety of laser-drive conditions and buried depths have shown that the LILAC predictions using f=0.06 and the nonlocal model accurately model the shock-wave heating and timing of the heat-front penetration while the shock is transiting the target. The observed discrepancy between the measured and simulated shock-wave heating at late times of the drive can be explained by the reduced radiative heating due to lateral heat flow in the corona.« less

Efficacy of the Duet lithotripter using two energy sources for stone fragmentation by shockwaves: an in vitro study.

PubMed

Greenstein, Alexander; Sofer, Mario; Matzkin, Haim

2004-12-01

To evaluate the efficacy of the Duet lithotripter's novel design of two independent spark-plug generator/reflector systems focused at a common F2. The apparatus allows either simultaneous delivery of shockwaves from both generators (resulting in a per-shock energy delivery at F2 equal to that delivered by its single generator at about 24 kV), alternating (between the two generators), or single-generator delivery of shockwaves at various energy levels and rates. Eighty-five phantom gypsum stones (volume 786 mm3 each) were placed in a net-like basket and immersed in a specially designed waterbath coupled with the Duet lithotripter (Direx Medical Systems Ltd., Petach Tikva, Israel). Shockwaves were delivered at rates of either 60 or 120 per minute and at intensities of 16 or 22.8 kV (electrohydraulic). Energy was delivered either separately from each generator, in an alternating mode, or simultaneously from both generators. The number of shocks required to fragment the stones sufficiently to allow all of the pieces to fall through the basket holes (complete fragmentation) was recorded. The number of shocks required for complete fragmentation in the alternate mode (120 shocks/min, each generator rate 60/min; 22.8kV) was lower than with the single generator, 112 +/- 19 v 134 +/- 18 (at a rate of 120/min; 22.8 kV). The simultaneous mode of dual generator shockwave delivery was more effective than the traditional single generator (114 +/- 28 shocks at a rate of 120/min, 16 kV v 159 +/- 40 shocks at a rate 120/min; 22.8kV). The Duet lithotripter is more effective when used in a simultaneous or alternating mode than is the classical single mode of shock delivery, with the added benefit of shorter treatment time.

Heat, mass and force flows in supersonic shockwave interaction

NASA Astrophysics Data System (ADS)

Dixon, John Michael

There is no cost effective way to deliver a payload to space and, with rising fuel prices, currently the price to travel commercially is also becoming more prohibitive to the public. During supersonic flight, compressive shock waves form around the craft which could be harnessed to deliver an additional lift on the craft. Using a series of hanging plates below a lifting wing design, the total lift generated can be increased above conventional values, while still maintaining a similar lift-to-drag ratio. Here, we study some of the flows involved in supersonic shockwave interaction. This analysis uses ANSYS Fluent Computational Fluid Dynamics package as the modeler. Our findings conclude an increase of up to 30% lift on the modeled craft while maintaining the lift-to-drag profile of the unmodified lifting wing. The increase in lift when utilizing the shockwave interaction could increase transport weight and reduce fuel cost for space and commercial flight, as well as mitigating negative effects associated with supersonic travel.

Extracorporeal shockwave lithotripsy in the management of salivary calculi.

PubMed

Escudier, M P; Brown, J E; Drage, N A; McGurk, M

2003-04-01

The aim was to investigate the results of extracorporeal shockwave lithotripsy in the management of salivary calculi using a dedicated sialolithotriptor. Some 122 salivary calculi (84 submandibular and 38 parotid) were treated in an experimental study using a sialolithotriptor. Complete success was achieved in 40 procedures (33 per cent), 27 of 84 submandibular and 13 of 38 parotid calculi. A further 43 patients (35 per cent) were rendered asymptomatic although some stone debris remained in the duct (26 submandibular and 17 parotid). Failure (retention of stone debris and continued symptoms) occurred in 39 patients (32 per cent), 30 submandibular and eight parotid glands. The chance of failure increased with the size of the calculus and increasing duration of symptoms. Extracorporeal shockwave lithotripsy provides a useful option for the management of salivary calculi, particularly for stones less than 7 mm in diameter. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

On the finite length-scale of compressible shock-waves formed in free-surface flows of dry granular materials down a slope

NASA Astrophysics Data System (ADS)

Faug, Thierry

2017-04-01

The Rankine-Hugoniot jump conditions traditionally describe the theoretical relationship between the equilibrium state on both sides of a shock-wave. They are based on the crucial assumption that the length-scale needed to adjust the equilibrium state upstream of the shock to downstream of it is too small to be of significance to the problem. They are often used with success to describe the shock-waves in a number of applications found in both fluid and solid mechanics. However, the relations based on jump conditions at singular surfaces may fail to capture some features of the shock-waves formed in complex materials, such as granular matter. This study addresses the particular problem of compressible shock-waves formed in flows of dry granular materials down a slope. This problem is for instance relevant to full-scale geophysical granular flows in interaction with natural obstacles or man-made structures, such as topographical obstacles or mitigation dams respectively. Steady-state jumps formed in granular flows and travelling shock-waves produced at the impact of a granular avalanche-flow with a rigid wall are considered. For both situations, new analytical relations which do not consider that the granular shock-wave shrinks into a singular surface are derived, by using balance equations in their depth-averaged forms for mass and momentum. However, these relations need additional inputs that are closure relations for the size and the shape of the shock-wave, and a relevant constitutive friction law. Small-scale laboratory tests and numerical simulations based on the discrete element method are shortly presented and used to infer crucial information needed for the closure relations. This allows testing some predictive aspects of the simple analytical approach proposed for both steady-state and travelling shock-waves formed in free-surface flows of dry granular materials down a slope.

Detecting cavitation in vivo from shock-wave therapy devices

NASA Astrophysics Data System (ADS)

Matula, Thomas J.; Yu, Jinfei; Bailey, Michael R.

2005-04-01

Extracorporeal shock-wave therapy (ESWT) has been used as a treatment for plantar faciitis, lateral epicondylitis, shoulder tendonitis, non-unions, and other indications where conservative treatments have been unsuccessful. However, in many areas, the efficacy of SW treatment has not been well established, and the mechanism of action, particularly the role of cavitation, is not well understood. Research indicates cavitation plays an important role in other ultrasound therapies, such as lithotripsy and focused ultrasound surgery, and in some instances, cavitation has been used as a means to monitor or detect a biological effect. Although ESWT can generate cavitation easily in vitro, it is unknown whether or not cavitation is a significant factor in vivo. The purpose of this investigation is to use diagnostic ultrasound to detect and monitor cavitation generated by ESWT devices in vivo. Diagnostic images are collected at various times during and after treatment. The images are then post-processed with image-processing algorithms to enhance the contrast between bubbles and surrounding tissue. The ultimate goal of this research is to utilize cavitation as a means for optimizing shock wave parameters such as amplitude and pulse repetition frequency. [Work supported by APL internal funds and NIH DK43881 and DK55674.

Stenting or not prior to extracorporeal shockwave lithotripsy for ureteral stones? Results of a prospective randomized study.

PubMed

Sfoungaristos, Stavros; Polimeros, Nikolaos; Kavouras, Adamantios; Perimenis, Petros

2012-06-01

To determine the need for pre-treatment stenting in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for ureteral stones sized 4-10 mm. A prospective randomized study was conducted between September 2009 and March 2011. Included 156 patients randomized in stented and non-stented groups and underwent a maximum of 3 ESWL sessions. Radiographic follow-up was used to assess the stone fragmentation and clearance. Results were compared in terms of stone-free rates, post-treatment morbidity and complications. Overall efficacy was 76.9%. Stone-free rates were statistically significantly lower (P = 0.026) in the stented group (68.6%) compared to the non-stented ones (83.7%). Furthermore, stenting was significantly correlated with post-treatment lower urinary tract symptoms (P ≤ 0.001), need for more ESWL sessions (P = 0.019) and possibility for operation due to ESWL failure (P = 0.026). A multivariate analysis was conducted to identify the parameters which may predict complete stone removal after ESWL. Stone size (P = 0.026), stone location (P = 0.011) and stenting (P = 0.007) were the most significant factors. ESWL is an efficient and safe treatment for 4- to 10-mm ureteral stones. Pre-treatment stenting is limiting stone-free rates and is significantly influencing post-ESWL morbidity and quality of life in a negative manner, while it contributes minimally to the prophylaxis of complications.

Investigation of supersonic jets shock-wave structure

NASA Astrophysics Data System (ADS)

Zapryagaev, V. I.; Gubanov, D. A.; Kavun, I. N.; Kiselev, N. P.; Kundasev, S. G.; Pivovarov, A. A.

2017-10-01

The paper presents an experimental studies overview of the free supersonic jet flow structure Ma = 1.0, Npr = 5, exhausting from a convergent profiled nozzle into a ambient space. Also was observed the jets in the presence of artificial streamwise vortices created by chevrons and microjets located on the nozzle exit. The technique of experimental investigation, schlieren-photographs and schemes of supersonic jets, and Pitot pressure distributions, are presented. A significant effect of vortex generators on the shock-wave structure of the flow is shown.

Laser-generated shockwaves enhance antibacterial activity against biofilms in vitro.

PubMed

Yao, William; Kuan, Edward C; Francis, Nathan C; St John, Maie A; Grundfest, Warren S; Taylor, Zachary D

2017-07-01

Bacterial biofilm formation within chronic wound beds, which provides an effective barrier against antibiotics, is a known cause of recalcitrant infections and a significant healthcare burden, often requiring repeated surgical debridements. Laser-generated shockwaves (LGS) is a novel, minimally invasive, and nonthermal modality for biofilm mechanical debridement which utilizes compressive stress waves, generated by photonic absorption in thin titanium films to mechanically disrupt the biofilm. Prior studies have demonstrated LGS monotherapy to be selectively efficacious for biofilm disruption and safe for host tissues. In this study, we sought to determine if LGS can enhance the antimicrobial activity and biofilm disruption capability of topical antibiotic therapy. Staphylococcus epidermidis biofilms grown in vitro on glass were treated with topical gentamicin (31, 62, and 124 μg/ml) with and without LGS (n = 3-11/treatment group). Mechanical shockwaves were generated with a 1,064 nm Nd:YAG laser (laser fluence 110.14 mJ/mm 2 , pulse duration 5 ns, spot size 3 mm). Following a 24-hour incubation period, bacterial viability was assessed by determining the number of colony-forming units (CFU) via the Miles and Misra method. Residual biofilm bioburden was analyzed using the crystal violet biofilm assay. With gentamicin monotherapy, CFU density (CFU/mm 2 ) at 31, 62, and 124 μg/ml were (282 ± 84) × 10 4 , (185 ± 34) × 10 4 , and (113 ± 9) × 10 4 , respectively. With LGS and gentamicin therapy, CFU density decreased to (170 ± 44) × 10 4 , (89 ± 24) × 10 4 , and (43 ± 3) × 10 4 , respectively (P = 0.1704, 0.0302, and 0.0004 when compared with gentamicin alone). Biofilm burden as measured by the assay in the gentamicin 31, 62, and 124 μg/ml groups was reduced by 80%, 95%, and 98% when LGS was added (P = 0.0102, >0.0001, and 0.0001 for all groups when compared with gentamicin alone

Comparative outcomes of extracorporeal shockwave therapy for shoulder tendinitis or partial tears of the rotator cuff in athletes and non-athletes: Retrospective study.

PubMed

Chou, Wen-Yi; Wang, Ching-Jen; Wu, Kuan-Ting; Yang, Ya-Ju; Cheng, Jai-Hong; Wang, Shih-Wei

2018-03-01

Refractory shoulder tendinitis or partial thickness rotator cuff tears (PTRCTs) are common findings in overhead athletes. Previous studies have examined the effectiveness of extracorporeal shockwave therapy (ESWT) for shoulder tendinitis. In the current study, we recruited 36 shoulders and performed a comparison between the professional athletes (13 shoulders, athletic group; AG) and the non-athletic population (23 shoulders, non-athletic group, NAG) with PTRCTs or shoulder tendinitis of the shoulder after ESWT. Patients with symptomatic tendinitis of the shoulder with or without a partial tear of the rotator cuff tendon and failed oral medication and physical therapy for more than 3 months were treated with electrohydraulic mode of ESWT. All patients that met the inclusion criteria were categorized into two groups according to their pre-treatment activity level. We found that NAG exhibited significant aging and degenerative change around the glenohumeral joint and subacromial space. After ESWT treatment, the patients in AG were with 53.8% high satisfaction rating and patients in NAG were 52.1% by one-year followed up. The results showed ESWT was equally effective treatment in both AG and NAG. In light of its efficacy and less-invasive nature, we suggest ESWT can be used to treat athletes with refractory tendinitis or PTRCTs before proceeding to arthroscopic intervention. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Internal Structure of Kidney Calculi as a Predictor for Shockwave Lithotripsy Success.

PubMed

Christiansen, Frederikke Eichner; Andreassen, Kim Hovgaard; Osther, Susanne Sloth; Osther, Palle Joern Sloth

2016-03-01

The internal structure of renal calculi can be determined on CT using bone windows and may be classified as homogeneous or inhomogeneous with void regions. In vitro studies have shown homogeneous stones to be less responsive to extracorporeal shockwave lithotripsy (SWL). The objective was to evaluate whether the internal morphology of calculi defined by CT bone window influences SWL outcome in vivo. One hundred eleven patients with solitary renal calculi treated with SWL were included. Treatment data were registered prospectively and follow-up data were collected retrospectively. All patients had noncontrast computed tomography (NCCT) performed before SWL and at 3-month follow-up. The stones were categorized as homogeneous or inhomogeneous. At follow-up, the patient's stone status was registered. Stone-free status was defined as no evidence of calculi on NCCT. Treatment was considered successful if the patient was either stone free or had clinically insignificant residual fragments. Using simple logistic regression, the odds for being stone free 3 months post-SWL were significantly reduced in the patients with inhomogeneous stones compared with patients with homogeneous stones (odds ratio 0.43 [95% confidence interval 0.20, 0.92; p < 0.05]). However, when adjusting for stone size by multiple logistic regression, including stone size (area) as a covariate, this difference became insignificant. The internal structure of kidney stones did not predict the outcome of SWL in vivo.

A new mathematical approach for shock-wave solution in a dusty plasma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Das, G.C.; Dwivedi, C.B.; Talukdar, M.

1997-12-01

The problem of nonlinear Burger equation in a plasma contaminated with heavy dust grains has been revisited. As discussed earlier [C. B. Dwivedi and B. P. Pandey, Phys. Plasmas {bold 2}, 9 (1995)], the Burger equation originates due to dust charge fluctuation dynamics. A new alternate mathematical approach based on a simple traveling wave formalism has been applied to find out the solution of the derived Burger equation, and the method recovers the known shock-wave solution. This technique, although having its own limitation, predicts successfully the salient features of the weak shock-wave structure in a dusty plasma with dust chargemore » fluctuation dynamics. It is emphasized that this approach of the traveling wave formalism is being applied for the first time to solve the nonlinear wave equation in plasmas. {copyright} {ital 1997 American Institute of Physics.}« less

Extracorporeal shockwave lithotripsy in infants.

PubMed

Ramakrishnan, Prem A; Medhat, Mohammed; Al-Bulushi, Younis H; Nair, Priti; Al-Kindy, Ahmed

2007-10-01

Pediatric urolithiasis is relatively uncommon and limited information is available on the application of minimally invasive management modalities in young children. We present a single centre experience with extracorporeal shockwave lithotripsy (ESWL) for infants with upper urinary tract calculi. A total of 74 infants aged 3 months to 24 months with upper urinary tract calculi were treated with ESWL under general anesthesia using the Wolf 2500 and the 2501 Piezolith lithotriptors over a 14 and a half-year period. Patient and stone characteristics, risk factors for urolithiasis, treatment parameters, clinical outcomes and long-term follow-up were assessed and recorded. The mean patient age was 14.5 (range 3 to 24) months. The mean renal stone size was 18.2 (range 7 to 32) mm while the mean ureteral stone size was 9.4 (range 5 to 14) mm. Metabolic abnormalities, structural anomalies and urinary tract infections were identified as contributory factors for stone formation in 34% of the infants. At the 3-month follow-up there was an overall successful outcome in 72 infants (97%) that included 65 (88%) who were rendered stone-free and 7 (9%) who had clinically insignificant stone fragments. Retreatment was required in 27 (35%) patients, auxiliary procedures after ESWL were needed in 5 (7%) and secondary operative procedures were required in 2 (3%). Major complications were encountered in 5 (7%) patients that included complete ureteral obstruction with sepsis in 2, partial ureteral obstruction in 1 and febrile urinary tract infection in 2 other children. Long-term follow-up was recorded in 39 infants: 8 developed recurrent stones, 2 had stone regrowth and 1 developed mild hypertension but none had significant deterioration of renal function. ESWL is an effective treatment for upper urinary tract calculi in infants. In the short-term, complications are minimal but long-term follow-up is important.

High-energy extracorporeal shock-wave therapy for treating chronic calcific tendinitis of the shoulder: a systematic review.

PubMed

Bannuru, Raveendhara R; Flavin, Nina E; Vaysbrot, Elizaveta; Harvey, William; McAlindon, Timothy

2014-04-15

Calcific and noncalcific tendinitis of the shoulder can be unresponsive to conventional therapies. Extracorporeal shock-wave therapy (ESWT) has been suggested as an alternative treatment. To assess the efficacy of ESWT in patients with calcific and noncalcific tendinitis. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Google Scholar were searched up to 1 November 2013. Randomized, controlled trials (RCTs) comparing high-energy versus low-energy ESWT or placebo for treatment of calcific or noncalcific tendinitis of the shoulder. Outcome measures included pain (visual analogue scale score), functional assessment (Constant-Murley score), and resolution of calcifications. Three independent reviewers abstracted data and determined eligibility and quality by consensus. Twenty-eight RCTs met the inclusion criteria. Studies were heterogeneous. Twenty RCTs compared ESWT energy levels and placebo and consistently showed that high-energy ESWT was significantly better than placebo in decreasing pain and improving function and resorption of calcifications in calcific tendinitis. No significant difference was found between ESWT and placebo in treatment of noncalcific tendinitis. The number of RCTs was small, and the studies were heterogeneous. High-energy ESWT is effective for improving pain and shoulder function in chronic calcific shoulder tendinitis and can result in complete resolution of calcifications. This therapy may be underutilized for a condition that can be difficult to manage. None.

[Extracorporeal shock-wave lithotripsy of gallstones].

PubMed

Freund, H R; Lebensart, P D; Muggia-Sullam, M; Durst, A L

1989-08-01

We performed 16 extracorporeal shock-wave lithotripsies (ESWL) to fragment gallstones in 11 women and 2 men, aged 19 to 57 (mean 41 +/- 10) years, during the past 10 months. Criteria for selection included a history of biliary colic, not more than 3 stones with a total diameter of not more than 30 mm, and a functioning gallbladder. 210 patients were examined, of whom 98 were referred for additional screening by combined ultrasonography and oral cholecystography. This resulted in rejection of another 71 patients due to multiple stones (38%), nonfunctioning gallbladder (22%), calcified stones (12%), stones not visualized in the prone position (9%), excessively large stones (3%) and other reasons (16%). Only 27 patients fulfilled all the criteria. Under epidural or general anesthesia (11 and 2 patients, respectively), we administered 1200-3500 (mean 2250 +/- 750) shock waves at 20-24 KV with the Tripter X1 (Direx, Israel-USA). This is an ultrasound-guided, modular portable, shock-wave generator utilizing underwater high energy spark discharge. Chenodeoxycholic or ursodeoxycholic acid, 10 mg/kg/day, was started 1 week prior to ESWL and continued for 3 months after disappearance of fragments and debris. We encountered skin petechiae in all patients, transient hematuria in 8, mild biliary colic in 1 and a small liver hematoma in 1. To date, 3 patients are free of stones, while in 7 only sludge and tiny fragments are present which we expect to disappear as a result of the litholytic therapy. 3 patients had fragments larger than 5 mm and required a second ESWL. Thus ESWL, which was indicated in only 13% of screened patients, proved to be safe and can be expected to be successful in 75% of selected candidates.

A prospective randomised double-blind placebo-controlled trial to assess the effect of diuretics on shockwave lithotripsy of calculi.

PubMed

Sabharwal, Sagar; Jeyaseelan, L; Panda, Arabind; Gnanaraj, Lionel; Kekre, Nitin S; Devasia, Antony

2017-12-01

To assess the effect of diuretics with shockwave lithotripsy (SWL) on the treatment of renal and upper ureteric calculi. Adult patients with a solitary non-obstructive radio-opaque renal or upper ureteric calculus with normal renal function were included. They were prospectively randomised to receive either SWL with placebo or SWL with diuretics (40 mg parenteral furosemide) in a double-blind manner with a sample size of 48 patients in each arm. The primary outcomes were the SWL success and failure rates. The secondary outcomes were the number of shocks and sessions. Complete fragmentation was achieved in 89.6% of the patients in the furosemide arm as compared to 81.3% in the placebo arm. Clearance was achieved in 77.1% of the patients in the furosemide arm as compared to 70.8% in the placebo arm. The number of shocks and the number of sessions were higher in the placebo arm. These differences were not statistically significant. The use of diuretics along with SWL treatment of renal and upper ureteric calculi does not show a statistically significant improvement in fragmentation or clearance.

Extracorporeal shockwave myocardial revascularization improves clinical symptoms and left ventricular function in patients with refractory angina.

PubMed

Zuozienė, Gitana; Laucevičius, Aleksandras; Leibowitz, David

2012-01-01

Medical therapy for refractory angina is limited and the prognosis is poor. Experimental data suggest that the use of extracorporeal shockwave myocardial revascularization (ESMR) can contribute to angiogenesis and improve symptoms of angina and left ventricular (LV) function. The objective of this study was to examine the effects of ESMR on clinical symptoms as well as LV function as assessed by cardiac MRI in patients with refractory angina. Patients with Canadian Cardiovascular Society (CCS) class III-IV angina despite medical therapy and ischemia documented on thallium or echo-dobutamine were eligible for the study. ESMR therapy was applied with a commercially available cardiac shockwave generator system under echocardiographic guidance. LV function was assessed before and 6 months after therapy by cardiac MRI. Twenty patients (four women, 16 men; mean age 64 years, range 45-83) were included in the study. The CCS class after treatment improved in all patients (16 patients angina pectoris CCS from III to II and four patients from IV to III). The use of sublingual nitroglycerin was significantly reduced as well. There was a significant improvement in LV ejection fraction as assessed by blinded MRI following therapy in the overall population (51 vs. 59%, P<0.05). This study demonstrates the potential efficacy of ESMR for the treatment of refractory angina pectoris. The patients showed both a significant clinical response as well as improved LV ejection fraction on serial MRI imaging. Larger studies are needed to adequately define the clinical utility of this novel therapy.

Shockwave Processing of Composite Boron and Titanium Nitride Powders

NASA Astrophysics Data System (ADS)

Beason, Matthew T.; Gunduz, I. Emre; Mukasyan, Alexander S.; Son, Steven F.

2015-06-01

Shockwave processing of powders has been shown to initiate reactions between condensed phase reactants. It has been observed that these reactions can occur at very short timescales, resulting in chemical reactions occurring at a high pressure state. These reactions have the potential to produce metastable phases. Kinetic limitations prevent gaseous reactants from being used in this type of synthesis reaction. To overcome this limitation, a solid source of gaseous reactants must be used. An example of this type of reaction is the nitrogen exchange reaction (e.g. B + TiN, B + Si3N4 etc.). In these reactions nitrogen is ``carried'' by a material that can be then reduced by the second reactant. This work explores the possibility of using nitrogen exchange reactions to synthesize the cubic phase of boron nitride (c-BN) through shockwave processing of ball milled mixtures of boron and titanium nitride. The heating from the passage of the shock wave (pore collapse, plastic work, etc.) combined with thermochemical energy from the reaction may provide a means to synthesize c-BN. This material is based upon work supported by the Department of Energy, National Nuclear Security Administration, under Award Number(s) DE-NA0002377. National Defense Science & Engineering Graduate Fellowship (NDSEG), 32 CFR 168a.

Influence of Shockwave Profile on Ejecta

NASA Astrophysics Data System (ADS)

Zellner, Michael B.; Dimonte, Guy; Germann, Timothy C.; Hammerberg, James E.; Rigg, Paulo A.; Stevens, Gerald D.; Turley, William D.; Buttler, William T.

2009-12-01

We investigate the relation between shock-pulse shape and the amount of micron-scale fragments ejected upon shock release at the metal/vacuum interface of shocked Sn targets. These micron-scale particles are commonly referred to as ejecta. Two shock-pulse shapes are considered: a supported shock created by impacting a Sn target with a sabot that was accelerated using a powder gun; and an unsupported or Taylor Shockwave, created by detonation of high explosive that was press-fit to the front-side of the Sn target. Ejecta production at the back-side or free-surface of the Sn coupons were characterized through use of piezoelectric pins, Asay foils, optical shadowgraphy, and x-ray attenuation.

Explosively driven two-shockwave tools with application to ejecta formation at the Los Alamos National Laboratory Proton Radiography Facility

NASA Astrophysics Data System (ADS)

Buttler, William

2013-06-01

We present the development of an explosively driven physics tool to generate two mostly uniaxial shockwaves. The tool is being used to extend single shockwave ejecta models to a subsequent shockwave event separated by a time interval on the order of a few microseconds. We explore the possibility of varying the amplitude of both the first and second shockwaves, and we apply the tool in experimental geometries on Sn with a surface roughness of Ra = 0 . 8 μ m. We then evaluate the tool further at the Los Alamos National Laboratory Proton Radiography (pRad) Facility in an application to Sn with larger scale perturbations of wavelength 550 μ m, and various amplitudes that gave wave-number amplitude products of η0 2 π / λ = { 3 / 4 , 1 / 2 , 1 / 4 , 1 / 8 } , where the perturbation amplitude is η0, and the wave-number k = 2 π / λ . The pRad data and velocimetry imply it should be possible to develop a second shock ejecta model based on unstable Richtmyer-Meshkov physics. In collaboration with David Oro, Fesseha Mariam, Alexander Saunders, Malcolm Andrews, Frank Cherne, James Hammerberg. Robert Hixson, Christopher Morris, Russell Olson, Dean Preston, Joseph Stone, Dale Tupa, and Wendy Vogan-McNeil, Los Alamos National Laboratory,

Dynamics of plasma expansion and shockwave formation in femtosecond laser-ablated aluminum plumes in argon gas at atmospheric pressures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miloshevsky, Alexander; Harilal, Sivanandan S.; Miloshevsky, Gennady, E-mail: gennady@purdue.edu

2014-04-15

Plasma expansion with shockwave formation during laser ablation of materials in a background gasses is a complex process. The spatial and temporal evolution of pressure, temperature, density, and velocity fields is needed for its complete understanding. We have studied the expansion of femtosecond (fs) laser-ablated aluminum (Al) plumes in Argon (Ar) gas at 0.5 and 1 atmosphere (atm). The expansion of the plume is investigated experimentally using shadowgraphy and fast-gated imaging. The computational fluid dynamics (CFD) modeling is also carried out. The position of the shock front measured by shadowgraphy and fast-gated imaging is then compared to that obtained frommore » the CFD modeling. The results from the three methods are found to be in good agreement, especially during the initial stage of plasma expansion. The computed time- and space-resolved fields of gas-dynamic parameters have provided valuable insights into the dynamics of plasma expansion and shockwave formation in fs-pulse ablated Al plumes in Ar gas at 0.5 and 1 atm. These results are compared to our previous data on nanosecond (ns) laser ablation of Al [S. S. Harilal et al., Phys. Plasmas 19, 083504 (2012)]. It is observed that both fs and ns plumes acquire a nearly spherical shape at the end of expansion in Ar gas at 1 atm. However, due to significantly lower pulse energy of the fs laser (5 mJ) compared to pulse energy of the ns laser (100 mJ) used in our studies, the values of pressure, temperature, mass density, and velocity are found to be smaller in the fs laser plume, and their time evolution occurs much faster on the same time scale. The oscillatory shock waves clearly visible in the ns plume are not observed in the internal region of the fs plume. These experimental and computational results provide a quantitative understanding of plasma expansion and shockwave formation in fs-pulse and ns-pulse laser ablated Al plumes in an ambient gas at atmospheric pressures.« less

Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis.

PubMed

Venzin, C; Ohlerth, S; Koch, D; Spreng, D

2004-03-01

A 15-month-old, spayed female, Bernese mountain dog was presented to the Institute of Small Animal Surgery at the University of Zurich because of chronic left forelimb lameness. The referring veterinarian diagnosed pain in the left shoulder region and had treated the dog with systemic non-steroidal anti-inflammatory drugs and restricted exercise for a two-week period. The follow-up examination revealed only minimal improvement and therefore, the dog was referred for further diagnostic evaluation. Chronic bicipital tenosynovitis and tendinitis of the infraspinatus muscle was diagnosed based on survey radiographs, arthrography, ultrasound, computed tomography (CT), and synovial fluid cytology. The dog underwent three sessions of extracorporeal shockwave therapy and substantial clinical improvement was observed. On follow-up examinations, only mild left forelimb lameness was evident following exercise, and changes in the intertubercular groove and at the supraglenoid tuberosity appeared less active on radiographs and CT. However, six months following treatment, mild degenerative joint disease was apparent.

Complications of extracorporeal shockwave therapy in plantar fasciitis: Systematic review.

PubMed

Roerdink, R L; Dietvorst, M; van der Zwaard, B; van der Worp, H; Zwerver, J

2017-10-01

Extracorporeal shockwave therapy (ESWT) seems to be an effective treatment for plantar fasciitis (PF) and is assumed to be safe. No systematic reviews have been published that specifically studied the complications and side effects of ESWT in treating PF. Aim of this systematic review is therefore to evaluate the complications and side effects of ESWT in order to determine whether ESWT is a safe treatment for PF. For this systematic review the databases PubMed, MEDLINE, Cochrane and Embase were used to search for relevant literature between 1 January 2005 and 1 January 2017. PRISMA guidelines were followed. Thirty-nine studies were included for this review, representing 2493 patients (2697 heels) who received between 6424 and 6497 ESWT treatment sessions, with an energy flux density between 0.01 mJ/mm 2 and 0.64 mJ/mm 2 and a frequency of 1000-3800 SWs. Average follow-up was 14.7 months (range: 24 h - 6 years). Two complications occurred: precordial pain and a superficial skin infection after regional anaesthesia. Accordingly, 225 patients reported pain during treatment and 247 reported transient red skin after treatment. Transient pain after treatment, dysesthesia, swelling, ecchymosis and/or petechiae, severe headache, bruising and a throbbing sensation were also reported. ESWT is likely a safe treatment for PF. No complications are expected at one-year follow-up. However, according to the current literature long-term complications are unknown. Better descriptions of treatment protocols, patient characteristics and registration of complications and side effects, especially pain during treatment, are recommended. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Treatment of Chronic Plantar Fasciitis with Noninvasive Interactive Neurostimulation: A Prospective Randomized Controlled Study.

PubMed

Razzano, Cristina; Carbone, Stefano; Mangone, Massimiliano; Iannotta, M Raffaella; Battaglia, Alessandro; Santilli, Valter

The initial treatment of plantar fasciitis should be conservative, with most cases responding to standard physiotherapy, nonsteroidal anti-inflammatory drugs (NSAIDs), heel pads, and stretching. In cases of chronic refractory symptoms, more invasive treatment could be necessary. Noninvasive interactive neurostimulation (NIN) is a form of electric therapy that works by locating areas of lower skin impedance. The objective of the present prospective randomized controlled study was to evaluate whether the use of NIN for chronic plantar fasciitis could result in greater improvement in a foot functional score, lower levels of reported pain, reduced patient consumption of NSAIDs, and greater patient satisfaction compared with electric shockwave therapy in patients without a response to standard conservative treatment. The patients were randomized using random blocks to the NIN program (group 1) or electric shockwave therapy (group 2). The outcome measurements were the pain subscale of the validated Foot Function Index (PS-FFI), patient-reported subjective assessment of the level of pain using a standard visual analog scale, and daily intake of NSAID tablets (etoricoxib 60 mg). The study group was evaluated at baseline (time 0), week 4 (time 1), and week 12 (final follow-up point). Group 1 (55 patients) experienced significantly better results compared with group 2 (49 patients) in term of the PS-FFI score, visual analog scale score, and daily intake of etoricoxib 60 mg. NIN was an effective treatment of chronic resistant plantar fasciitis, with full patient satisfaction in >90% of cases. The present prospective randomized controlled study showed superior results for noninvasive neurostimulation compared with electric shockwave therapy, in terms of the functional score, pain improvement, and use of NSAIDs. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Shock-induced collapse of a gas bubble in shockwave lithotripsy.

PubMed

Johnsen, Eric; Colonius, Tim

2008-10-01

The shock-induced collapse of a pre-existing nucleus near a solid surface in the focal region of a lithotripter is investigated. The entire flow field of the collapse of a single gas bubble subjected to a lithotripter pulse is simulated using a high-order accurate shock- and interface-capturing scheme, and the wall pressure is considered as an indication of potential damage. Results from the computations show the same qualitative behavior as that observed in experiments: a re-entrant jet forms in the direction of propagation of the pulse and penetrates the bubble during collapse, ultimately hitting the distal side and generating a water-hammer shock. As a result of the propagation of this wave, wall pressures on the order of 1 GPa may be achieved for bubbles collapsing close to the wall. The wall pressure decreases with initial stand-off distance and pulse width and increases with pulse amplitude. For the stand-off distances considered in the present work, the wall pressure due to bubble collapse is larger than that due to the incoming shockwave; the region over which this holds may extend to ten initial radii. The present results indicate that shock-induced collapse is a mechanism with high potential for damage in shockwave lithotripsy.

Shock-induced collapse of a gas bubble in shockwave lithotripsy

PubMed Central

Johnsen, Eric; Colonius, Tim

2008-01-01

The shock-induced collapse of a pre-existing nucleus near a solid surface in the focal region of a lithotripter is investigated. The entire flow field of the collapse of a single gas bubble subjected to a lithotripter pulse is simulated using a high-order accurate shock- and interface-capturing scheme, and the wall pressure is considered as an indication of potential damage. Results from the computations show the same qualitative behavior as that observed in experiments: a re-entrant jet forms in the direction of propagation of the pulse and penetrates the bubble during collapse, ultimately hitting the distal side and generating a water-hammer shock. As a result of the propagation of this wave, wall pressures on the order of 1 GPa may be achieved for bubbles collapsing close to the wall. The wall pressure decreases with initial stand-off distance and pulse width and increases with pulse amplitude. For the stand-off distances considered in the present work, the wall pressure due to bubble collapse is larger than that due to the incoming shockwave; the region over which this holds may extend to ten initial radii. The present results indicate that shock-induced collapse is a mechanism with high potential for damage in shockwave lithotripsy. PMID:19062841

Simulation of shock-induced bubble collapse with application to vascular injury in shockwave lithotripsy

NASA Astrophysics Data System (ADS)

Coralic, Vedran

Shockwave lithotripsy is a noninvasive medical procedure wherein shockwaves are repeatedly focused at the location of kidney stones in order to pulverize them. Stone comminution is thought to be the product of two mechanisms: the propagation of stress waves within the stone and cavitation erosion. However, the latter mechanism has also been implicated in vascular injury. In the present work, shock-induced bubble collapse is studied in order to understand the role that it might play in inducing vascular injury. A high-order accurate, shock- and interface-capturing numerical scheme is developed to simulate the three-dimensional collapse of the bubble in both the free-field and inside a vessel phantom. The primary contributions of the numerical study are the characterization of the shock-bubble and shock-bubble-vessel interactions across a large parameter space that includes clinical shockwave lithotripsy pressure amplitudes, problem geometry and tissue viscoelasticity, and the subsequent correlation of these interactions to vascular injury. Specifically, measurements of the vessel wall pressures and displacements, as well as the finite strains in the fluid surrounding the bubble, are utilized with available experiments in tissue to evaluate damage potential. Estimates are made of the smallest injurious bubbles in the microvasculature during both the collapse and jetting phases of the bubble's life cycle. The present results suggest that bubbles larger than one micrometer in diameter could rupture blood vessels under clinical SWL conditions.

New sonic shockwave multi-element sensors mounted on a small airfoil flown on F-15B testbed aircraft

NASA Technical Reports Server (NTRS)

1996-01-01

An experimental device to pinpoint the location of a shockwave that develops in an aircraft flying at transonic and supersonic speeds was recently flight-tested at NASA's Dryden Flight Research Center, Edwards, California. The shock location sensor, developed by TAO Systems, Hampton, Va., utilizes a multi-element hot-film sensor array along with a constant-voltage anemometer and special diagnostic software to pinpoint the exact location of the shockwave and its characteristics as it develops on an aircraft surface. For this experiment, the 45-element sensor was mounted on the small Dryden-designed airfoil shown in this illustration. The airfoil was attached to the Flight Test Fixture mounted underneath the fuselage of Dryden's F-15B testbed aircraft. Tests were flown at transonic speeds of Mach 0.7 to 0.9, and the device isolated the location of the shock wave to within a half-inch. Application of this technology could assist designers of future supersonic aircraft in improving the efficiency of engine air inlets by controlling the shockwave, with a related improvement in aircraft performance and fuel economy.

Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model.

PubMed

Qiu, Xuefeng; Lin, Guiting; Xin, Zhongcheng; Ferretti, Ludovic; Zhang, Haiyang; Lue, Tom F; Lin, Ching-Shwun

2013-03-01

Introduction.  Low-energy shockwave therapy (LESWT) has been shown to improve erectile function in patients suffering from diabetes mellitus (DM)-associated erectile dysfunction (ED). However, the underlying mechanism remains unknown. Aim.  The aim of this study is to investigate whether LESWT can ameliorate DM-associated ED in a rat model and examine the associated changes in the erectile tissues. Methods.  Newborn male rats were intraperitoneally injected with 5-ethynyl-2-deoxyuridine (EdU; 50 mg/kg) for the purpose of tracking endogenous mesenchymal stem cells (MSCs). Eight weeks later, eight of these rats were randomly chosen to serve as normal control (N group). The remaining rats were injected intraperitoneally with 60 mg/kg of streptozotocin (STZ) to induce DM. Eight of these rats were randomly chosen to serve as DM control (DM group), whereas another eight rats were subject to shockwave (SW) treatment (DM+SW group). Each rat in the DM+SW group received 300 shocks at energy level of 0.1 mJ/mm(2) and frequency of 120/minute. This procedure was repeated three times a week for 2 weeks. Another 2 weeks later, all 24 rats were evaluated for erectile function by intracavernous pressure (ICP) measurement. Afterward, their penile tissues were examined by histology. Main Outcome Measures.  Erectile function was measured by ICP. Neuronal nitric oxide synthase (nNOS)-positive nerves and the endothelium were examined by immunofluorescence staining. Smooth muscle and MSCs were examined by phalloidin and EdU staining, respectively. Results.  STZ treatment caused a significant decrease in erectile function and in the number of nNOS-positive nerves and in endothelial and smooth muscle contents. These DM-associated deficits were all partially but significantly reversed by LESWT. MSCs (EdU-positive cells) were significantly more numerous in DM+SW than in DM rats. Conclusion.  LESWT can partially ameliorate DM-associated ED by promoting regeneration of n

Are We Banging Our Heads Against the Wall? The Effect of Treatment Head Wear on the Outcomes of Extracorporeal Shockwave Lithotripsy.

PubMed

Hoy, Nathan Y; Shapka, Larissa; Rudzinski, Jan; Schuler, Trevor D; Wollin, Timothy A; Bochinski, Derek; De, Shubha K

2016-09-01

The manufacturer for the Storz Modulith SLX-F2 lithotripter recommends treatment head exchange after 1.65 million shocks. However, there is no documentation describing longevity of the treatment head with continued usage. The objective of this study is to determine whether there is a difference in stone fragmentation effectiveness with the treatment head at the beginning versus the end of its treatment life. We conducted a retrospective chart review of 200 patients-50 consecutive patients treated immediately preceding, and following, two separate treatment head exchanges. Primary outcome measures were stone-free rate (no stone), total stone fragmentation (any decrease in size), and fragmentation rate ≤4 mm (decrease in size with largest residual fragment ≤4 mm), based on most recent follow-up imaging post shockwave. There were no baseline characteristic differences between the pre-exchange and postexchange groups with respect to first time lithotripsy for the stone (85% vs. 77%), stone location, preoperative stenting (3% vs. 4%), mean stone density (912 hounsfield units [HU] vs. 840 HU), mean stone size (9.0 mm vs. 8.1 mm), stone location, and mean number of shocks delivered (3105 vs. 3089). Mean time to follow-up was 2.7 weeks in both groups, with most follow-up imaging consisting of a kidney ureter bladder X-ray (87% pre-exchange vs. 85% postexchange). Stone free (34% vs. 27%), total stone fragmentation (76% vs. 76%), fragmentation ≤4 mm (48% vs. 42%), re-treatment rates (38% vs. 51%), and complication rates (6% vs. 7%), were not statistically different between the pre and postexchange groups, respectively. Exchanging the Storz Modulith F2 lithotripter head at the manufacturer recommended 1.65 million shocks does not affect the stone-free or fragmentation rate. If the manufacturer's recommendation for treatment head longevity is based on clinical outcomes, then there is likely room to extend this number without affecting treatment efficacy.

Approaches to optimize focused extracorporeal shockwave therapy (ESWT) based on an observational study of 363 feet with recalcitrant plantar fasciitis.

PubMed

Scheuer, R; Friedrich, M; Hahne, J; Holzapfel, J; Machacek, P; Ogon, M; Pallamar, M

2016-03-01

Extracorporeal shockwave therapy (ESWT) is an established second-line treatment option for plantar fasciitis. Longer term results of focused ESWT are rare in literature. This study assessed the treatment success-rates of single session ESWT compared to repetitive ESWT treatment sessions, the mid-term results as well as treatment- or patient-related factors influencing the outcome of focused ESWT for plantar fasciitis. 284 patients (363 feet) received ESWT for plantar fasciitis and answered a questionnaire on socio-demographic and anamnestic data immediately before as well as 19-77 weeks after the first application of ESWT. 76 percent of patients treated only once and 74 percent of all patients reported satisfying pain relief (with up to three treatment sessions). This was consistent in the mid-term and over different physicians as well as independent of assessed patient- or treatment-related factors. Applying repeated ESWT in weekly intervals by default may be helpful in reducing healing time for those patients requiring more than one treatment session. Prospective research is needed to find out whether further treatment sessions are justifiable in patients who indicate no improvement after two or three treatment sessions. In many cases, focused ESWT needs to be applied only once. Further research should focus on the number of treatment sessions as well as the minimum energy flux density needed. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

In Situ Activation of Penile Progenitor Cells With Low-Intensity Extracorporeal Shockwave Therapy.

PubMed

Lin, Guiting; Reed-Maldonado, Amanda B; Wang, Bohan; Lee, Yung-Chin; Zhou, Jun; Lu, Zhihua; Wang, Guifang; Banie, Lia; Lue, Tom F

2017-04-01

decreased number and quality of penile stem or progenitor cells associated with aging. Li-ESWT activation of local penile progenitor cells might be one of the mechanisms that contribute to the beneficial effects of shockwave treatment for erectile dysfunction, which represents a non-invasive alternative to exogenous stem cell therapy. Lin G, Reed-Maldonado AB, Wang B, et al. In Situ Activation of Penile Progenitor Cells With Low-Intensity Extracorporeal Shockwave Therapy. J Sex Med 2017;14:493-501. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Extracorporeal shockwave therapy on muscle tissue: the effects on healthy athletes.

PubMed

Notarnicola, A; Covelli, I; Maccagnano, G; Marvulli, R; Mastromauro, L; Ianieri, G; Boodhoo, S; Turitto, A; Petruzzella, L; Farì, G; Bianchi, F P; Tafuri, S; Moretti, B

2018-01-01

The aim of this study is to investigate the effects of extracorporeal shock wave therapy (ESWT) on muscle rheological and functional properties in a population of young athletes. Thirty-two football and basketball players were recruited and randomized into two groups. The athletes underwent three sessions of therapy administered every five days to the thigh muscles. The treatment consisted of ESWT (electromagnetic generator, Energy Flux Density=0.03 mJ/mm2) or a placebo treatment bilaterally on the quadricep and femoral bicep muscles. Monitoring was carried out at recruitment (T0), at the end of treatment (15 days, T1) and at 30 days (T2) with myometric evaluation (measuring elasticity, stiffness and muscular tone) and electromiography exam (recording the Motor Unit Amplitude Potential values). The results showed a significant increase in the treated athletes in the elasticity (lateral vastus muscle, p=0.007), in muscular tone (femoral rectus, p=0.031) and in muscular recruitment (the lateral vastus, p<0.005; medial vastus muscle, p=0.055). These results could represent a translational interpretation of the known biological effect on connective tissue: an increase in blood flow, oxygenation, metabolic process activation and proliferative effect. The effects found may represent the justification for verifying the usefulness of using of shockwave therapy to reduce muscular fatigue and improve performance during the sport season.

Impact of ablator thickness and laser drive duration on a platform for supersonic, shockwave-driven hydrodynamic instability experiments

DOE PAGES

Wan, W. C.; Malamud, Guy; Shimony, A.; ...

2016-12-07

Here, we discuss changes to a target design that improved the quality and consistency of data obtained through a novel experimental platform that enables the study of hydrodynamic instabilities in a compressible regime. The experiment uses a laser to drive steady, supersonic shockwave over well-characterized initial perturbations. Early experiments were adversely affected by inadequate experimental timescales and, potentially, an unintended secondary shockwave. These issues were addressed by extending the 4 x 10 13 W/cm 2 laser pulse from 19 ns to 28 ns, and increasing the ablator thickness from 185 µm to 500 µm. We present data demonstrating the performancemore » of the platform.« less

Impact of ablator thickness and laser drive duration on a platform for supersonic, shockwave-driven hydrodynamic instability experiments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wan, W. C.; Malamud, Guy; Shimony, A.

Here, we discuss changes to a target design that improved the quality and consistency of data obtained through a novel experimental platform that enables the study of hydrodynamic instabilities in a compressible regime. The experiment uses a laser to drive steady, supersonic shockwave over well-characterized initial perturbations. Early experiments were adversely affected by inadequate experimental timescales and, potentially, an unintended secondary shockwave. These issues were addressed by extending the 4 x 10 13 W/cm 2 laser pulse from 19 ns to 28 ns, and increasing the ablator thickness from 185 µm to 500 µm. We present data demonstrating the performancemore » of the platform.« less

High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff: a randomised trial.

PubMed

Albert, J-D; Meadeb, J; Guggenbuhl, P; Marin, F; Benkalfate, T; Thomazeau, H; Chalès, G

2007-03-01

In a prospective randomised trial of calcifying tendinitis of the rotator cuff, we compared the efficacy of dual treatment sessions delivering 2500 extracorporeal shock waves at either high- or low-energy, via an electromagnetic generator under fluoroscopic guidance. Patients were eligible for the study if they had more than a three-month history of calcifying tendinitis of the rotator cuff, with calcification measuring 10 mm or more in maximum dimension. The primary outcome measure was the change in the Constant and Murley Score. A total of 80 patients were enrolled (40 in each group), and were re-evaluated at a mean of 110 (41 to 255) days after treatment when the increase in Constant and Murley score was significantly greater (t-test, p = 0.026) in the high-energy treatment group than in the low-energy group. The improvement from the baseline level was significant in the high-energy group, with a mean gain of 12.5 (-20.7 to 47.5) points (p < 0.0001). The improvement was not significant in the low-energy group. Total or subtotal resorption of the calcification occurred in six patients (15%) in the high-energy group and in two patients (5%) in the low-energy group. High-energy shock-wave therapy significantly improves symptoms in refractory calcifying tendinitis of the shoulder after three months of follow-up, but the calcific deposit remains unchanged in size in the majority of patients.

A meta-analysis of the effects of shockwave and high pressure processing on color and cook loss of fresh meat.

PubMed

Ha, Minh; Dunshea, Frank R; Warner, Robyn D

2017-10-01

Meta-analysis is a statistical approach for investigating experimental differences across studies. Meta-analyses were performed to examine the effects of hydrodynamic processing (shockwave; n=12 papers) and high pressure processing (HPP; n=8 papers) on the color and cook loss of fresh meat. Shockwave did not affect color (L*, a*), whereas cook loss was increased by 0.6% relative to untreated meat. HPP resulted in an increase in lightness (L*) and a decrease in redness (a*), with the effect being greater at higher pressures (>300MPa vs <300MPa). In addition, HPP applied at moderate pressure (<300MPa) reduced cook loss but at high pressure (>300MPa) the cook loss was increased (-1.5% vs 3.0% respectively). The increased cook loss with shockwave and high pressure (>300MPa) processing needs to be balanced against benefits in texture if this technology is applied to meat. The reduced cook loss of meat treated at moderate pressures (<300MPa) is an advantage which would likely improve sensory traits. Copyright © 2017 Elsevier Ltd. All rights reserved.

Tension of Liquids by Shockwaves

NASA Astrophysics Data System (ADS)

Utkin, A. V.; Sosikov, V. A.

2009-12-01

Experimental investigations of dynamic tension of liquids (water, ethanol, glycerol, hexane, hexadecane, pentadecane, and transformer oil) under shock waves have been made. The method of spall strength measurements was applied and wave profiles were registered by laser interferometer VISAR. It was found that negative pressures in liquids were almost independent from the value of stain rate when the temperature was far from melting point. But near the melting point the spall strength of water, hexadecane, pentadecane, and glycerol is a strong function of strain rate and shock-wave amplitude. The process of cavitation in hexadecane and methanol is double-staged. At the first stage formation of cavities starts, and a kinked of free velocity profile is observed. At the second stage the cavity growth rate increases and the spall-pulse occurs. The theory of homogeneous bubble nucleation was used to explain the experimental results. It was observed for water that spall-pulse amplitude may be higher than the shock wave amplitude. To explain this phenomenon the model of failure kinetics, taking into account the inertial bubbles growth, has been proposed.

Extracorporeal Shockwave Lithotripsy Monotherapy is not Adequate for Management of Staghorn Renal Calculi.

PubMed

Koko, Abdelmoniem K; Onuora, Vincent C; Al Turki, Mohammed A; Mesbed, Ahmed H; Al Jawini, Nasser A

2003-01-01

Between 1990 and 1999 a total of 186 patients with staghorn renal stones were treated in our unit. Of them, 76 patients were managed by extra-corporeal shockwave lithotripsy (ESWL) alone using a third generation Siemen's Lithostar Plus lithotriptor. Sixty-one of these patients who completed a follow-up of 41 months formed the subjects of this study. ESWL was done after routine stenting of the affected side in all cases except one. The mean number of ESWL sessions was 5.2, delivering an average 15,940 shocks per patient. The average hospital stay was 21.68 days and the duration of the treatment was 1-41 months (mean 6.75 months). Significant complications occurred in 35 patients (57.4%) eight of whom sustained multiple significant complications. A total of 162 auxiliary procedures were used in conjunction with ESWL and in the management of complications. The stone free rate at three months was 18%, but rose by the end of the treatment period (41 months) to 63.9%. Our study indicates that ESWL monotherapy is associated with high morbidity rates, high rates of unplanned invasive procedures as well as prolonged treatment periods and hospitalization. Thus, ESWL monotherapy is not adequate for the management of staghorn calculi.

Laser-induced shock-wave lithotripsy of canine urocystoliths and nephroliths

NASA Astrophysics Data System (ADS)

Woods, J. P.; Bartels, Kenneth E.; Stair, Ernest L.; Schafer, Steven A.; Nordquist, Robert E.

1997-05-01

Urolithiasis is a common disease affecting dogs which can sometimes be treated with dietary and medical protocols. In many cases, however, medical management cannot be employed because the dietary restrictions are contraindicated, effective medical dissolution protocols for the calculi (uroliths) do not exist, or obstruction by the calculi may result in deterioration of renal function during the time required for medical dissolution. At present, the management of medically untreatable calculi has been surgical removal which may result in temporary but dramatic decrease in renal function, irreversible loss of damaged nephrons, and significant risk, particularly for bilateral or recurrent nephroliths. An innovative technique for the removal of these uroliths would involve laser lithotripsy which transforms light energy into acoustical energy generating a shock wave sufficient to fragment stones (photoacoustic ablation). The laser is transmitted via quartz fibers which are small and flexible and can be used under direct vision through endoscopes resulting in effective fragmentation with little surrounding tissue damage. Lasers are becoming increasingly more utilized in veterinary medicine, in contrast to the limited availability of other non-invasive methods of treatment of nephroliths (i.e. extracorporeal shock-wave lithotripsy).

Low-Intensity Extracorporeal Shockwave Therapy Can Improve Erectile Function in Patients Who Failed to Respond to Phosphodiesterase Type 5 Inhibitors

PubMed Central

Tsai, Chia-Chun; Wang, Chii-Jye; Lee, Yung-Chin; Kuo, Yen-Ting; Lin, Hsiao-Hua; Li, Ching-Chia; Wu, Wen-Jeng; Liu, Chia-Chu

2017-01-01

Managing patients with erectile dysfunction (ED) who failed to respond to phosphodiesterase type 5 inhibitors (PDE5is) is a challenging task. Recently, low-intensity extracorporeal shockwave therapy (LI-ESWT) was reported to improve ED by enhancing perfusion of the penis. The current study was performed to evaluate whether combined treatment with LI-ESWT and PDE5is can restore erectile function in patients who failed to respond to PDE5is alone. This was an open-label single-arm prospective study. ED patients with an erection hardness score (EHS) ≦2 under a maximal dosage of PDE5is were enrolled. Sociodemographic information and detailed medical history were recorded. LI-ESWT treatment consisted of 3,000 shockwaves once weekly for 12 weeks. All patients continued their regular PDE5is use. The EHS and the 5-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate the change in erectile function 1 and 3 months after LI-ESWT. A total of 52 patients were enrolled. After LI-ESWT treatment, 35 of the 52 patients (67.3%) could achieve an erection hard enough for intercourse (EHS ≧ 3) under PDE5is use at the 1-month follow-up. Initial severity of ED was the only significant predictor of a successful response (EHS1: 35.7% vs. EHS2: 78.9%, p = .005). Thirty-three of the 35 (94.3%) subjects who responded to LI-ESWT could still maintain their erectile function at the 3-month follow-up. LI-ESWT can serve as a salvage therapy for ED patients who failed to respond to PDE5is. Initial severity of ED was an important predictor of a successful response. PMID:28884638

Generation of cylindrically convergent shockwaves in water on the MACH facility

NASA Astrophysics Data System (ADS)

Bland, Simon; Krasik, Ya. E.; Yanuka, D.; Gardner, R.; MacDonald, J.; Virozub, A.; Efimov, S.; Gleizer, S.; Chaturvedi, N.

2017-06-01

We report on the first experiments utilizing MACH facility at Imperial College London to explode copper wire arrays in water, generating extremely symmetric, cylindrical convergent shockwaves. The experiments were carried out with 10mm diameter arrays consisting of 60 × 130 μm wires, and currents >500 kA were achieved despite the high inductance load. Laser backlit framing images and streak photography of the implosion showed a highly uniform, stable shockwave that travelled towards the axis at velocities up to 7.5 kms-1. For the first time, imaging of the shock front has been carried at radii < 0.5 mm, and there is strong evidence that even at radii < 0.1 mm the shock front remains stable, resulting in a convergence ratio of 50:1. 2D hydrodynamic simulations that match the experimentally obtained implosion trajectory suggest pressures of >1 Mbar are produced within 10 μm of the axis, with water densities 3 gcm-3 and temperatures of many 1000 s of Kelvin. The results represent a significant step in the application of the technique to drive different material samples, and calculations of scaling the technique to larger pulsed power facilities are presented. This work was supported by the Institute of Shock Physics, funded by AWE Aldermaston, and the NNSA under DOE Cooperative Agreement Nos. DE-F03-02NA00057 and DE-SC-0001063.

Comparison of hydrodynamic simulations with two-shockwave drive target experiments

NASA Astrophysics Data System (ADS)

Karkhanis, Varad; Ramaprabhu, Praveen; Buttler, William

2015-11-01

We consider hydrodynamic continuum simulations to mimic ejecta generation in two-shockwave target experiments, where metallic surface is loaded by two successive shock waves. Time of second shock in simulations is determined to match experimental amplitudes at the arrival of the second shock. The negative Atwood number (A --> - 1) of ejecta simulations leads to two successive phase inversions of the interface corresponding to the passage of the shocks from heavy to light media in each instance. Metallic phase of ejecta (solid/liquid) depends on shock loading pressure in the experiment, and we find that hydrodynamic simulations quantify the liquid phase ejecta physics with a fair degree of accuracy, where RM instability is not suppressed by the strength effect. In particular, we find that our results of free surface velocity, maximum ejecta velocity, and maximum ejecta areal density are in excellent agreement with their experimental counterparts, as well as ejecta models. We also comment on the parametric space for hydrodynamic simulations in which they can be used to compare with the target experiments.

Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain.

PubMed

Rompe, Jan D; Furia, John; Cacchio, Angelo; Schmitz, Christoph; Maffulli, Nicola

2015-12-01

Whether shock wave therapy or shock wave therapy combined with plantar fascia-specific stretching is more efficient in treating chronic plantar heel pain remains unclear. The aim of the study was to test the null hypothesis of no difference of these two forms of management for patients who had unilateral plantar fasciopathy for a minimum duration of twelve months and which had failed at least three other forms of treatment. One hundred and fifty-two patients with chronic plantar fasciopathy were assigned to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group 1, n = 73) or to receive the identical shock wave treatment and to perform an eight-week plantar fascia-specific stretching program (Group 2, n = 79). All patients completed the nine-item pain subscale of the validated Foot Function Index and a subject-relevant outcome questionnaire. Patients were evaluated at baseline, and at two, four, and twenty-four months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first steps of walking in the morning) on this Index, and satisfaction with treatment. No difference in mean age, sex, weight or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with shock-wave therapy plus plantar fascia-specific stretching than those managed with shock-wave therapy alone (p < 0.001), as well as individually for item 2 (p < 0.001). Twenty-four patients in Group 1 (32%) versus forty-seven patients in Group 2 (59%) were satisfied with the treatment (p < 0.001). Significant differences persisted at four months, but not at twenty-four months. A program of manual stretching exercises specific to the plantar fascia in combination with repetitive low-energy radial

Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial.

PubMed

Kolk, A; Yang, K G Auw; Tamminga, R; van der Hoeven, H

2013-11-01

The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were randomly allocated to a treatment group who received low-dose rESWT (three sessions at an interval 10 to 14 days, 2000 pulses, 0.11 mJ/mm(2), 8 Hz) or to a placebo group, with a follow-up of six months. The patients and the treating orthopaedic surgeon, who were both blinded to the treatment, evaluated the results. A total of 44 patients were allocated to the rESWT group and 38 patients to the placebo group. A visual analogue scale (VAS) score for pain, a Constant-Murley (CMS) score and a simple shoulder test (SST) score significantly improved in both groups at three and six months compared with baseline (all p ≤ 0.012). The mean VAS was similar in both groups at three (p = 0.43) and six months (p = 0.262). Also, the mean CMS and SST scores were similar in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or improve function in patients chronic rotator cuff tendinitis compared with placebo treatment.

Shock-Wave Pulse Compression and Stretching of Dodecane and Mineral Oils

NASA Astrophysics Data System (ADS)

Bannikova, I. A.; Zubareva, A. N.; Utkin, A. V.

2018-04-01

The behavior of dodecane, vacuum, and transformer oils under shock-wave pulse compression and stretching are studied experimentally. The wave profiles are registered using a VISAR laser interferometer. The shock adiabats, the dependence of the sound velocity on the pressure, and the maximum negative pressures developed in the studied liquids are determined. It is shown that the negative pressure value does not depend on the deformation rate in the case of oils and is a strong function of the compression pulse amplitude in the case of dodecane.

Single center, single operator comparative study of the effectiveness of electrohydraulic and electromagnetic lithotripters in the management of 10- to 20-mm single upper urinary tract calculi.

PubMed

Jamshaid, Anila; Ather, M Hammad; Hussain, Ghazi; Khawaja, Karim B

2008-11-01

This study compared the efficacy and safety profile of electrohydraulic (EH) and electromagnetic (EM) lithotriptors in the treatment of 10- to 20-mm renal and proximal ureteric stones at a single center and by a single operator. Between January 2001 and December 2006, we sequentially treated patients meeting study inclusion criteria with MPL 9000 Dornier EH for the first 3 years, followed by the EM Siemens Modularis shockwave lithotripsy (SWL) unit. A single operator performed all SWL treatments under the supervision of an admitting urologist. We analyzed the demographic features and stone- and treatment-related parameters including complications for both groups. In each group, the stone-free rate and efficiency quotient was determined at 1-3 months. Of 274 patients, we sequentially treated 112 using the EH lithotriptor, and 162 the EM lithotriptor. The pre-SWL patients and stone-related parameters were similar in the two groups, except for diagnostic imaging modalities. The mean number of SWL sessions, need for ancillary procedure, retreatment rate, stone location, stone-free rate, and efficiency quotient were not significantly different between groups. The mean number of shockwaves required for complete fragmentation was 2977 and 6044 (P < .000) for the EH and EM groups, respectively. Single center, single operator experience with two types of lithotriptor indicated that both are equally efficacious, with similar safety profiles. The only significant difference was that the EH lithotriptor required fewer shockwaves for fragmentation.

[Design of a multicenter study for assessing the effectiveness of extracorporeal shockwave therapy in epicondylitis humeri radialis].

PubMed

Haake, M; Jensen, K; Prinz, H; Willenberg, T

2000-01-01

Previously published studies concerning, extracorporeal shock-wave therapy (ESWT) in the treatment of lateral epicondylitis do not fulfil the biometric standards of modern clinical research. The objective of the trial is to show that ESWT is effective in the treatment of chronic LE. A prospective, randomized, placebo-controlled, single-blinded, multicenter trial with an independent blinded observer was designed. The effectiveness of ESWT is evaluated by comparison with a control group in which sham-ESWT is performed, both under local anaesthesia. Outcome is determined on the basis of the Roles/Maudsley-Score. Inclusion criteria are a history of at least 6 months of LE and failure of conventional treatment. The therapy includes 3 sessions of low energy ESWT with 2000 impulses (energy flux density 0.07-0.09 mJ/mm2). Sample size is 272 patients. Randomisation started in October 1998 and is planned over a period of two and a half years. Only a randomised clinical trial with adequate control of placebo effects and observer bias can provide the required evidence for the efficiency of ESWT in the treatment of lateral epicondylitis of the elbow.

Percutaneous nephrolithotomy vs. extracorporeal shockwave lithotripsy for treating a 20-30 mm single renal pelvic stone.

PubMed

Hassan, Mohammed; El-Nahas, Ahmed R; Sheir, Khaled Z; El-Tabey, Nasr A; El-Assmy, Ahmed M; Elshal, Ahmed M; Shokeir, Ahmed A

2015-09-01

To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20-30 mm single renal pelvic stone. The computerised records of patients who underwent PNL or ESWL for a 20-30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged <18 years who had a branched stone, advanced hydronephrosis, a solitary kidney, anatomical renal abnormality, or had a surgical intervention within the past 6 months were excluded. The study included 337 patients with a mean (SD, range) age of 49.3 (12.2, 20-81) years. The patients' criteria (age, sex, body mass index) and the stone characteristics (side, stone length, surface area, attenuation value and skin-to-stone distance) were compared between the groups. The re-treatment rate, the need for secondary procedures, success rate, complications and the total costs were calculated and compared. In all, 167 patients were treated by ESWL and 170 by PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P < 0.001). The success rate was significantly higher in the PNL group (95% vs. 75%, P < 0.001), as was the complication rate (13% vs. 6.6%, P = 0.050). The total costs of primary and secondary procedures were significantly higher for PNL (US$ 1120 vs. 490; P < 0.001). PNL was more effective than ESWL for treating a single renal pelvic stone of 20-30 mm. However, ESWL was associated with fewer complications and a lower cost.

The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction.

PubMed

Korakakis, Vasileios; Whiteley, Rodney; Tzavara, Alexander; Malliaropoulos, Nikolaos

2018-03-01

To evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT). Systematic review. Randomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated. Moderate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting. Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Molecular changes after shockwave therapy in osteoarthritic knee in rats

NASA Astrophysics Data System (ADS)

Wang, C.-J.; Sun, Y.-C.; Wu, C.-T.; Weng, L.-H.; Wang, F.-S.

2016-01-01

This study investigated the molecular changes of DKK-1, MMP13, Wnt-5a and \\upbeta -catenin after extracorporeal shockwave therapy (ESWT) in anterior cruciate ligament transected (ACLT) osteoarthritic (OA) knee in rats. 27 male Spraque-Dawley rats were divided into three groups. Group I was the control one and received sham knee arthrotomy but no ACLT or ESWT. Group II underwent ACLT, but no ESWT. Group III underwent ACLT and received ESWT. The animals were killed at 12 weeks, and the harvested knee specimens were subjected to histopathological examination and immunohistochemical analysis. Radiographs of the knees were obtained at 0 and 12 weeks. At 12 weeks, radiographs of group II showed more arthritic changes with formation of osteochondral fragments, whereas very subtle arthritis was noted in groups I and III. In histopathological examination, group II showed a significant increase of Mankin score and a decrease of subchondral bone as compared to groups I and III. Group III showed a significant decrease of Mankin score and an increase of subchondral bone, with the data comparable to group I. In immunohistochemical analysis, group II showed significant increases of DKK-1 and MMP13 and decreases of Wnt-5a and \\upbeta -catenin in articular cartilage and subchondral bone as compared to groups I and III. Group III showed significant decreases of DKK-1 and MMP13 and increases of Wnt-5a and \\upbeta -catenin, with the data comparable to group I. In conclusion, the application of ESWT causes molecular changes that are consistent with the improvement in subchondral bone remodeling and chondroprotective effect in ACLT OA knees in rats.

Shockwave therapy in the management of complex regional pain syndrome in medial femoral condyle of the knee.

PubMed

Notarnicola, Angela; Moretti, Lorenzo; Tafuri, Silvio; Panella, Antonio; Filipponi, Marco; Casalino, Alessio; Panella, Michele; Moretti, Biagio

2010-06-01

The aim of this prospective study was to assess the efficacy of shockwave (SW) therapy in the management of complex regional pain syndrome (CRPS). In this study, 30 patients (pts) who were affected by CRPS of the medial femoral condyle and unresponsive to previous standard physiotherapeutic and pharmacological treatment underwent 3 SW sessions at 72-h intervals, each consisting of 4000 shocks emitted by a MiniLith SL1 Storz electromagnetic generator. An energy flux density (EFD) of 0.035 or 0.09 mJ/mm(2) was used, depending on how well the patient endured the pain during the treatment. Satisfactory results were observed in 76.7% of the cases (23 pts) at the 2-month follow-up (FU) visit, and in 80% (24 pts) at the 6-month FU visit. The therapeutic effects of SW were caused by decreasing pain. The significant improvements we obtained bear witness to the potential value of SW therapy in the management of CRPS. Copyright 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Effect of Shockwave Curvature on Run Distance Observed with a Modified Wedge Test

NASA Astrophysics Data System (ADS)

Lee, Richard; Dorgan, Robert; Sutherland, Gerrit; Benedetta, Ashley; Milby, Christopher

2011-06-01

The effect of wave curvature on shock initiation in PBXN-110 was investigated using a modified wedge test configuration. Various thicknesses of PBXN-110 donor slabs were used to define the shockwave curvature introduced to wedge samples of the same explosive. The donor slabs were initiated with line-wave generators so that the introduced shock would be the same shape, magnitude and duration across the entire input surface of the wedge. The shock parameters were varied for a given donor thickness via different widths of PMMA spacers placed between the donor and the wedge. A framing camera was used to observe where initiation occurred along the face of the wedge. Initiation always occurred at the center of the shock front instead of the sides like that reported by others using a much smaller test format. Results were compared to CTH calculations to indicate if there were effects associated with highly curved shock fronts that could not be adequately predicted. The run distance predicted in CTH for a 50.8 mm thick donor slab (low curvature) compared favorably with experimental results. However, results from thinner donor slabs (higher curvature) indicate a more sensitive behavior than the simulations predicted.

Emergency extracorporeal shockwave lithotripsy (eSWL) as opposed to delayed SWL (dSWL) for the treatment of acute renal colic due to obstructive ureteral stone: a prospective randomized trial.

PubMed

Bucci, Stefano; Umari, Paolo; Rizzo, Michele; Pavan, Nicola; Liguori, Giovanni; Barbone, Fabio; Trombetta, Carlo

2018-05-14

To assess the efficacy of emergency extracorporeal shockwave lithotripsy (eSWL) as first-line treatment in patients with acute colic due to obstructive ureteral stone. 74 patients were randomized to emergency SWL within 12 hours (eSWL group) and deferred SWL later than 3 days (dSWL group). Follow-up included ultrasound, KUB (Kidney-Ureter-Bladder) radiography and CT (computed tomography) scan at 24 hours, 7 days, 1 and 3 months from the treatment. When necessary, repeated SWL (re-SWL) or ureteroscopy (auxiliary-URS) was performed. Preoperative and postoperative data were compared and stone free rates (SFR) and efficiency quotients (EQ) were evaluated. Analyses were performed using SAS software. Complete data of 70 patients were collected. 36 underwent eSWL and 34 dSWL. The mean patient age was 48.7. Mean stone size was 9.8 mm (CI 95%, 8.9-10.8). 25 (35.7%) were proximal and 45 (64.3%) distal. Mean SWL energy was 19.2 kV (CI 95%, 18.5-19.9) and mean number of shocks was 2657 (CI 95%, 2513-2802). eSWL patients needs less auxiliary-URS than dSWL patients (13.9% vs 44.1%, p=0.039) and less re-SWL sessions (8.3% vs 32.4%, p=0.093). SFR at 24 hours was 52.8% and 11.8% (p<0.001) and the EQ at 3 months was 79.1% and 57.5% in the eSWL and dSWL group respectively. Patients from the dSWL group spent more time in the hospital (2.21 vs 1.36 days, p=0.046) and complication rates between the two groups were similar. eSWL is a safe procedure and delivers high SFR even within 24 hours especially for <10mm stones. It is able to reduce the number of auxiliary procedures and hospitalization.

Comparison of hydrodynamic simulations with two-shockwave drive target experiments

NASA Astrophysics Data System (ADS)

Karkhanis, Varad; Ramaprabhu, Praveen; Buttler, William

2015-11-01

We consider hydrodynamic continuum simulations to mimic ejecta generation in two-shockwave target experiments, where metallic surface is loaded by two successive shock waves. Time of second shock in simulations is determined to match experimental amplitudes at the arrival of the second shock. The negative Atwood number A --> - 1 of ejecta simulations leads to two successive phase inversions of the interface corresponding to the passage of the shocks from heavy to light media in each instance. Metallic phase of ejecta (solid/liquid) depends on shock loading pressure in the experiment, and we find that hydrodynamic simulations quantify the liquid phase ejecta physics with a fair degree of accuracy, where RM instability is not suppressed by the strength effect. In particular, we find that our results of free surface velocity, maximum ejecta velocity, and maximum ejecta areal density are in excellent agreement with their experimental counterparts, as well as ejecta models. We also comment on the parametric space for hydrodynamic simulations in which they can be used to compare with the target experiments. This work was supported in part by the (U.S.) Department of Energy (DOE) under Contract No. DE-AC52-06NA2-5396.

Renal calculi: trends in the utilization of shockwave lithotripsy and ureteroscopy.

PubMed

Seklehner, Stephan; Laudano, Melissa A; Del Pizzo, Joseph; Chughtai, Bilal; Lee, Richard K

2015-02-01

To assess trends in the usage of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in the treatment of renal calculi. An analysis of the 5% Medicare Public Use Files (years 2001, 2004, 2007 and 2010) was performed to evaluate changes in the use of SWL and URS to treat renal calculi. Patients were identified using ICD-9 (cm) and CPT codes. Statistical analyses, including the Fisher, 2 tests, and multivariate logistic regression analysis were performed using SAS 9.3 (SAS Institute Inc., Cary, NC, USA) and SPSS v20 (IBM Corp., Armonk, NY, USA). The absolute number of patients diagnosed with (+85.1%) and treated for (+31.5%) kidney calculi increased from 2001 to 2010. The ratio of diagnosed/treated patients declined from 15.2% in 2001 to 10.8% in 2010. Whites (OR = 1.27, p < 0.0001), patients in the South (OR = 1.16, p < 0.0001) and those ≤ 84 years of age were more likely to be treated. The utilization of SWL (84.7%) was greater than URS (15.3%), but the utilization of URS increased over time from 8.4% in 2001 to 20.6% of cases by 2010 (p < 0.0001). Treatment via URS was more likely in women (OR = 1.28, p < 0.0001), in patients living outside the South (OR = 1.29-1.45, p ≤ 0.006) and in later years of the study (OR = 2.87, p < 0.0001). Treatment patterns for renal calculi changed from 2001 to 2010. The usage of URS increased at the cost of SWL. Multiple sociodemographic factors correlated with the likelihood of being treated surgically as well as the choice of the surgical approach.

Long-term outcomes of extracorporeal shockwave therapy for chronic foot ulcers.

PubMed

Wang, Ching-Jen; Wu, Cheng-Ta; Yang, Ya-Ju; Liu, Rue-Tsuan; Kuo, Yur-Ren

2014-06-15

Recent studies showed that extracorporeal shockwave therapy (ESWT) is effective in the treatment of chronic foot ulcers in short term. However, the long-term effects of ESWT in chronic foot ulcers are unknown. The purpose of this study was to evaluate the long-term outcomes of ESWT in chronic foot ulcers with 5-y follow-up. The study cohort consisted of 67 patients with 72 ulcers including 38 patients with 40 ulcers in the diabetes mellitus (DM) group and 29 patients with 32 ulcers in the non-diabetes mellitus (non-DM) group. Each patient received ESWT to the affected foot twice per week for 3 wk for a total of six treatments. The evaluations included clinical assessment for the ulcer status, local blood flow perfusion, and analysis of mortality and morbidity. The results showed completely healed ulcers in 55.6% and 57.4% of total series, 48% and 43% of DM group, and 66% and 71% of non-DM group at 1 and 5 y (P = 0.022 and P = 0.027), respectively. The mortality rate was 15% in total series, 24% in DM group, and 3% in non-DM group (P = 0.035). The rate of amputation was 11% in total series, 17% in DM group, and 3.6% in non-DM group (P = 0.194). The blood flow perfusion rate significantly increased after ESWT for up to 1 yr but decreased from 1-5 y in both groups. However, the non-DM group showed significantly better blood flow perfusion than the DM group at 5 y (P = 0.04). ESWT appears effective in chronic diabetic and nondiabetic foot ulcers. However, the effects decreased from 1-5 y after treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

Turbulence measurements in hypersonic shock-wave boundary-layer interaction flows

NASA Technical Reports Server (NTRS)

Mikulla, V.; Horstman, C. C.

1976-01-01

Turbulent intensity and Reynolds shear stress measurements are presented for two nonadiabatic hypersonic shock-wave boundary-layer interaction flows, one with and one without separation. These measurements were obtained using a new hot-wire probe specially designed for heated flows. Comparison of the separated and attached flows shows a significant increase above equilibrium values in the turbulent intensity and shear stress downstream of the interaction region for the attached case, while for the separated case, the turbulent fluxes remain close to equilibrium values. This effect results in substantial differences in turbulence lifetime for the two flows. We propose that these differences are due to a coupling between the turbulent energy and separation bubble unsteadiness, a hypothesis supported by the statistical properties of the turbulent fluctuations.

Turbulence measurements in hypersonic shock-wave boundary-layer interaction flows

NASA Technical Reports Server (NTRS)

Mikulla, V.; Horstman, C. C.

1976-01-01

Turbulent intensity and Reynolds shear stress measurements are presented for two nonadiabatic hypersonic shock-wave boundary-layer interaction flows, one with and one without separation. These measurements were obtained using a new hot-wire probe specially designed for heated flows. Comparison of the separated and attached flows shows a significant increase above equilibrium values in the turbulent intensity and shear stress downstream of the interaction region for the attached case, while for the separated case, the turbulent fluxes remain close to equilibrium values. This effect results in substantial differences in turbulence lifetimes for the two flows. It is proposed that these differences are due to a coupling between the turbulent energy and separation bubble unsteadiness, a hypothesis supported by the statistical properties of the turbulent fluctuations.

Effect of Low-Energy Linear Shockwave Therapy on Erectile Dysfunction-A Double-Blinded, Sham-Controlled, Randomized Clinical Trial.

PubMed

Fojecki, Grzegorz L; Tiessen, Stefan; Osther, Palle J S

2017-01-01

Previous studies have shown that focal low-energy extracorporeal shockwave therapy (Li-ESWT) can have a positive effect in men with erectile dysfunction (ED). Linear Li-ESWT (LLi-ESWT) for ED has not been previously assessed in a randomized trial. To evaluate the treatment outcome of LLi-ESWT for ED. Men with ED (n = 126) and a score lower than 25 points on the International Index of Erectile Function erectile function domain (IIEF-EF) were included. Subjects were allocated to receive LLi-ESWT once a week for 5 weeks or sham treatment once a week for 5 weeks. After a 4-week break, the two groups received active treatment once a week for 5 weeks. Subjects completed the IIEF, Erection Hardness Scale (EHS), Sexual Quality of Life-Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction at baseline, after 9 weeks, and after 18 weeks. The primary outcome measurement was an increase of at least five points on the IIEF-EF score. The secondary outcome measurement was an increased EHS score to at least 3 in men with a score no higher than 2 at baseline. Data were analyzed by linear and logistic regression. Mean IIEF-EF scores were 11.5 at baseline (95% CI = 9.8-13.2), 13.0 after five sessions (95% CI = 11.0-15.0), and 12.6 after 10 sessions (95% CI = 11.0-14.2) in the sham group and correspondingly 10.9 (95% CI = 9.1-12.7), 13.1 (95% CI = 9.3-13.4), and 11.8 (95% CI = 10.1-13.4) in the ESWT group. Success rates based on IIEF-EF score were 38.3% in the sham group and 37.9% in the ESWT group (odds ratio = 0.95, 95% CI = 0.45-2.02, P = .902). Success rates based on EHS score were 6.7% in the sham group and 3.5% in the ESWT group (odds ratio = 0.44, 95% CI = 0.08-2.61, P = .369). A limitation of this study is that device settings (number of shockwaves and penetration depth) were estimated based on an existing trial on focused ESWT. No clinically relevant effect of LLi-ESWT on ED was found. Copyright © 2016 The Authors. Published by Elsevier Inc

Prognostic factors for the outcome of extracorporeal shockwave therapy for calcific tendinitis of the shoulder.

PubMed

Chou, W-Y; Wang, C-J; Wu, K-T; Yang, Y-J; Ko, J-Y; Siu, K-K

2017-12-01

We conducted a study to identify factors that are prognostic of the outcome of extracorporeal shockwave therapy (ESWT) for calcific tendinitis of the shoulder. Since 1998, patients with symptomatic calcific tendinitis of the rotator cuff have been treated with ESWT using an electrohydraulic mode shockwave device. One year after ESWT, patients were grouped according to the level of resorption of calcification. Of 241 symptomatic shoulders, complete resorption (CR) of calcification occurred in 134 (CR group). The remaining 107 shoulders had incomplete resorption (ICR) (ICR group). Gartner type I calcification was most common (64.5%) in the ICR group. The mean duration of symptoms before ESWT was significantly longer in the ICR group. Overall, 81% of the CR group and 23.4% of the ICR group were symptom free. There was a strong relationship between subsidence of symptoms and remission of calcification. Poor prognosis was significantly related to Gartner type I calcification, calcification extent > 15 mm and duration of symptoms > 11 months. Patients with calcific tendinitis of the shoulder who have the factors identified for a poor outcome after ESWT should undergo a different procedure. Cite this article: Bone Joint J 2017;99-B:1643-50. ©2017 The British Editorial Society of Bone & Joint Surgery.

Estimating the pressure of laser-induced plasma shockwave by stimulated Raman shift of lattice translational modes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li Zhanlong; College of Physics, Jilin University, Changchun 130012; Shan Xiaoning

2012-07-09

The current paper investigates stimulated Raman scattering (SRS) when laser-induced plasma is formed in heavy water by focusing an intense pulsed 532 nm Nd:YAG laser beam at room temperature. An unexpected low-frequency SRS line attributed to the lattice translational modes of ice-VII (D{sub 2}O) is observed. The pressure of the plasma shockwave is estimated using low-frequency SRS line shift.

Extracorporeal shockwave therapy (ESWT) in Achilles tendinopathy. A long-term follow-up observational study.

PubMed

Vulpiani, M C; Trischitta, D; Trovato, P; Vetrano, M; Ferretti, A

2009-06-01

The etiology, pathogenesis and natural course of Achilles tendinopathy are not yet completely known. Various forms of therapies, either conservative or surgical, have been proposed for its treatment. In the last few years, extracorporeal shockwave therapy (ESWT) has been proposed in the treatment of these tendinopathies and has shown encouraging short-term results. The purpose of this type-C study was to evaluate the effectiveness of ESWT in the symptomatic treatment of Achilles tendinopathies over time. One hundred five patients (127 tendons) aged between 18 and 74 years (mean age 47.8) were enrolled in this study. All patients underwent clinical and instrumental diagnosis (ultrasonography, magnetic resonance imaging and X-rays) in order to identify presence, location and seriousness of the specific tendinopathy. The symptomatology was classified using the Visual Analogical Scale (VAS) and according to a five-stage clinical evaluation range. Shock wave treatment was applied with an electromagnetic shock wave generator. The protocol consisted in an average of four sessions (minimum three, maximum five), at a 2/7-day interval. In each session 1 500-2 500 impulses were administered with an energy varying between 0.08 and 0.40 mJ/mm2. All patients were evaluated before therapy and two months after the last ESWT session. Also, all patients were assessed and evaluated at medium-term (6 to 12 months), and 121 patients also at long-term (13 to 24 months). Authors obtained satisfactory results in 47.2% of cases (60 out of 127 tendons) at two-months follow-up, which increased to 73.2% at medium-term follow-up (93 out of 127 tendons), and then reaching 76% in the last evaluation (92 out of 121 tendons). The outcome of the described shock wave treatment appears to be satisfactory and confirms the role of this alternative treatment in the management of the tendon disorders.

Experimental studies of hypersonic shock-wave boundary-layer interactions

NASA Technical Reports Server (NTRS)

Lu, Frank K.

1992-01-01

Two classes of shock-wave boundary-layer interactions were studied experimentally in a shock tunnel in which a low Reynolds number, turbulent flow at Mach 8 was developed on a cold, flat test surface. The two classes of interactions were: (1) a swept interaction generated by a wedge ('fin') mounted perpendicularly on the flat plate; and (2) a two-dimensional, unseparated interaction induced by a shock impinging near an expansion corner. The swept interaction, with wedge angles of 5-20 degrees, was separated and there was also indication that the strongest interactions prossessed secondary separation zones. The interaction spread out extensively from the inviscid shock location although no indication of quasi-conical symmetry was evident. The surface pressure from the upstream influence to the inviscid shock was relatively low compared to the inviscid downstream value but it rose rapidly past the inviscid shock location. However, the surface pressure did not reach the downstream inviscid value and reasons were proposed for this anomalous behavior compared to strongly separated, supersonic interactions. The second class of interactions involved weak shocks impinging near small expansion corners. As a prelude to studying this interaction, a hypersonic similarity parameter was identified for the pure, expansion corner flow. The expansion corner severely damped out surface pressure fluctuations. When a shock impinged upstream of the corner, no significant changes to the surface pressure were found as compared to the case when the shock impinged on a flat plate. But, when the shock impinged downstream of the corner, a close coupling existed between the two wave systems, unlike the supersonic case. This close coupling modified the upstream influence. Regardless of whether the shock impinged ahead or behind the corner, the downstream region was affected by the close coupling between the shock and the expansion. Not only was the mean pressure distribution modified but the

Quantification of the Range of Motion of Kidney and Ureteral Stones During Shockwave Lithotripsy in Conscious Patients.

PubMed

Harrogate, Suzanne R; Yick, L M Shirley; Williams, James C; Cleveland, Robin O; Turney, Benjamin W

2016-04-01

Effective shockwave lithotripsy requires accurate targeting of the stone throughout the course of treatment. Stone movement secondary to respiratory movement can make this more difficult. In vitro work has shown that stone motion outside the focal region reduces the efficacy of stone fragmentation; however, there are few clinical data on the degree of stone movement in patients during treatment. To investigate this, X-ray fluoroscopic images of the kidney and ureteral stones at the upper and lower limits of the normal respiratory cycle were acquired during shock wave lithotripsy of 58 conscious patients, and stone excursion was calculated from these images. In addition, the respiration rate and patient perceived pain were recorded during the course of the treatment. It was found that stone motion secondary to respiration was 7.7 ± 2.9 mm for kidney stones and 3.6 ± 2.1 mm for ureteral stones-less than has been reported in studies with anesthetized patients. There was no significant change of motion over the course of treatment although pain was found to increase. These data suggest that stone motion in conscious patients is less than in anesthetized patients. Furthermore, it suggests that lithotripters with focal regions of 8 mm or greater should not suffer from a marked drop in fragmentation efficiency due to stone motion.

Shockwave treatment of erectile dysfunction.

PubMed

Gruenwald, Ilan; Appel, Boaz; Kitrey, Noam D; Vardi, Yoram

2013-04-01

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization. As a result of these characteristics we initiated a series of experiments evaluating the effect of LI-ESWT on the cavernosal tissue of patients with vasculogenic ED. The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects. Although further extensive research is needed, LI-ESWT may create a new standard of care for men with vasculogenic ED.

Effect of shockwave curvature on run distance observed with a modified wedge test

NASA Astrophysics Data System (ADS)

Lee, Richard; Dorgan, Robert J.; Sutherland, Gerrit; Benedetta, Ashley; Milby, Christopher

2012-03-01

The effect of wave curvature on shock initiation in PBXN-110 was investigated using a modified wedge test configuration. Various widths of PBXN-110 donor slabs were used to define the shockwave curvature introduced to wedge samples of the same explosive. The donor slabs were initiated with line-wave generators so that the shock from the donor would be the same shape, magnitude and duration across the entire input surface of the wedge. The shock parameters were varied for a given donor with PMMA spacers placed between the donor and the wedge sample. A high-speed electronic framing camera was used to observe where initiation occurred along the face of the wedge. Initiation always occurred at the center of the shock front instead of along the sides like that reported by others using a much smaller test format. Results were compared to CTH calculations to indicate if there were effects associated with highly curved shock fronts that could not be adequately predicted. The run distance predicted in CTH for a 50.8 mm wide donor slab (low curvature) compared favorably with experimental results. However, results from thinner donor slabs (higher curvature) indicate a more sensitive behavior than the simulations predicted.

Ground Measurements of Airplane Shock-Wave Noise at Mach Numbers to 2.0 and at Altitudes to 60,000 Feet

NASA Technical Reports Server (NTRS)

Lina, Lindsay J.; Maglieri, Domenic J.

1960-01-01

The intensity of shock-wave noise at the ground resulting from flights at Mach numbers to 2.0 and altitudes to 60,000 feet was measured. Meagurements near the ground track for flights of a supersonic fighter and one flight of a supersonic bomber are presented. Level cruising flight at an altitude of 60,000 feet and a Mach number of 2.0 produced sonic booms which were considered to be tolerable, and it is reasonable t o expect that cruising flight at higher altitudes will produce booms of tolerable intensity for airplanes of the size and weight of the test airplanes. The measured variation of sonic-boom intensity with altitude was in good agreement with the variation calculated by an equation given in NASA Technical Note D-48. The effect of Mach number on the ground overpressure is small between Mach numbers of 1.4 and 2.0, a result in agreement with the theory. No amplification of the shock-wave overpressures due to refraction effects was apparent near the cutoff Mach number. A method for estimating the effect of fligh-path angle on cutoff Mach number is shown. Experimental results indicate agreement with the method, since a climb maneuver produced booms of a much decreased intensity as compared with the intensity of those measured in level flight at about the same altitude and Mach number. Comparison of sound pressure levels for the fighter and bomber airp lanes indicated little effect of either airplane size or weight at an altitude of 40,000 feet.

Laser-excited gold nanoparticles for treatment of cancer cells in vitro

NASA Astrophysics Data System (ADS)

Zamora-Romero, Noé; Robles, Vicente; Alvarez, Crysthal; Cuando-Espitia, Natanael; Devia-Cruz, Luis F.; Penilla, Elias; Halaney, David L.; Aguilar, Guillermo

2017-07-01

Several in vitro and in vivo studies have been performed to investigate the potential of Photothermal Therapy (PTT) as a cancer treatment strategy. However, there are still open questions concerning the optimal parameters for generating cavitation bubbles and acoustic shockwaves for increasing the damage to malignant cells, and the primary mechanism for cell damage in PTT is still a matter of debate. This study investigates PTT based on shockwaves from cavitation induced far from the cells, due to laser absorption by gold nanorods (GNR) colloidal solutions in vitro. The effects of laser energy and distance from the cavitation on cell viability is investigated in PC3 prostate cancer cells, and Escherichia coli (E. coli) cells, respectively.

Extracorporeal shockwave lithotripsy, endourology and open surgery: the management and follow-up of 200 patients with urinary calculi.

PubMed Central

Webb, D. R.; McNicholas, T. A.; Whitfield, H. N.; Wickham, J. E.

1985-01-01

The management and follow up of 200 consecutive patients with renal and ureteric calculi are presented. The primary treatment of 185 (92.5%) was by extracorporeal shockwave lithotripsy (ESWL), of whom three (1.6)%) with large calculi underwent percutaneous nephrolithotripsy (PCNL) prior to ESWL as a planned combined procedure. Twelve (6%) were treated by PCNL or ureterorenoscopy (URS) as their definitive treatment and three (1.5%) by conventional open renal and ureteric surgery. The average in-patient stay was 3.8 days and most returned to normal activity within one day of discharge. Of the 185 patients 102 (55%) required no analgesia after treatment by ESWL, 29 (15.6%) required parenteral analgesia and the rest were comfortable with oral non-narcotic medication. Thirty (16%) required auxillary treatment by percutaneous nephrostomy (PCN), PCNL and URS following ESWL for obstructive complications from stone particles. Two required further ESWL and one PCNL at three months for large fragments. Overall, open surgery was required for only 1% of renal calculi and 13% of ureteric stones. These results are consistant with the extensive West German experience confirming that most urinary calculi are now best managed by ESWL and endoscopic techniques. Where these facilities are available open surgery should only be necessary for less than 5% of upper urinary tract stones. PMID:4073760

Laser Shockwave Technique For Characterization Of Nuclear Fuel Plate Interfaces

DOE Office of Scientific and Technical Information (OSTI.GOV)

James A. Smith; Barry H. Rabin; Mathieu Perton

2012-07-01

The US National Nuclear Security Agency is tasked with minimizing the worldwide use of high-enriched uranium. One aspect of that effort is the conversion of research reactors to monolithic fuel plates of low-enriched uranium. The manufacturing process includes hot isostatic press bonding of an aluminum cladding to the fuel foil. The Laser Shockwave Technique (LST) is here evaluated for characterizing the interface strength of fuel plates using depleted Uranium/Mo foils. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves and is therefore well adapted to the quality assurance of this process.more » Preliminary results show a clear signature of well-bonded and debonded interfaces and the method is able to classify/rank the bond strength of fuel plates prepared under different HIP conditions.« less

Laser shockwave technique for characterization of nuclear fuel plate interfaces

DOE Office of Scientific and Technical Information (OSTI.GOV)

Perton, M.; Levesque, D.; Monchalin, J.-P.

2013-01-25

The US National Nuclear Security Agency is tasked with minimizing the worldwide use of high-enriched uranium. One aspect of that effort is the conversion of research reactors to monolithic fuel plates of low-enriched uranium. The manufacturing process includes hot isostatic press bonding of an aluminum cladding to the fuel foil. The Laser Shockwave Technique (LST) is here evaluated for characterizing the interface strength of fuel plates using depleted Uranium/Mo foils. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves and is therefore well adapted to the quality assurance of this process.more » Preliminary results show a clear signature of well-bonded and debonded interfaces and the method is able to classify/rank the bond strength of fuel plates prepared under different HIP conditions.« less

The pulsed dye laser versus the Q-switched Nd:YAG laser in laser-induced shock-wave lithotripsy.

PubMed

Thomas, S; Pensel, J; Engelhardt, R; Meyer, W; Hofstetter, A G

1988-01-01

To date, there are two fairly well-established alternatives for laser-induced shock-wave lithotripsy in clinical practice. The Q-switched Nd:YAG laser is distinguished by the high-stone selectivity of its coupler systems. The necessity of a coupler system and its fairly small conversion rate of light energy into mechanical energy present serious drawbacks. Furthermore, the minimal outer diameter of the transmission system is 1.8 mm. The pulsed-dye laser can be used with a highly flexible and uncomplicated 200-micron fiber. However, the laser system itself is more complicated than the Q-switched Nd:YAG laser and requires a great deal of maintenance. Biological evaluation of damage caused by direct irradiation shows that both laser systems produce minor damage of different degrees. YAG laser lithotripsy with the optomechanical coupler was assessed in 31 patients with ureteral calculi. The instability and limited effectiveness of the fiber application system necessitated auxiliary lithotripsy methods in 14 cases. Dye-laser lithotripsy is currently being tested in clinical application. Further development, such as systems for blind application or electronic feedback mechanisms to limit adverse tissue effects, have yet to be optimized. Nevertheless, laser-induced shock-wave lithotripsy has the potential to become a standard procedure in the endourologic management of stone disease.

Molecular-level Analysis of Shock-wave Physics and Derivation of the Hugoniot Relations for Soda-lime Glass

DTIC Science & Technology

2011-06-17

based glasses like fused silica and soda - lime glass , the polyhedral central cation is silicon. In this case, each silicon is surrounded by four oxygen...to two network forming cations) oxygen atoms per network polyhedron. The equilibrium values for this parameter in fused silica and soda - lime glass ...Molecular-level analysis of shock-wave physics and derivation of the Hugoniot relations for soda - lime glass M. Grujicic • B. Pandurangan • W. C. Bell

Quantum molecular dynamics simulation of shock-wave experiments in aluminum

NASA Astrophysics Data System (ADS)

Minakov, D. V.; Levashov, P. R.; Khishchenko, K. V.; Fortov, V. E.

2014-06-01

We present quantum molecular dynamics calculations of principal, porous, and double shock Hugoniots, release isentropes, and sound velocity behind the shock front for aluminum. A comprehensive analysis of available shock-wave data is performed; the agreement and discrepancies of simulation results with measurements are discussed. Special attention is paid to the melting region of aluminum along the principal Hugoniot; the boundaries of the melting zone are estimated using the self-diffusion coefficient. Also, we make a comparison with a high-quality multiphase equation of state for aluminum. Independent semiempirical and first-principle models are very close to each other in caloric variables (pressure, density, particle velocity, etc.) but the equation of state gives higher temperature on the principal Hugoniot and release isentropes than ab initio calculations. Thus, the quantum molecular dynamics method can be used for calibration of semiempirical equations of state in case of lack of experimental data.

Extracorporeal shockwave enhanced regeneration of fibrocartilage in a delayed tendon-bone insertion repair model.

PubMed

Chow, Dick Ho Kiu; Suen, Pui Kit; Huang, Le; Cheung, Wing-Hoi; Leung, Kwok-Sui; Ng, Chun; Shi, San Qiang; Wong, Margaret Wan Nar; Qin, Ling

2014-04-01

Fibrous tissue is often formed in delayed healing of tendon bone insertion (TBI) instead of fibrocartilage. Extracorporeal shockwave (ESW) provides mechanical cues and upregulates expression of fibrocartilage-related makers and cytokines. We hypothesized that ESW would accelerate fibrocartilage regeneration at the healing interface in a delayed TBI healing model. Partial patellectomy with shielding at the TBI interface was performed on 32 female New Zealand White Rabbits for establishing this delayed TBI healing model. The rabbits were separated into the control and ESW group for evaluations at postoperative week 8 and 12. Shielding was removed at week 4 and a single ESW treatment was applied at week 6. Fibrocartilage regeneration was evaluated histomorphologically and immunohistochemically. Vickers hardness of the TBI matrix was measured by micro-indentation. ESW group showed higher fibrocartilage area, thickness, and proteoglycan deposition than the control in week 8 and 12. ESW increased expression of SOX9 and collagen II significantly in week 8 and 12, respectively. ESW group showed a gradual transition of hardness from bone to fibrocartilage to tendon, and had a higher Vickers hardness than the control group at week 12. In conclusion, ESW enhanced fibrocartilage regeneration at the healing interface in a delayed TBI healing model. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Spherical shock-wave propagation in three-dimensional granular packings.

PubMed

Xue, Kun; Bai, Chun-Hua

2011-02-01

We investigate numerically the spherical shock-wave propagation in an open dense granular packing perturbed by the sudden expansion of a spherical intruder in the interior of the pack, focusing on the correlation between geometrical fabrics and propagating properties. The measurements of the temporal and spatial variations in a variety of propagating properties define a consistent serrated wave substructure with characteristic length on the orders of particle diameters. Further inspection of particle packing reveals a well-defined particle layering that persists several particle diameters away from the intruder, although its dominant effects are only within one to two diameters. This interface-induced layering not only exactly coincides with the serrated wave profile, but also highlights the competition between two energy transmission mechanisms involving distinct transport speeds. The alternating dominances between these two mechanisms contribute to the nonlinear wave propagation on the particle scale. Moreover, the proliferation of intricate three-dimensional contact force networks suggests the anisotropic stress transmission, which is found to also arise from the localized packing structure in the vicinity of the intruder.

Quantum molecular dynamics simulation of shock-wave experiments in aluminum

DOE Office of Scientific and Technical Information (OSTI.GOV)

Minakov, D. V.; Khishchenko, K. V.; Fortov, V. E.

2014-06-14

We present quantum molecular dynamics calculations of principal, porous, and double shock Hugoniots, release isentropes, and sound velocity behind the shock front for aluminum. A comprehensive analysis of available shock-wave data is performed; the agreement and discrepancies of simulation results with measurements are discussed. Special attention is paid to the melting region of aluminum along the principal Hugoniot; the boundaries of the melting zone are estimated using the self-diffusion coefficient. Also, we make a comparison with a high-quality multiphase equation of state for aluminum. Independent semiempirical and first-principle models are very close to each other in caloric variables (pressure, density,more » particle velocity, etc.) but the equation of state gives higher temperature on the principal Hugoniot and release isentropes than ab initio calculations. Thus, the quantum molecular dynamics method can be used for calibration of semiempirical equations of state in case of lack of experimental data.« less

Influence of Shockwave Profile on Ejection of Micron-Scale Material From Shocked Tin Surfaces

NASA Astrophysics Data System (ADS)

Zellner, Michael; Hammerberg, Jim; Hixson, Robert; Olson, Russel; Rigg, Paulo; Stevens, Gerald; Turley, William; Buttler, William

2008-03-01

This effort investigates the relation between shock-pulse shape and the amount of micron-scale fragments ejected (ejecta) upon shock release at the metal/vacuum interface of shocked Sn targets. Two shock-pulse shapes are considered: a supported shock created by impacting a Sn target with a sabot that was accelerated using a powder gun; and an unsupported or triangular-shaped Taylor shockwave, created by detonation of high explosive that was press-fit to the front-side of the Sn target. Ejecta production at the back-side or free-side of the Sn coupons were characterized through use of piezoelectric pins, Asay foil, optical shadowgraphy, and X-ray attenuation.

Use of the Hugoniot elastic limit in laser shockwave experiments to relate velocity measurements

NASA Astrophysics Data System (ADS)

Smith, James A.; Lacy, Jeffrey M.; Lévesque, Daniel; Monchalin, Jean-Pierre; Lord, Martin

2016-02-01

The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. This fuel-cladding interface qualification will ensure the survivability of the fuel plates in the harsh reactor environment even under abnormal operating conditions. One of the concerns of the project is the difficulty of calibrating and standardizing the laser shock technique. An analytical study under development and experimental testing supports the hypothesis that the Hugoniot Elastic Limit (HEL) in materials can be a robust and simple benchmark to compare stresses generated by different laser shock systems.

DSMC study of oxygen shockwaves based on high-fidelity vibrational relaxation and dissociation models

NASA Astrophysics Data System (ADS)

Borges Sebastião, Israel; Kulakhmetov, Marat; Alexeenko, Alina

2017-01-01

This work evaluates high-fidelity vibrational-translational (VT) energy relaxation and dissociation models for pure O2 normal shockwave simulations with the direct simulation Monte Carlo (DSMC) method. The O2-O collisions are described using ab initio state-specific relaxation and dissociation models. The Macheret-Fridman (MF) dissociation model is adapted to the DSMC framework by modifying the standard implementation of the total collision energy (TCE) model. The O2-O2 dissociation is modeled with this TCE+MF approach, which is calibrated with O2-O ab initio data and experimental equilibrium dissociation rates. The O2-O2 vibrational relaxation is modeled via the Larsen-Borgnakke model, calibrated to experimental VT rates. All the present results are compared to experimental data and previous calculations available in the literature. It is found that, in general, the ab initio dissociation model is better than the TCE model at matching the shock experiments. Therefore, when available, efficient ab initio models are preferred over phenomenological models. We also show that the proposed TCE + MF formulation can be used to improve the standard TCE model results when ab initio data are not available or limited.

Cavitation in ultrasound and shockwave therapy

NASA Astrophysics Data System (ADS)

Colonius, Tim

2014-11-01

Acoustic waves, especially high-intensity ultrasound and shock waves, are used for medical imaging and intra- and extra-corporeal manipulation of cells, tissue, and urinary calculi. Waves are currently used to treat kidney stone disease, plantar fasciitis, and bone nonunion, and they are being investigated as a technique to ablate cancer tumors and mediate drug delivery. In many applications, acoustic waves induce the expansion and collapse of preexisting or newly cavitating bubbles whose presence can either mediate the generation of localized stresses or lead to collateral damage, depending on how effectively they can be controlled. We describe efforts aimed at simulating the collapse of bubbles, both individually and in clusters, with the aim to characterize the induced mechanical stresses and strains. To simulate collapse of one or a few bubbles, compressible Euler and Navier-Stokes simulations of multi-component materials are performed with WENO-based shock and interface capturing schemes. Repetitive insonification generates numerous bubbles that are difficult to resolve numerically. Such clouds are also important in traditional engineering applications such as caveating hydrofoils. Models that incorporate the dynamics of an unresolved dispersed phase consisting of the bubble cloud are also developed. The results of several model problems including bubble collapse near rigid surfaces, bubble collapse near compliant surfaces and in small capillaries are analyzed. The results are processed to determine the potential for micron-sized preexisting gas bubbles to damage capillaries. The translation of the fundamental fluid dynamics into improvements in the design and clinical application of shockwave lithotripters will be discussed. NIH Grant PO1-DK043881.

A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy.

PubMed

Dogan, Hasan Serkan; Altan, Mesut; Citamak, Burak; Bozaci, Ali Cansu; Karabulut, Erdem; Tekgul, Serdar

2015-04-01

Despite the fact that shock-wave lithotripsy (SWL) remains a very good treatment option for smaller stones, it is being challenged by endourologic treatment modalities, which offer similar or even higher success rates in a shorter time, with minimal morbidity and invasiveness. The present study aimed to bring a new and practical insight in order to predict the outcomes of pediatric SWL and to provide objective information about pediatric SWL outcomes. To design a nomogram for predicting the outcomes of pediatric shock-wave lithotripsy. The study was conducted with a retrospective design and included 402 renal units who underwent SWL between January 2009 and August 2013. Patients with known cystine stone disease and cystinuria, with internal or external urinary diversion, were excluded. Analysis was performed on 383 renal units. Postoperative imaging was performed by plain abdominal graphy and ultrasonography with 3-month intervals. Patients who were completely free of stones were considered to be a success and statistical analysis was done regardingly Multivariate analysis was conducted by logistic regression analysis and a nomogram was developed. The male/female distribution was 216/167, with a mean age of 48 ± 40 months and a mean stone size of 9 ± 3.5 mm. The overall stone-free rate was 70% (270/383) and efficacy quotient was 0.57. Mean follow-up was 11 ± 11 months (3-54 months). The number of shock waves and amplitude of energy were higher in failed cases. Multivariate analysis showed that gender, stone size, number of stones, age, location of the stone, and history of previous intervention were found to be the independent prognostic factors for assessing the stone clearance rates. A nomogram was developed using these parameters. In this nomogram, the points achieved from each parameter are summed and total points correspond to the risk of failure in percent. A previous nomogram study by Onal et al. showed that younger age (<5 years), smaller stone burden

A special terpene combination (Rowatinex®) improves stone clearance after extracorporeal shockwave lithotripsy in urolithiasis patients: results of a placebo-controlled randomised controlled trial.

PubMed

Romics, Imre; Siller, György; Kohnen, Ralf; Mavrogenis, Stelios; Varga, József; Holman, Endre

2011-01-01

To investigate the safety and efficacy of a special terpene combination in the treatment of patients with urolithiasis after extracorporeal shockwave lithotripsy (ESWL). 222 patients with clinically stable kidney or ureter stones of 0.3-2.0 cm undergoing complication-free ESWL were randomised to receive a special terpene combination (Rowatinex®; 3 × 2 capsules/day) or placebo. The study consisted of a 12-week active treatment phase and a 2-week follow-up phase. All patients had a physical examination, and diagnosis of kidney stones was made by X-ray, intravenous pyelogram or ultrasound at weeks 1, 4, 8 and 12 as well as after 2 weeks of follow-up. Stone-free status was defined as obviously successful expulsion of calculi/fragments, being without any stone. In all, when compared to placebo, significantly more patients receiving the terpene combination treatment in the intent-to-treat (ITT) group [72 (67.9%) vs. 49 (50.0%); p = 0.0009] and the per-protocol (PP) group [69 (78.4%) vs. 48 (52.2%); p = 0.0004] were stone-free at the end of the study. Treatment with the terpene combination was also more effective when analysed with respect to the size of the treated stone. In addition, treatment with the terpene combination significantly reduced the median time to stone-free status from 85.0 to 56.0 days (p = 0.0061) and from 85.0 to 49.5 days (p = 0.0028) in the ITT and PP populations, respectively. Nine mild-to-moderate adverse events (AE; terpene combination group: 7 AE in 4 patients; placebo group: 2 AE in 2 patients) were assessed as drug-related. Treatment with the terpene combination is well tolerated and safe. The terpene combination was found to be an efficacious treatment in eliminating calculi fragments generated by ESWL as compared to placebo. The pharmacodynamic properties of the terpene combination (antilithogenic, antibacterial, antiinflammatory, spasmolytic and analgesic effects), which have been also confirmed in preclinical studies, represent a

Shockwave-Induced Plasticity Via Large-Scale Nonequilibrium Molecular Dynamics

NASA Astrophysics Data System (ADS)

Holian, Brad Lee

1997-07-01

In nonequilibrium molecular-dynamics (MD) simulations of shock waves in single crystals, carried out in 1979 at Los Alamos,(B.L. Holian and G.K. Straub, Phys. Rev. Lett. 43), 1598 (1979). we discovered that, above a threshold strength, strongly shocked crystals deform in a very simple way. Rather than experiencing massive deformation, a simple slippage occurs at the shock front, relieving the peak shear stress, and leaving behind a stacking fault. We realized, of course, that real materials could yield at much lower thresholds, and speculated then that pre-existing defects could nucleate plastic flow at lower shock strengths than those characteristic of pure single crystals. (Historical note: at about the same time as our earliest dynamical shockwave simulations, Mogilevsky, working independently in the Soviet Union, carried out relaxation MD calculations under uniaxial strain, and observed spontaneous production of dislocations.(M.A. Mogilevsky, in Shock Waves and High Strain Rate Phenomena in Metals) (Plenum, New York, 1981), p.531.) Further Los Alamos calculations, carried out nearly a decade later in five-times larger systems (up to 10,000 atoms), confirmed this observation and quantified the threshold strength, namely the yield strength of the perfect crystal.(B.L. Holian, Phys. Rev. A 37), 2562 (1988); for a review, see B.L. Holian, Shock Waves 5, 149 (1995). Subsequently, Zaretskii and co-workers,(E.B. Zaretskii, G.I. Kanel, P.A. Mogilevskii, and V.E. Fortov, Sov. Phys. Dokl. 36), 76 (1991). using x-ray diffraction of shocked single crystals, confirmed our MD observations of stacking faults produced by shockwave passage. With the advent of massively parallel computers, we have recently studied systems with over six-times larger cross-sectional area and four-times longer distance of run to the steady state (approximately 270,000 atoms). We have seen that the increased cross-section allows the system to slip along both available forward slip systems, in

Developing a laser shockwave model for characterizing diffusion bonded interfaces

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lacy, Jeffrey M., E-mail: Jeffrey.Lacy@inl.gov; Smith, James A., E-mail: Jeffrey.Lacy@inl.gov; Rabin, Barry H., E-mail: Jeffrey.Lacy@inl.gov

2015-03-31

The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengthsmore » in fresh and irradiated fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However, because the deposition of laser energy into the containment layer on a specimen's surface is intractably complex, the shock wave energy is inferred from the surface velocity measured on the backside of the fuel plate and the depth of the impression left on the surface by the high pressure plasma pulse created by the shock laser. To help quantify the stresses generated at the interfaces, a finite element method (FEM) model is being utilized. This paper will report on initial efforts to develop and validate the model by comparing numerical and experimental results for back surface velocities and front surface depressions in a single aluminum plate representative of the fuel cladding.« less

Developing a laser shockwave model for characterizing diffusion bonded interfaces

NASA Astrophysics Data System (ADS)

Lacy, Jeffrey M.; Smith, James A.; Rabin, Barry H.

2015-03-01

The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) with the goal of reducing the worldwide use of high-enriched uranium (HEU). A salient component of that initiative is the conversion of research reactors from HEU to low enriched uranium (LEU) fuels. An innovative fuel is being developed to replace HEU in high-power research reactors. The new LEU fuel is a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to support the fuel qualification process, the Laser Shockwave Technique (LST) is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However, because the deposition of laser energy into the containment layer on a specimen's surface is intractably complex, the shock wave energy is inferred from the surface velocity measured on the backside of the fuel plate and the depth of the impression left on the surface by the high pressure plasma pulse created by the shock laser. To help quantify the stresses generated at the interfaces, a finite element method (FEM) model is being utilized. This paper will report on initial efforts to develop and validate the model by comparing numerical and experimental results for back surface velocities and front surface depressions in a single aluminum plate representative of the fuel cladding.

Angular distributions of the protons in the reaction. pi. /sup +/+Xe. -->. p+xxx at 2. 34 GeV/c as a background for the shock-wave effect

DOE Office of Scientific and Technical Information (OSTI.GOV)

Slowinski, B.; Strugalski, Z.

1977-02-20

Results are presented of an analysis of the angular distributions of protons with E/sub p/> or =30 MeV emitted with different numbers of secondary charged particles in ..pi../sup +/+Xe interactions at 2.34 GeV/c. The obtained distributions are compared with the analogous characteristics of the protons emitted in collisions of protons or ..cap alpha.. particles with heavy emulsion nuclei and with lead at 70 and 17 GeV/c. It is concluded that the investigated distributions reveal no irregularities capable of attesting to a noticable role of the shock-wave mechanism in the target nuclei.

Influence of shockwave profile on ejecta: An experimental and computational study

NASA Astrophysics Data System (ADS)

Zellner, Michael; Germann, Timothy; Hammerberg, James; Rigg, Paulo; Stevens, Gerald; Turley, William; Buttler, William

2009-06-01

This effort investigates the relation between shock-pulse shape and the amount of micron-scale fragments ejected (ejecta) upon shock release at the metal/vacuum interface of shocked Sn targets. Two shock-pulse shapes are considered: a supported shock created by impacting a Sn target with a sabot that was accelerated using a powder gun; and an unsupported or Taylor shockwave, created by detonation of high explosive that was press-fit to the front-side of the Sn target. Ejecta production at the back-side or free-side of the Sn coupons were characterized through use of piezoelectric pins, Asay foils, optical shadowgraph, and x-ray attenuation. In addition to the experimental results, SPaSM, a short-ranged parallel molecular dynamics code developed at Los Alamos National Laboratory, was used to investigate the relation between shock-pulse shape and production of ejecta from a first principles point-of-view.

Comparison of geometrical shock dynamics and kinematic models for shock-wave propagation

NASA Astrophysics Data System (ADS)

Ridoux, J.; Lardjane, N.; Monasse, L.; Coulouvrat, F.

2018-03-01

Geometrical shock dynamics (GSD) is a simplified model for nonlinear shock-wave propagation, based on the decomposition of the shock front into elementary ray tubes. Assuming small changes in the ray tube area, and neglecting the effect of the post-shock flow, a simple relation linking the local curvature and velocity of the front, known as the A{-}M rule, is obtained. More recently, a new simplified model, referred to as the kinematic model, was proposed. This model is obtained by combining the three-dimensional Euler equations and the Rankine-Hugoniot relations at the front, which leads to an equation for the normal variation of the shock Mach number at the wave front. In the same way as GSD, the kinematic model is closed by neglecting the post-shock flow effects. Although each model's approach is different, we prove their structural equivalence: the kinematic model can be rewritten under the form of GSD with a specific A{-}M relation. Both models are then compared through a wide variety of examples including experimental data or Eulerian simulation results when available. Attention is drawn to the simple cases of compression ramps and diffraction over convex corners. The analysis is completed by the more complex cases of the diffraction over a cylinder, a sphere, a mound, and a trough.

Shock-Wave Acceleration of Protons on OMEGA EP

NASA Astrophysics Data System (ADS)

Haberberger, D.; Froula, D. H.; Pak, A.; Link, A.; Patel, P.; Fiuza, F.; Tochitsky, S.; Joshi, C.

2015-11-01

Recent experimental results using shock-wave acceleration (SWA) driven by a CO2 laser in a H2 gas-jet plasma have shown the possibility of producing proton beams with energy spreads <10% and with energies of up to 20 MeV using a modest peak laser power of 4 TW. Here we propose the investigation of the scaling of the SWA mechanism to higher laser powers using the 1- μm OMEGA EP Laser System at the Laboratory for Laser Energetics. The required tailored plasma profile is created by expanding a CH target using the thermal x-ray emission from a UV ablated material. The desired characteristics optimal for SWA are met: (a) peak plasma density is overcritical for the 1- μm main pulse and (b) the plasma profile exponentially decays over a long scale length on the rear side. Results will be shown using a 4 ω probe to experimentally characterize the plasma density profile. Scaling from simulations of the SWA mechanism shows that ion energies in the range of 100 MeV/amu are achievable with a focused a0 of 5 from the OMEGA EP Laser System. This material is based upon work supported by the Department of Energy National Nuclear Security Administration under Award Number DE-NA0001944.

Single-center experience using three shockwave lithotripters with different generator designs in management of urinary calculi.

PubMed

Ng, C F; Thompson, T J; McLornan, L; Tolley, D A

2006-01-01

We retrospectively reviewed the treatment outcomes of extracorporeal shockwave lithotripsy (SWL) in a single center using either the Wolf Piezolith 2300 (a piezoelectric lithotripter), the Dornier MPL9000 (an electrohydraulic lithotripter), or the Dornier Compact Delta (an electromagnetic lithotripter) from January 1992 to June 2002. A series of 3123 (1449 Piezolith 2300, 780 MPL9000, and 894 Compact Delta) solitary radiopaque urinary stones of < or =15 mm receiving primary SWL were identified. "Stone free" was defined as the absence of evidence of stone on plain radiography. Treatment outcomes were assessed by the stone-free rate 3 months after one treatment session, the retreatment rate, the auxiliary procedure rate, the complication rate, and the effectiveness quotient (EQ). In order to have a better assessment of the efficacy of individual lithotripters, multiple logistic regression was performed to control various factors affecting treatment outcomes, including lithotripter-type, patients' sex and age, history of previous SWL, the stone characteristics (side, site, and size), and the presence of a stent or nephrostomy tube. There were significant differences in the stone site distribution and mean stone size among the three groups. The overall EQ for the Piezolith 2300, MPL9000, and Compact Delta were 0.345, 0.303, and 0.257, respectively. However, using the multiple logistic regression model, the adjusted odds ratio (AOR) of a patient being stone-free after 3 month for the Piezolith 2300 and MPL9000 (using the Compact Delta as the referent category) were 1.38 (95% CI 1.15, 1.65) and 1.72 (95% CI 1.39, 2.11), respectively. Patients treated using the MPL9000 had significantly less re-treatment (AOR = 0.57; 95% CI 0.48, 0.69) than the other groups. No significant difference in the auxiliary procedure rate and complication rate for the three machines was observed. Based on multivariate analysis results, the Dornier MPL9000 had the best treatment outcomes in terms

Long-term effect of extracorporeal shock wave therapy on the treatment of chronic pelvic pain syndrome due to non bacterial prostatitis.

PubMed

Moayednia, Amir; Haghdani, Saeid; Khosrawi, Saeid; Yousefi, Elham; Vahdatpour, Babak

2014-04-01

There is limited evidence about the chronic pelvic pain syndrome (CPPS) treatment by shockwave therapy, and the aim of this study was to evaluate the effect of extracorporeal shockwave therapy on CPPS due to non bacterial prostatitis in a long-term period. In a follow-up survey, 40 patients with CPPS (that were randomly distributed into the treatment or sham groups were evaluated at 16, 20, and 24 weeks. In the treatment group, patients were treated by extracorporeal shock wave therapy (ESWT) once a week for 4 weeks by a protocol of 3000 impulses, 0.25 mJ/m(2) and 3 Hz of frequency. 0.05 mJ/m(2) were added in each week. In the sham group, the same protocol was applied, but with the probe being turned off. The follow-up assessments were done by visual analog scale for pain and National Institutes of Health-developed Chronic Prostatitis Symptom Index (NIH-CPSI). Data were compared using independent t-test or analysis of variences. Three patients did not complete the study protocol, 37 patients were evlauated (19 patients in treatment and 18 patients in the sham group). At week 24, the mean of pain score, urinary score, quality-of-life and NIH-CPSI score between two groups were not statistically different. Although, ESWT therapy as a safe and effective therapy in CPPS in short-term follow-up has been established, its long-term efficacy was not supported by this study.

Effect of target-fixture geometry on shock-wave compacted copper powders

NASA Astrophysics Data System (ADS)

Kim, Wooyeol; Ahn, Dong-Hyun; Yoon, Jae Ik; Park, Lee Ju; Kim, Hyoung Seop

2018-01-01

In shock compaction with a single gas gun system, a target fixture is used to safely recover a powder compact processed by shock-wave dynamic impact. However, no standard fixture geometry exists, and its effect on the processed compact is not well studied. In this study, two types of fixture are used for the dynamic compaction of hydrogen-reduced copper powders, and the mechanical properties and microstructures are investigated using the Vickers microhardness test and electron backscatter diffraction, respectively. With the assistance of finite element method simulations, we analyze several shock parameters that are experimentally hard to control. The results of the simulations indicate that the target geometry clearly affects the characteristics of incident and reflected shock waves. The hardness distribution and the microstructure of the compacts also show their dependence on the geometry. With the results of the simulations and the experiment, it is concluded that the target geometry affects the shock wave propagation and wave interaction in the specimen.

How the Toughest Inorganic Fullerene Cages Absorb Shockwave Pressures in a Protective Nanocomposite: Experimental Evidence from Two In Situ Investigations.

PubMed

Xu, Fang; Kobayashi, Takamichi; Yang, Zhuxian; Sekine, Toshimori; Chang, Hong; Wang, Nannan; Xia, Yongde; Zhu, Yanqiu

2017-08-22

Nanocomposites fabricated using the toughest caged inorganic fullerene WS 2 (IF-WS 2 ) nanoparticles could offer ultimate protection via absorbing shockwaves; however, if the IF-WS 2 nanomaterials really work, how they behave and what they experience within the nanocomposites at the right moment of impact have never been investigated effectively, due to the limitations of existing investigation techniques that are unable to elucidate the true characteristics of high-speed impacts in composites. We first fabricated Al matrix model nanocomposites and then unlocked the exact roles of IF-WS 2 in it at the exact moment of impact, at a time resolution that has never been attempted before, using two in situ techniques. We find that the presence of IF-WS 2 reduced the impact velocity by over 100 m/s and in pressure by at least 2 GPa against those Al and hexagonal WS 2 platelet composites at an impact speed of 1000 m/s. The IF-WS 2 composites achieved an intriguing inelastic impact and outperformed other reference composites, all originating from the "balloon effect" by absorbing the shockwave pressures. This study not only provides fundamental understanding for the dynamic performance of composites but also benefits the development of protective nanocomposite engineering.

Spectroscopic diagnostics of plume rebound and shockwave dynamics of confined aluminum laser plasma plumes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yeates, P.; Kennedy, E. T.; School of Physical Sciences, Dublin City University

2011-06-15

Generation and expansion dynamics of aluminum laser plasma plumes generated between parallel plates of varying separation ({Delta}Z = 2.0, 3.2, 4.0, and 5.6 mm), which confined plume expansion normal to the ablation surface, were diagnosed. Space and time resolved visible emission spectroscopy in the spectral range {lambda} = 355-470 nm and time gated visible imaging were employed to record emission spectra and plume dynamics. Space and time resolved profiles of N{sub e} (the electron density), T{sub e} (the electron temperature), and T{sub ionz} (the ionization temperature) were compared for different positions in the plasma plume. Significant modifications of the profilesmore » of the above parameters were observed for plasma-surface collisions at the inner surface of the front plate, which formed a barrier to the free expansion of the plasma plume generated by the laser light on the surface of the back plate. Shockwave generation at the collision interface resulted in delayed compression of the low-density plasma plume near the inner ablation surface, at late stages in the plasma history. Upon exiting the cavity formed by the two plates, through an aperture in the front plate, the plasma plume underwent a second phase of free expansion.« less

Bubble Proliferation or Dissolution of Cavitation Nuclei in the Beam Path of a Shock-Wave Lithotripter

NASA Astrophysics Data System (ADS)

Frank, Spencer; Lautz, Jaclyn; Sankin, Georgy N.; Szeri, Andrew J.; Zhong, Pei

2015-03-01

It is hypothesized that the decreased treatment efficiency in contemporary shock-wave lithotripters is related to tensile wave attenuation due to cavitation in the prefocal beam path. Utilizing high-speed imaging of the beam path and focal pressure waveform measurements, tensile attenuation is associated with bubble proliferation. By systematically testing different combinations of pulse-repetition frequency and gas concentration, we modulate the bubble-dissolution time to identify which conditions lead to bubble proliferation and show that reducing bubble proliferation in the beam path significantly improves acoustic transmission and stone comminution efficiency in vitro. In addition to experiments, a bubble-proliferation model is developed that takes gas diffusion across the bubble wall and bubble fragmentation into account. By aligning the model with experimental observations, the number of daughter bubbles produced after a single lithotripter bubble collapse is estimated to be in the range of 253 ˜510 . This finding is on the same order of magnitude with previous measurements of an isolated bubble collapse in a lithotripter field by Pishchalnikov, McAteer, and Williams [BJU Int. 102, 1681 (2008), 10.1111/j.1464-410X.2008.07896.x], and this estimate improves the general understanding of lithotripsy bubble dynamics in the beam path.

Correlation between the outcome of extracorporeal shockwave therapy and pretreatment MRI findings for chronic plantar fasciitis.

PubMed

Maki, Masahiro; Ikoma, Kazuya; Imai, Kan; Kido, Masamitsu; Hara, Yusuke; Arai, Yuji; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2015-05-01

The purpose of this study was to investigate the relationship between magnetic resonance imaging (MRI) findings before extracorporeal shockwave therapy (ESWT) and the treatment outcome of ESWT. This study examined 50 feet with chronic plantar fasciitis. The scores before ESWT and after a six-month follow-up were investigated using the Japanese Society for Surgery of the Foot (JSSF) Ankle-Hindfoot Scale and the Visual Analog Scale (VAS). MRI before ESWT was used for image evaluation. MRI revealed thickening of the plantar fascia (PF), and an investigation was conducted regarding the findings of a high-signal-intensity area (HSIA) inside the PF, edema near the PF, and bone marrow edema (BME) of the calcaneus. The average JSSF score and VAS score improved significantly at follow-up. In total, 44 feet were noted in the improved group. MRI revealed that the average amounts of PF thickening did not significantly differ between the improved group and the non-improved group. HSIA, edema near the PF, and BME were observed in 36, 41, and 11 feet in the improved group, respectively; and 2, 4, and 2 feet in the non-improved group, respectively. An HSIA in the PF predicted symptom improvement more easily than other MRI findings. IV.

Treatment of Standardized Fractures by Extracorporeal Shockwave Therapy (ESWT)

DTIC Science & Technology

2001-10-25

prostate carcinoma and melanomas [4,7,18,19]. Having an analgesic effect, shock waves, are also used in treatment of tendinosis calcarea, tennis ... elbow and heel spurs [6,11,15]. Another application area for ESWT is pseudoarthrosis [9,12,13]. In bone tissue, ESWT imitates a fresh fracture

Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation

PubMed Central

Kim, Jung Kwon; Ha, Seung Beom; Jeon, Chan Hoo; Oh, Jong Jin; Cho, Sung Yong; Oh, Seung-June; Kim, Hyeon Hoe; Jeong, Chang Wook

2016-01-01

Purpose Shock-wave lithotripsy (SWL) is accepted as the first line treatment modality for uncomplicated upper urinary tract stones; however, validated prediction models with regards to stone-free rates (SFRs) are still needed. We aimed to develop nomograms predicting SFRs after the first and within the third session of SWL. Computed tomography (CT) information was also modeled for constructing nomograms. Materials and Methods From March 2006 to December 2013, 3028 patients were treated with SWL for ureter and renal stones at our three tertiary institutions. Four cohorts were constructed: Total-development, Total-validation, CT-development, and CT-validation cohorts. The nomograms were developed using multivariate logistic regression models with selected significant variables in a univariate logistic regression model. A C-index was used to assess the discrimination accuracy of nomograms and calibration plots were used to analyze the consistency of prediction. Results The SFR, after the first and within the third session, was 48.3% and 68.8%, respectively. Significant variables were sex, stone location, stone number, and maximal stone diameter in the Total-development cohort, and mean Hounsfield unit (HU) and grade of hydronephrosis (HN) were additional parameters in the CT-development cohort. The C-indices were 0.712 and 0.723 for after the first and within the third session of SWL in the Total-development cohort, and 0.755 and 0.756, in the CT-development cohort, respectively. The calibration plots showed good correspondences. Conclusions We constructed and validated nomograms to predict SFR after SWL. To the best of our knowledge, these are the first graphical nomograms to be modeled with CT information. These may be useful for patient counseling and treatment decision-making. PMID:26890006

In vitro study of the mechanical effects of shock-wave lithotripsy.

PubMed

Howard, D; Sturtevant, B

1997-01-01

Impulsive stress in repeated shock waves administered during extracorporeal shock-wave lithotripsy (ESWL) causes injury to kidney tissue. In a study of the mechanical input of ESWL, the effects of focused shock waves on thin planar polymeric membranes immersed in a variety of tissue-mimicking fluids have been examined. A direct mechanism of failure by shock compression and an indirect mechanism by bubble collapse have been observed. Thin membranes are easily damaged by bubble collapse. After propagating through cavitation-free acoustically heterogeneous media (liquids mixed with hollow glass spheres, and tissue) shock waves cause membranes to fail in fatigue by a shearing mechanism. As is characteristic of dynamic fatigue, the failure stress increases with strain rate, determined by the amplitude and rise time of the attenuated shock wave. Shocks with large amplitude and short rise time (i.e., in uniform media) cause no damage. Thus the inhomogeneity of tissue is likely to contribute to injury in ESWL. A definition of dose is proposed which yields a criterion for damage based on measurable shock wave properties.

Treatment efficacy and outcomes using a third generation shockwave lithotripter.

PubMed

Neisius, Andreas; Wöllner, Jens; Thomas, Christian; Roos, Frederik C; Brenner, Walburgis; Hampel, Christian; Preminger, Glenn M; Thüroff, Joachim W; Gillitzer, Rolf

2013-11-01

To evaluate the clinical efficiency of a third generation electromagnetic shock wave lithotripter, the Lithoskop(®) (Siemens, Erlangen, Germany), regarding outcomes, stone disintegration, retreatment and complication rates. To compare the results of the Lithoskop with other currently available systems and the reference standard lithotripter, the HM-3 (Dornier MedTech Europe GmbH, Wessling, Germany). We analysed the data from 183 patients, including 13 children, undergoing extracorporeal shock wave lithotripsy (ESWL) for renal and ureteric calculi collected from a prospectively populated database. Outcomes were assessed by plain abdominal film of kidney, ureter and bladder and renal ultrasonography for radiopaque and computerized tomography for radiolucent stones 1 day after treatment and after 3 months. We analysed stone size and location before and after treatment, stone disintegration rate, retreatment rate, stone-free and residual fragment rates after 3 months, along with auxiliary procedures and complications. The mean (range) patient age was 48.6 (1.3-81.4) years, including 13 children with a mean (range) age of 8.4 (1.3-16.7) years, and 77% of the patients were male. In all, 46% of the calculi were localized in the kidney and 54% in the ureter. Renal stones were localized in the upper, middle and lower calyx and in the renal pelvis in 9, 29, 30 and 32% of patients, respectively. Ureteric stones were localized in the upper, mid- and distal ureter in 29, 19 and 52% of patients, respectively. The median (range) stone size before ESWL was 10 (4-25) mm in the kidney and 8 (4-28) mm in the ureteric calculi. The overall stone-free rate after 3 months was 91% (88% for renal and 93% for ureteric calculi); the mean number of sessions to achieve these rates was 1.3. Stone-free rates and the required number of sessions were determined only by stone size. In 7.1% of the patients (n = 13) post-interventional auxiliary procedures were necessary. We observed one perirenal

A cumulative shear mechanism for tissue damage initiation in shock-wave lithotripsy.

PubMed

Freund, Jonathan B; Colonius, Tim; Evan, Andrew P

2007-09-01

Evidence suggests that inertial cavitation plays an important role in the renal injury incurred during shock-wave lithotripsy. However, it is unclear how tissue damage is initiated, and significant injury typically occurs only after a sufficient dose of shock waves. Although it has been suggested that shock-induced shearing might initiate injury, estimates indicate that individual shocks do not produce sufficient shear to do so. In this paper, we hypothesize that the cumulative shear of the many shocks is damaging. This mechanism depends on whether there is sufficient time between shocks for tissue to relax to its unstrained state. We investigate the mechanism with a physics-based simulation model, wherein the basement membranes that define the tubules and vessels in the inner medulla are represented as elastic shells surrounded by viscous fluid. Material properties are estimated from in-vitro tests of renal basement membranes and documented mechanical properties of cells and extracellular gels. Estimates for the net shear deformation from a typical lithotripter shock (approximately 0.1%) are found from a separate dynamic shock simulation. The results suggest that the larger interstitial volume (approximately 40%) near the papilla tip gives the tissue there a relaxation time comparable to clinical shock delivery rates (approximately 1 Hz), thus allowing shear to accumulate. Away from the papilla tip, where the interstitial volume is smaller (approximately 20%), the model tissue relaxes completely before the next shock would be delivered. Implications of the model are that slower delivery rates and broader focal zones should both decrease injury, consistent with some recent observations.

[Physical factors in the treatment and rehabilitation of patients with chronic prostatitis complicated by impotence].

PubMed

Karpukhin, I V; Bogomol'nyĭ, V A

1999-01-01

103 patients with chronic prostatitis complicated by erectile impotence were given combined treatment including shock-wave massage, mud applications, local vacuum magnetotherapy. This combination was found to stimulate copulative function, urodynamics of the lower urinary tracts, to produce an antiinflammatory effect. These benefits allow to recommend the above physical factors for management of chronic prostatitis patients with copulative dysfunction.

Shock-induced bubble jetting into a viscous fluid with application to tissue injury in shock-wave lithotripsy.

PubMed

Freund, J B; Shukla, R K; Evan, A P

2009-11-01

Shock waves in liquids are known to cause spherical gas bubbles to rapidly collapse and form strong re-entrant jets in the direction of the propagating shock. The interaction of these jets with an adjacent viscous liquid is investigated using finite-volume simulation methods. This configuration serves as a model for tissue injury during shock-wave lithotripsy, a medical procedure to remove kidney stones. In this case, the viscous fluid provides a crude model for the tissue. It is found that for viscosities comparable to what might be expected in tissue, the jet that forms upon collapse of a small bubble fails to penetrate deeply into the viscous fluid "tissue." A simple model reproduces the penetration distance versus viscosity observed in the simulations and leads to a phenomenological model for the spreading of injury with multiple shocks. For a reasonable selection of a single efficiency parameter, this model is able to reproduce in vivo observations of an apparent 1000-shock threshold before wide-spread tissue injury occurs in targeted kidneys and the approximate extent of this injury after a typical clinical dose of 2000 shock waves.

Shock-induced bubble jetting into a viscous fluid with application to tissue injury in shock-wave lithotripsy

PubMed Central

Freund, J. B.; Shukla, R. K.; Evan, A. P.

2009-01-01

Shock waves in liquids are known to cause spherical gas bubbles to rapidly collapse and form strong re-entrant jets in the direction of the propagating shock. The interaction of these jets with an adjacent viscous liquid is investigated using finite-volume simulation methods. This configuration serves as a model for tissue injury during shock-wave lithotripsy, a medical procedure to remove kidney stones. In this case, the viscous fluid provides a crude model for the tissue. It is found that for viscosities comparable to what might be expected in tissue, the jet that forms upon collapse of a small bubble fails to penetrate deeply into the viscous fluid “tissue.” A simple model reproduces the penetration distance versus viscosity observed in the simulations and leads to a phenomenological model for the spreading of injury with multiple shocks. For a reasonable selection of a single efficiency parameter, this model is able to reproduce in vivo observations of an apparent 1000-shock threshold before wide-spread tissue injury occurs in targeted kidneys and the approximate extent of this injury after a typical clinical dose of 2000 shock waves. PMID:19894850

The Effectiveness of High-Energy Extracorporeal Shockwave Therapy Versus Ultrasound-Guided Needling Versus Arthroscopic Surgery in the Management of Chronic Calcific Rotator Cuff Tendinopathy: A Systematic Review.

PubMed

Louwerens, Jan K G; Veltman, Ewout S; van Noort, Arthur; van den Bekerom, Michel P J

2016-01-01

The objectives of this comprehensive quantitative review of the treatment of calcific tendinopathy of the rotator cuff were to investigate if there is a sustainable positive effect on outcomes after treatment with high-energy extracorporeal shockwave therapy (ESWT) or ultrasound (US)-guided needling and to compare these results with those of treatment with arthroscopic surgery. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2014 to identify relevant clinical articles in peer-reviewed journals with at least 6 months' follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the calcific deposit. Twenty-two studies were included (1,258 shoulders). The mean Coleman Methodology Score for the included studies was 77.1 ± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either high-energy ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered. Patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Side effects and post-treatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider high-energy ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of deposit removal and the additional benefit of subacromial decompression remain unclear. Level IV, systematic review of Level I, II, and IV studies. Copyright �

The midterm effectiveness of extracorporeal shockwave therapy in the management of chronic calcific shoulder tendinitis.

PubMed

Lee, Soak-Yee; Cheng, Bijun; Grimmer-Somers, Karen

2011-07-01

This systematic review explored the midterm effectiveness of extracorporeal shockwave therapy (ESWT) in reducing pain and improving shoulder function. Calcified rotator cuff tendinitis is a common cause of chronic shoulder pain that leads to significant pain and functional limitations. ESWT is an alternative to surgery when conservative treatments such as nonsteroidal antiinflammatory drugs, steroidal injections, and physiotherapy fail to relieve symptoms. It is hypothesised that ESWT is effective in the midterm for reducing pain and improving function for patients with chronic calcific tendinitis and that a dose-response relationship exists in the treatment parameters for effectiveness. Articles were electronically searched from the Cochrane Controlled Trials Register, MEDLINE, CINAHL, PUBMED, EMBASE, SPORTSDiscus and PEDro using a comprehensive search strategy. Studies were included if they were randomized controlled trials testing the midterm effectiveness of ESWT for chronic calcific tendonitis. Methodologic quality was assessed by PEDro (total score = 10). The strength of the evidence was reported using the National Health and Medical Research Council body of evidence framework. Six of the nine included studies scored 7 or more for methodologic quality. All studies had follow-up periods of at least 6 months. Common methodologic flaws were insufficient blinding of clinicians and assessors. There was consistent evidence of midterm effectiveness of ESWT in reducing pain and improving shoulder function for patients with chronic calcified tendinitis. ESWT is a potential alternative to surgery with good mid-term effectiveness and minimal side effects. This review noted several limitations with the current body of evidence. Studies were mainly from a few European countries involving medical doctors, with a lack of diverse perspectives and effectiveness evaluation from other health professionals who might use this treatment option for patients with chronic calcific

The effects of shockwave profile shape and shock obliquity on spallation in Cu and Ta: kinetic and stress-state effects on damage evolution(u)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gray, George T

2010-12-14

Widespread research over the past five decades has provided a wealth of experimental data and insight concerning shock hardening and the spallation response of materials subjected to square-topped shock-wave loading profiles. Less quantitative data have been gathered on the effect of direct, in-contact, high explosive (HE)-driven Taylor wave (or triangular-wave) loading profile shock loading on the shock hardening, damage evolution, or spallation response of materials. Explosive loading induces an impulse dubbed a 'Taylor Wave'. This is a significantly different loading history than that achieved by a square-topped impulse in terms of both the pulse duration at a fixed peak pressure,more » and a different unloading strain rate from the peak Hugoniot state achieved. The goal of this research is to quantify the influence of shockwave obliquity on the spallation response of copper and tantalum by subjecting plates of each material to HE-driven sweeping detonation-wave loading and quantify both the wave propagation and the post-mortem damage evolution. This talk will summarize our current understanding of damage evolution during sweeping detonation-wave spallation loading in Cu and Ta and show comparisons to modeling simulations. The spallation responses of Cu and Ta are both shown to be critically dependent on the shockwave profile and the stress-state of the shock. Based on variations in the specifics of the shock drive (pulse shape, peak stress, shock obliquity) and sample geometry in Cu and Ta, 'spall strength' varies by over a factor of two and the details of the mechanisms of the damage evolution is seen to vary. Simplistic models of spallation, such as P{sub min} based on 1-D square-top shock data lack the physics to capture the influence of kinetics on damage evolution such as that operative during sweeping detonation loading. Such considerations are important for the development of predictive models of damage evolution and spallation in metals and alloys.« less

Cavitation cluster dynamics in shock-wave lithotripsy: part 1. Free field.

PubMed

Arora, M; Junge, L; Ohl, C D

2005-06-01

The spatiotemporal dynamics of cavitation bubble growth and collapse in shock-wave lithotripsy in a free field was studied experimentally. The lithotripter was equipped with two independently triggerable layers of piezoceramics. The front and back layers generated positive pressure amplitudes of 30 MPa and 15 MPa, respectively, and -10 MPa negative amplitude. The time interval between the launch of the shock waves was varied from 0 and 0.1 s, covering the regimens of pulse-modification (regimen A, delay 0 to 4 micros), shock wave-cavitation cluster interaction (B, 4 micros to 64 micros) and shock wave-gas bubble interaction (C, 256 micros to 0.1 s). The time-integrated cavitation activity was most strongly influenced in regimen A and, in regimen B, the spatial distribution of bubbles was altered, whereas enhancement of cavitation activity was observed in regimen C. Quantitative measurements of the spatial- and time-integrated void fractions were obtained with a photographic and light-scattering technique. The preconditions for a reproducible experiment are explained, with the existence of two distinct types of cavitation nuclei, small particles suspended in the liquid and residuals of bubbles from prior cavitation clusters.

Dynamics in a one-dimensional ferrogel model: relaxation, pairing, shock-wave propagation.

PubMed

Goh, Segun; Menzel, Andreas M; Löwen, Hartmut

2018-05-23

Ferrogels are smart soft materials, consisting of a polymeric network and embedded magnetic particles. Novel phenomena, such as the variation of the overall mechanical properties by external magnetic fields, emerge consequently. However, the dynamic behavior of ferrogels remains largely unveiled. In this paper, we consider a one-dimensional chain consisting of magnetic dipoles and elastic springs between them as a simple model for ferrogels. The model is evaluated by corresponding simulations. To probe the dynamics theoretically, we investigate a continuum limit of the energy governing the system and the corresponding equation of motion. We provide general classification scenarios for the dynamics, elucidating the touching/detachment dynamics of the magnetic particles along the chain. In particular, it is verified in certain cases that the long-time relaxation corresponds to solutions of shock-wave propagation, while formations of particle pairs underlie the initial stage of the dynamics. We expect that these results will provide insight into the understanding of the dynamics of more realistic models with randomness in parameters and time-dependent magnetic fields.

Changes of articular cartilage and subchondral bone after extracorporeal shockwave therapy in osteoarthritis of the knee

PubMed Central

Wang, Ching-Jen; Cheng, Jai-Hong; Chou, Wen-Yi; Hsu, Shan-Ling; Chen, Jen-Hung; Huang, Chien-Yiu

2017-01-01

We assessed the pathological changes of articular cartilage and subchondral bone on different locations of the knee after extracorporeal shockwave therapy (ESWT) in early osteoarthritis (OA). Rat knees under OA model by anterior cruciate ligament transaction (ACLT) and medial meniscectomy (MM) to induce OA changes. Among ESWT groups, ESWT were applied to medial (M) femur (F) and tibia (T) condyles was better than medial tibia condyle, medial femur condyle as well as medial and lateral (L) tibia condyles in gross osteoarthritic areas (p<0.05), osteophyte formation and subchondral sclerotic bone (p<0.05). Using sectional cartilage area, modified Mankin scoring system as well as thickness of calcified and un-calcified cartilage analysis, the results showed that articular cartilage damage was ameliorated and T+F(M) group had the most protection as compared with other locations (p<0.05). Detectable cartilage surface damage and proteoglycan loss were measured and T+F(M) group showed the smallest lesion score among other groups (p<0.05). Micro-CT revealed significantly improved in subchondral bone repair in all ESWT groups compared to OA group (p<0.05). There were no significantly differences in bone remodeling after ESWT groups except F(M) group. In the immunohistochemical analysis, T+F(M) group significant reduced TUNEL activity, promoted cartilage proliferation by observation of PCNA marker and reduced vascular invasion through observation of CD31 marker for angiogenesis compared to OA group (P<0.001). Overall the data suggested that the order of the effective site of ESWT was T+F(M) ≧ T(M) > T(M+L) > F(M) in OA rat knees. PMID:28367081

Changes of articular cartilage and subchondral bone after extracorporeal shockwave therapy in osteoarthritis of the knee.

PubMed

Wang, Ching-Jen; Cheng, Jai-Hong; Chou, Wen-Yi; Hsu, Shan-Ling; Chen, Jen-Hung; Huang, Chien-Yiu

2017-01-01

We assessed the pathological changes of articular cartilage and subchondral bone on different locations of the knee after extracorporeal shockwave therapy (ESWT) in early osteoarthritis (OA). Rat knees under OA model by anterior cruciate ligament transaction (ACLT) and medial meniscectomy (MM) to induce OA changes. Among ESWT groups, ESWT were applied to medial (M) femur (F) and tibia (T) condyles was better than medial tibia condyle, medial femur condyle as well as medial and lateral (L) tibia condyles in gross osteoarthritic areas (p<0.05), osteophyte formation and subchondral sclerotic bone (p<0.05). Using sectional cartilage area, modified Mankin scoring system as well as thickness of calcified and un-calcified cartilage analysis, the results showed that articular cartilage damage was ameliorated and T+F(M) group had the most protection as compared with other locations (p<0.05). Detectable cartilage surface damage and proteoglycan loss were measured and T+F(M) group showed the smallest lesion score among other groups (p<0.05). Micro-CT revealed significantly improved in subchondral bone repair in all ESWT groups compared to OA group (p<0.05). There were no significantly differences in bone remodeling after ESWT groups except F(M) group. In the immunohistochemical analysis, T+F(M) group significant reduced TUNEL activity, promoted cartilage proliferation by observation of PCNA marker and reduced vascular invasion through observation of CD31 marker for angiogenesis compared to OA group (P<0.001). Overall the data suggested that the order of the effective site of ESWT was T+F(M) ≧ T(M) > T(M+L) > F(M) in OA rat knees.

Shock-induced bubble collapse in a vessel: Implications for vascular injury in shockwave lithotripsy

NASA Astrophysics Data System (ADS)

Coralic, Vedran; Colonius, Tim

2014-11-01

In shockwave lithotripsy, shocks are repeatedly focused on kidney stones so to break them. The process leads to cavitation in tissue, which leads to hemorrhage. We hypothesize that shock-induced collapse (SIC) of preexisting bubbles is a potential mechanism for vascular injury. We study it numerically with an idealized problem consisting of the three-dimensional SIC of an air bubble immersed in a cylindrical water column embedded in gelatin. The gelatin is a tissue simulant and can be treated as a fluid due to fast time scales and small spatial scales of collapse. We thus model the problem as a compressible multicomponent flow and simulate it with a shock- and interface-capturing numerical method. The method is high-order, conservative and non-oscillatory. Fifth-order WENO is used for spatial reconstruction and an HLLC Riemann solver upwinds the fluxes. A third-order TVD-RK scheme evolves the solution. We evaluate the potential for injury in SIC for a range of pressures, bubble and vessel sizes, and tissue properties. We assess the potential for injury by comparing the finite strains in tissue, obtained by particle tracking, to ultimate strains from experiments. We conclude that SIC may contribute to vascular rupture and discuss the smallest bubble sizes needed for injury. This research was supported by NIH Grant No. 2PO1DK043881 and utilized XSEDE, which is supported by NSF Grant No. OCI-1053575.

[The long-term results of the application of the combined rehabilitative treatment in the patients presenting with knee osteoarthrosis].

PubMed

Razumov, A N; Purigа, A O; Yurova, O V

2015-01-01

The rehabilitative treatment of the patients suffering from knee osteoarthrosis (OA) up-to-date remains one of the most important medical and social problems of modern medicine due to the high prevalence of this disease, heavy morbidity, and the significant deterioration of the quality of the patients' life. The objective of the present study was to evaluate the long-term results of the combined application of radon and extracorporeal shock-wave therapy for the rehabilitation of the patients presenting with knee OA. The study involved 75 patients at the age from 35 to 62 years with the confirmed diagnosis of stage II and III knee osteoarthrosis. They were divided into 3 groups. Those comprising the main group received extracorporeal shock-wave therapy in combination with the treatment based on the use of radon baths. The patients included in the group of comparison were given a course of radon therapy alone while the patients of the control group received the standard treatment including physiotherapy, magnetic therapy, and the use of non-steroidal anti-inflammatory drugs (NSAIDs). The study has demonstrated the high effectiveness of the combined application of the radon baths and extracorporeal shock-wave therapy that was manifested as the substantial decrease of pain intensity, the increased range of motion in the knee joints, and the improvement of the general quality of life. These beneficial effects persisted during a period of up to 12 months. The stable remission was documented in 82% of the patients comprising the main group. The data obtained give reason to recommend the method employed in the present study for the extensive practical application at different stages of medical rehabilitation of the patients presenting with knee osteoarthrosis.

A new electromagnetic shock-wave generator "SLX-F2" with user-selectable dual focus size: ex vivo evaluation of renal injury.

PubMed

Leistner, Rasmus; Wendt-Nordahl, Gunnar; Grobholz, Rainer; Michel, Maurice Stephan; Marlinghaus, Ernst; Köhrmann, Kai Uwe; Alken, Peter; Häcker, Axel

2007-08-01

Storz Medical AG (Kreutzlingen/Switzerland) has developed a new electromagnetic shockwave (SW) generator, the "SLX-F2", which allows the user to choose between a small-focus, high-pressure treatment regime or a wide-focus, low-pressure option. The aim of this study was to investigate, under standardized conditions, the impact of these two different treatment regimes on SW-induced renal injury. SW-induced renal injury was investigated by using the standardized model of the perfused ex vivo kidney. SWs were applied under ultrasound control in the parenchyma of a kidney pole. Different SW numbers (20, 50, 125, 250, 500, 1,000) were applied in three groups: group A was treated with a wider focus (80 MPa), groups B (60 MPa) and C (120 MPa) with a smaller focus (each parameter setting was repeated ten-fold). Disintegration capacity (measured by crater volume in cubes of plaster of Paris) was the same in groups A and C. After SW exposure, barium sulphate suspension was perfused through the renal artery. The maximum diameter (mm) of the extravasation in the cortex, representing the extent of vascular injury, was measured on X-ray mammography films. H&E staining was performed. In all three groups (A, B, C) a higher number of SWs caused the diameter of the extravasate to increase, with statistical significance appearing at 1,000 shots versus 20 shots (p < 0.05). Vascular injury was not influenced by the focal size and positive peak pressure at identical SW numbers applied. Histology of the focal area showed gap-like defects. Our ex vivo data show that renal vascular injury is independent of the focal diameter of the SW generator at the same peak positive pressure and disintegration power. This confirms the in vivo findings that show renal injury caused by SW as being related to the number of SWs administered. Clinical studies are needed to investigate whether there is any advantage to offering both treatment regimes in one SW machine-for example, by using the "wide

Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction-12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study.

PubMed

Fojecki, Grzegorz Lukasz; Tiessen, Stefan; Osther, Palle Jørn Sloth

2018-03-01

Short-term data on the effect of low-intensity extracorporeal shockwave therapy (Li-ESWT) on erectile dysfunction (ED) have been inconsistent. The suggested mechanisms of action of Li-ESWT on ED include stimulation of cell proliferation, tissue regeneration, and angiogenesis, which can be processes with a long generation time. Therefore, long-term data on the effect of Li-ESWT on ED are strongly warranted. To assess the outcome at 6 and 12 months of linear Li-ESWT on ED from a previously published randomized, double-blinded, sham-controlled trial. Subjects with ED (N = 126) who scored lower than 25 points in the erectile function domain of the International Index of Erectile Function (IIEF-EF) were eligible for the study. They were allocated to 1 of 2 groups: 5 weekly sessions of sham treatment (group A) or linear Li-ESWT (group B). After a 4-week break, the 2 groups received active treatment once a week for 5 weeks. At baseline and 6 and 12 months, subjects were evaluated by the IIEF-EF, the Erectile Hardness Scale (EHS), and the Sexual Quality of Life in Men. The primary outcome measure was an increase of at least 5 points in the IIEF-EF (ΔIIEF-EF score). The secondary outcome measure was an increase in the EHS score to at least 3 in men with a score no higher than 2 at baseline. Data were analyzed by linear and logistic regressions. Linear regression of the ΔIIEF-EF score from baseline to 12 months included 95 patients (dropout rate = 25%). Adjusted for the IIEF-EF score at baseline, the difference between groups B and A was -1.30 (95% CI = -4.37 to 1.77, P = .4). The success rate based on the main outcome parameter (ΔIIEF-EF score ≥ 5) was 54% in group A vs 47% in group B (odds ratio = 0.67, P = .28). Improvement based on changes in the EHS score in groups A and B was 34% and 24%, respectively (odds ratio = 0.47, P = .82). Exposure to 2 cycles of linear Li-ESWT for ED is not superior to 1 cycle at 6- and 12-month follow-ups. Fojecki GL, Tiessen S

Bifocal reflector for electrohydraulic lithotripters.

PubMed

Prieto, F E; Loske, A M

1999-03-01

To describe the design and construction of a bifocal reflector that could be used in electrohydraulic extracorporeal shockwave lithotripters in order to increase their efficiency. The new reflector is obtained by joining two sectors of two rotationally symmetric ellipsoidal reflectors having different distances between their foci, which results in a bifocal composite reflector with the F1 foci in coincidence and the two F2 foci separated by a certain distance. As in conventional reflectors, shockwaves are generated by the electrical breakdown of water between two electrodes, located at the focus (F1) closest to the reflector. A prototype was constructed and tested in an experimental shockwave generator of our own make, using two different types of kidney-stone models, one to test the stone fragmentation abilities, and the other to test the stone pitting abilities. Fragmentation data for the new reflector were compared with those of a conventional ellipsoidal reflector tested on the same device. The new design appeared to be more efficient in breaking up both types of kidney-stone models than the conventional reflector. Pressure measurements were obtained with both reflectors using needle hydrophones. The physical background of shockwave reflection on both reflectors is also explained. With this new reflector, it could be possible, in principle, to reduce the treatment time of extracorporeal shockwave lithotripsy.

Supersonic, shockwave-driven hydrodynamic instability experiments at OMEGA-EP

NASA Astrophysics Data System (ADS)

Wan, Willow

2016-10-01

Hydrodynamic instabilities play a dominant role in the transport of mass, momentum, and energy in nearly every plasma environment, governing the dynamics of natural and engineering systems such as solar convective zones, magnetospheric boundaries, and fusion experiments. In past decades, limitations in our understanding of hydrodynamic instabilities have led to discrepancies between observations and predictions. Since then, significant improvements have been made to our available experimental techniques, diagnostics, and simulation capabilities. Here, we present a novel experimental platform that can sustain a steady, supersonic flow across a precision-machined, well-characterized material interface for unprecedented durations We applied this platform to a series of Kelvin-Helmholtz instability experiments. The Kelvin-Helmholtz instability generates vortical structures and turbulence at an interface with shear flow. In a supersonic flow, the growth rate is inhibited and the instability structure is altered. The data were obtained at the OMEGA-EP facility by firing three laser beams in sequence to produce a 12 kJ, 28 ns stitched laser pulse. The ablation pressure sustained a steady shockwave for 70 ns over a foam-plastic, single-mode or dual-mode interface. A spherical crystal imager was used to measure the evolution of these modulations with high-resolution x-ray radiography using Cu Kα radiation at 8.0 keV. The observed structure was reproduced with 2D hydrodynamic simulations. Supported by the U.S. DOE, through NNSA Grants DE-NA0002956 (SSAA) and DE-NA0002719 (NLUF), by the LLE under DE-NA0001944, and by the LLNL under subcontract B614207 to DE-AC52-07NA27344.

Xenon Protects against Blast-Induced Traumatic Brain Injury in an In Vitro Model.

PubMed

Campos-Pires, Rita; Koziakova, Mariia; Yonis, Amina; Pau, Ashni; Macdonald, Warren; Harris, Katie; Edge, Christopher J; Franks, Nicholas P; Mahoney, Peter F; Dickinson, Robert

2018-04-15

The aim of this study was to evaluate the neuroprotective efficacy of the inert gas xenon as a treatment for patients with blast-induced traumatic brain injury in an in vitro laboratory model. We developed a novel blast traumatic brain injury model using C57BL/6N mouse organotypic hippocampal brain-slice cultures exposed to a single shockwave, with the resulting injury quantified using propidium iodide fluorescence. A shock tube blast generator was used to simulate open field explosive blast shockwaves, modeled by the Friedlander waveform. Exposure to blast shockwave resulted in significant (p < 0.01) injury that increased with peak-overpressure and impulse of the shockwave, and which exhibited a secondary injury development up to 72 h after trauma. Blast-induced propidium iodide fluorescence overlapped with cleaved caspase-3 immunofluorescence, indicating that shock-wave-induced cell death involves apoptosis. Xenon (50% atm) applied 1 h after blast exposure reduced injury 24 h (p < 0.01), 48 h (p < 0.05), and 72 h (p < 0.001) later, compared with untreated control injury. Xenon-treated injured slices were not significantly different from uninjured sham slices at 24 h and 72 h. We demonstrate for the first time that xenon treatment after blast traumatic brain injury reduces initial injury and prevents subsequent injury development in vitro. Our findings support the idea that xenon may be a potential first-line treatment for those with blast-induced traumatic brain injury.

Xenon Protects against Blast-Induced Traumatic Brain Injury in an In Vitro Model

PubMed Central

Campos-Pires, Rita; Koziakova, Mariia; Yonis, Amina; Pau, Ashni; Macdonald, Warren; Harris, Katie; Edge, Christopher J.; Franks, Nicholas P.; Mahoney, Peter F.

2018-01-01

Abstract The aim of this study was to evaluate the neuroprotective efficacy of the inert gas xenon as a treatment for patients with blast-induced traumatic brain injury in an in vitro laboratory model. We developed a novel blast traumatic brain injury model using C57BL/6N mouse organotypic hippocampal brain-slice cultures exposed to a single shockwave, with the resulting injury quantified using propidium iodide fluorescence. A shock tube blast generator was used to simulate open field explosive blast shockwaves, modeled by the Friedlander waveform. Exposure to blast shockwave resulted in significant (p < 0.01) injury that increased with peak-overpressure and impulse of the shockwave, and which exhibited a secondary injury development up to 72 h after trauma. Blast-induced propidium iodide fluorescence overlapped with cleaved caspase-3 immunofluorescence, indicating that shock-wave–induced cell death involves apoptosis. Xenon (50% atm) applied 1 h after blast exposure reduced injury 24 h (p < 0.01), 48 h (p < 0.05), and 72 h (p < 0.001) later, compared with untreated control injury. Xenon-treated injured slices were not significantly different from uninjured sham slices at 24 h and 72 h. We demonstrate for the first time that xenon treatment after blast traumatic brain injury reduces initial injury and prevents subsequent injury development in vitro. Our findings support the idea that xenon may be a potential first-line treatment for those with blast-induced traumatic brain injury. PMID:29285980

Extracorporeal shock-wave lithotripsy monotherapy of partial staghorn calculi. Prognostic factors and long-term results.

PubMed

El-Assmy, Ahmed; El-Nahas, Ahmed R; Madbouly, Khaled; Abdel-Khalek, Mohamed; Abo-Elghar, Mohamed E; Sheir, Khaled Z

2006-01-01

To define factors affecting the success and long-term outcome of extracorporeal shock-wave lithotripsy (ESWL) monotherapy of partial staghorn calculi. We retrospectively reviewed 92 patients with partial staghorn calculi who were treated with ESWL monotherapy. The outcome of the treatment was evaluated after 3 months. Long-term follow-up data (>24 months) were available for 49 patients. These data were further analyzed to determine long-term outcome. At 3 months, the overall stone-free rate was 59.8%. Multiple ESWL sessions were required in 85.8% of patients. Stone surface area>500 mm2 was the only factor that significantly decreased the stone-free rate. Post-ESWL complications occurred in 12 patients (13%), among whom renal obstruction was observed in 10.8%. Secondary procedures were needed in 17 cases (18.4%). After a mean follow-up period of 7.5 years, the stone-free rate was 59.2% (29/49) and one-third of patients developed recurrence. In the long term, clinically insignificant residual fragments (CIRFs) passed spontaneously in 23% of patients, remained stable in 38.5% and became bigger in 38.5%. Regrowth of CIRFs was related to a history of stone recurrence. No patients showed deterioration of kidney function on the treated side and an improvement in pre-ESWL hydronephrosis was observed in 73.3% of patients. ESWL is suitable for staghorn stones

Preliminary Investigation on the Effects of Shockwaves on Water Samples Using a Portable Semi-Automatic Shocktube

NASA Astrophysics Data System (ADS)

Wessley, G. Jims John

2017-10-01

The propagation of shock waves through any media results in an instantaneous increase in pressure and temperature behind the shockwave. The scope of utilizing this sudden rise in pressure and temperature in new industrial, biological and commercial areas has been explored and the opportunities are tremendous. This paper presents the design and testing of a portable semi-automatic shock tube on water samples mixed with salt. The preliminary analysis shows encouraging results as the salinity of water samples were reduced up to 5% when bombarded with 250 shocks generated using a pressure ratio of 2. 5. Paper used for normal printing is used as the diaphragm to generate the shocks. The impact of shocks of much higher intensity obtained using different diaphragms will lead to more reduction in the salinity of the sea water, thus leading to production of potable water from saline water, which is the need of the hour.

Shooter position estimation with muzzle blast and shockwave measurements from separate locations

NASA Astrophysics Data System (ADS)

Grasing, David

2016-05-01

There are two acoustical events associated with small arms fire: the muzzle blast (created by bullets being expelled from the barrel of the weapon), and the shockwave (created by bullets which exceed the speed of sound). Assuming the ballistics of a round are known, the times and directions of arrival of the acoustic events furnish sufficient information to determine the origin of the shot. Existing methods tacitly assume that it is a single sensor which makes measurements of the times and direction of arrival. If the sensor is located past the point where the bullet goes transonic or if the sensor is far off the axis of the shot line a single sensor localization become highly inaccurate due to the ill-conditioning of the localization problem. In this paper, a more general approach is taken which allows for localizations from measurements made at separate locations. There are considerable advantages to this approach, the most noteworthy of which is the improvement in localization accuracy due to the improvement in the conditioning of the problem. Additional benefits include: the potential to locate in cases where a single sensor has insufficient information, furnishing high quality initialization to data fusion algorithms, and the potential to identify the round from a set of possible rounds.

Shock-wave flow regimes at entry into the diffuser of a hypersonic ramjet engine: Influence of physical properties of the gas medium

NASA Astrophysics Data System (ADS)

Tarnavskii, G. A.

2006-07-01

The physical aspects of the effective-adiabatic-exponent model making it possible to decompose the total problem on modeling of high-velocity gas flows into individual subproblems (“physicochemical processes” and “ aeromechanics”), which ensures the creation of a universal and efficient computer complex divided into a number of independent units, have been analyzed. Shock-wave structures appearing at entry into the duct of a hypersonic aircraft have been investigated based on this methodology, and the influence of the physical properties of the gas medium in a wide range of variations of the effective adiabatic exponent has been studied.

Numerical shockwave anomalies in presence of hydraulic jumps in the SWE with variable bed elevation.

NASA Astrophysics Data System (ADS)

Navas-Montilla, Adrian; Murillo, Javier

2017-04-01

When solving the shallow water equations appropriate numerical solvers must allow energy-dissipative solutions in presence of steady and unsteady hydraulic jumps. Hydraulic jumps are present in surface flows and may produce significant morphological changes. Unfortunately, it has been documented that some numerical anomalies may appear. These anomalies are the incorrect positioning of steady jumps and the presence of a spurious spike of discharge inside the cell containing the jump produced by a non-linearity of the Hugoniot locus connecting the states at both sides of the jump. Therefore, this problem remains unresolved in the context of Godunov's schemes applied to shallow flows. This issue is usually ignored as it does not affect to the solution in steady cases. However, it produces undesirable spurious oscillations in transient cases that can lead to misleading conclusions when moving to realistic scenarios. Using spike-reducing techniques based on the construction of interpolated fluxes, it is possible to define numerical methods including discontinuous topography that reduce the presence of the aforementioned numerical anomalies. References: T. W. Roberts, The behavior of flux difference splitting schemes near slowly moving shock waves, J. Comput. Phys., 90 (1990) 141-160. Y. Stiriba, R. Donat, A numerical study of postshock oscillations in slowly moving shock waves, Comput. Math. with Appl., 46 (2003) 719-739. E. Johnsen, S. K. Lele, Numerical errors generated in simulations of slowly moving shocks, Center for Turbulence Research, Annual Research Briefs, (2008) 1-12. D. W. Zaide, P. L. Roe, Flux functions for reducing numerical shockwave anomalies. ICCFD7, Big Island, Hawaii, (2012) 9-13. D. W. Zaide, Numerical Shockwave Anomalies, PhD thesis, Aerospace Engineering and Scientific Computing, University of Michigan, 2012. A. Navas-Montilla, J. Murillo, Energy balanced numerical schemes with very high order. The Augmented Roe Flux ADER scheme. Application to

New treatments compared to established treatments in randomized trials

PubMed Central

Djulbegovic, Benjamin; Kumar, Ambuj; Glasziou, Paul P; Perera, Rafael; Reljic, Tea; Dent, Louise; Raftery, James; Johansen, Marit; Di Tanna, Gian Luca; Miladinovic, Branko; Soares, Heloisa P; Vist, Gunn E; Chalmers, Iain

2012-01-01

Background The proportion of proposed new treatments that are ’successful’ is of ethical, scientific, and public importance. We investigated how often new, experimental treatments evaluated in randomized controlled trials (RCTs) are superior to established treatments. Objectives Our main question was: “On average how often are new treatments more effective, equally effective or less effective than established treatments?” Additionally, we wanted to explain the observed results, i.e. whether the observed distribution of outcomes is consistent with the ’uncertainty requirement’ for enrollment in RCTs. We also investigated the effect of choice of comparator (active versus no treatment/placebo) on the observed results. Search methods We searched the Cochrane Methodology Register (CMR) 2010, Issue 1 in The Cochrane Library (searched 31 March 2010); MEDLINE Ovid 1950 to March Week 2 2010 (searched 24 March 2010); and EMBASE Ovid 1980 to 2010 Week 11 (searched 24 March 2010). Selection criteria Cohorts of studies were eligible for the analysis if they met all of the following criteria: (i) consecutive series of RCTs, (ii) registered at or before study onset, and (iii) compared new against established treatments in humans. Data collection and analysis RCTs from four cohorts of RCTs met all inclusion criteria and provided data from 743 RCTs involving 297,744 patients. All four cohorts consisted of publicly funded trials. Two cohorts involved evaluations of new treatments in cancer, one in neurological disorders, and one for mixed types of diseases. We employed kernel density estimation, meta-analysis and meta-regression to assess the probability of new treatments being superior to established treatments in their effect on primary outcomes and overall survival. Main results The distribution of effects seen was generally symmetrical in the size of difference between new versus established treatments. Meta-analytic pooling indicated that, on average, new treatments

Focal Adhesion Kinase Signaling Mediated the Enhancement of Osteogenesis of Human Mesenchymal Stem Cells Induced by Extracorporeal Shockwave

NASA Astrophysics Data System (ADS)

Hu, Jun; Liao, Haojie; Ma, Zebin; Chen, Hongjiang; Huang, Zhonglian; Zhang, Yuantao; Yu, Menglei; Chen, Youbin; Xu, Jiankun

2016-02-01

Extracorporeal shockwave (ESW) has been shown of great potential in promoting the osteogenesis of bone marrow mesenchymal stem cells (BMSCs), but it is unknown whether this osteogenic promotion effect can also be achieved in other MSCs (i.e., tendon-derived stem cells (TDSCs) and adipose-derived stem cells (ADSCs)). In the current study, we aimed not only to compare the osteogenic effects of BMSCs induced by ESW to those of TDSCs and ADSCs; but also to investigate the underlying mechanisms. We show here that ESW (0.16 mj/mm2) significantly promoted the osteogenic differentiation in all the tested types of MSCs, accompanied with the downregulation of miR-138, but the activation of FAK, ERK1/2, and RUNX2. The enhancement of osteogenesis in these MSCs was consistently abolished when the cells were pretreated with one of the following conditions: overexpression of miR-138, FAK knockdown using specific siRNA, and U0126, implying that all of these elements are indispensable for mediating the effect of ESW. Moreover, our study provides converging genetic and molecular evidence that the miR-138-FAK-ERK1/2-RUNX2 machinery can be generally activated in ESW-preconditioned MSCs, suggesting that ESW may be a promising therapeutic strategy for the enhancement of osteogenesis of MSCs, regardless of their origins.

Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete.

PubMed

Saxena, Amol; Fournier, Magali; Gerdesmeyer, Ludger; Gollwitzer, Hans

2012-10-01

Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient's return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment. II.

CT Texture Analysis of Ex Vivo Renal Stones Predicts Ease of Fragmentation with Shockwave Lithotripsy.

PubMed

Cui, Helen W; Devlies, Wout; Ravenscroft, Samuel; Heers, Hendrik; Freidin, Andrew J; Cleveland, Robin O; Ganeshan, Balaji; Turney, Benjamin W

2017-07-01

Understanding the factors affecting success of extracorporeal shockwave lithotripsy (SWL) would improve informed decision-making on the most appropriate treatment modality for an individual patient. Although stone size and skin-to-stone distance do correlate with fragmentation efficacy, it has been shown that stone composition and architecture, as reflected by structural heterogeneity on CT, are also important factors. This study aims to determine if CT texture analysis (CTTA), a novel, nondestructive, and objective tool that generates statistical metrics reflecting stone heterogeneity, could have utility in predicting likelihood of SWL success. Seven spontaneously passed, intact renal tract stones, were scanned ex vivo using standard CT KUB and micro-CT. The stones were then fragmented in vitro using a clinical lithotripter, after which, chemical composition analysis was performed. CTTA was used to generate a number of metrics that were correlated to the number of shocks needed to fragment the stone. CTTA metrics reflected stone characteristics and composition, and predicted ease of SWL fragmentation. The strongest correlation with number of shocks required to fragment the stone was mean Hounsfield unit (HU) density (r = 0.806, p = 0.028) and a CTTA metric measuring the entropy of the pixel distribution of the stone image (r = 0.804, p = 0.039). Using multiple linear regression analysis, the best model showed that CTTA metrics of entropy and kurtosis could predict 92% of the outcome of number of shocks needed to fragment the stone. This was superior to using stone volume or density. CTTA metrics entropy and kurtosis have been shown in this experimental ex vivo setting to strongly predict fragmentation by SWL. This warrants further investigation in a larger clinical study for the contribution of CT textural metrics as a measure of stone heterogeneity, along with other known clinical factors, to predict likelihood of SWL success.

On the possibility of using multi-element phased arrays for shock-wave action on deep brain structures

NASA Astrophysics Data System (ADS)

Rosnitskiy, P. B.; Gavrilov, L. R.; Yuldashev, P. V.; Sapozhnikov, O. A.; Khokhlova, V. A.

2017-09-01

A noninvasive ultrasound surgery method that relies on using multi-element focused phased arrays is being successfully used to destroy tumors and perform neurosurgical operations in deep structures of the human brain. However, several drawbacks that limit the possibilities of the existing systems in their clinical use have been revealed: a large size of the hemispherical array, impossibility of its mechanical movement relative to the patient's head, limited volume of dynamic focusing around the center of curvature of the array, and side effect of overheating skull. Here we evaluate the possibility of using arrays of smaller size and aperture angles to achieve shock-wave formation at the focus for thermal and mechanical ablation (histotripsy) of brain tissue taking into account current intensity limitations at the array elements. The proposed approach has potential advantages to mitigate the existing limitations and expand the possibilities of transcranial ultrasound surgery.

[Renal hematoma after extracorporeal shockwave lithotripsy in a series of 324 consecutive sessions with the DOLI-S lithotripter: incidents, characteristrics, multifactorial analysis and review].

PubMed

Orozco Fariñas, Rodolfo; Iglesias Prieto, José Ignacio; Massarrah Halabi, Jorge; Mancebo Gómez, José M; Perez-Castro Ellendt, Enrique

2008-10-01

with hematoma remained symptomatic between 2 and six months later. Renal hematoma after shock wave lithotripsy is more frequent than what is believed. Hematoma's size and evolution depend on multiple factors some of them with a greater weight (hepatopathy, perioperative blood pressure behavior, usual intake of anti-aggregation drugs with need of perioperative low weight heparin) which a greater risk when three or more factors concurred. Subcapsular and perirenal hematomas have a different clinical behavior. Initial ultrasound hematoma diameters equal 24 cm were more prone to progression. The risk of symptomatic clinical presentation or progression was evident within the first five days after shockwave lithotripsy even when asymptomatic or clinically/radiologically stable over the first 24 hours, therefore, careful follow-up and physical resting is counselled over the first week in patients with high risk, and relative physical resting during at least five days in all patients undergoing treatment. Lumbar pain may persist up to six months in some patients with renal clinically significant hematoma after shockwave lithotripsy.

A meteor shockwave event recorded at seismic and infrasound stations in northern Taiwan

NASA Astrophysics Data System (ADS)

Kumar, Utpal; Chao, Benjamin F.; Hsieh, Yikai; Chang, Emmy T. Y.

2017-12-01

Three mysterious explosion sounds were heard in the coastal towns of Tamsui, west of Taipei in northern Taiwan, in the early evening of December 5, 2013. The event left clear signals that are identified in the recordings of 12 regional seismometers and 3 infrasound sensors and processed by means of travel time analysis. The apparent velocity of 330 m/s of the signals confirms that the energy transmission was through the atmosphere, and the characteristics of the waveforms suggest the meteor-generated shockwaves. We use the graphical method as well as the Genetic Algorithm optimization approach to constrain the trajectory of the meteor and to locate its projected intercept with the ground—(25.33 N, 121.26 E), approximately 20 km off the coast of Tamsui. The trajectory has azimuth (measured from north in a map view in the clockwise direction) of 303° and (near-vertical) elevation angle of 70°. From the observed period of 1.3 s at the maximum amplitude of the infrasound signal, we estimate by conventional scaling law that the meteor in question had impact energy on the order of 5 × 1010 J (equivalent to an earthquake of local magnitude 4) or roughly a size of 0.5 m across.

Does the type of lithotripter affect outcomes in children with upper tract urolithiasis?

PubMed

Raza, Syed Johar; Ather, M Hammad

2009-02-01

To compare the treatment outcome and short-term safety of electrohydraulic and electromagnetic lithotripters in children. Comparative analysis of children undergoing shockwave lithotripsy (SWL) with a Dornier MPL 9000 electrohydraulic lithotripter (EHL) and a Siemens Modularis electromagnetic lithotripter (EML) was performed. All SWL treatments were performed by a single operator under the supervision of an admitting urologist. The demographic features, stone, and treatment-related parameters, including complications, were analyzed for both groups. Stone-free (SF) rates, re-treatment rate, and efficiency quotient (EQ) were calculated and compared for the two groups. Ninety-eight children had SWL for renal and proximal ureteral stones. There were 58 children in the EHL group and 40 in the EML group. There were no statistically significant differences between the groups in terms of age, sex, type of anesthesia, diagnostic modality, site, side, and size of the stones. Number of shockwaves used with EML was greater than with EHL (P < 0.00). SF rate was 95% and 77% for EHL and EML, respectively, with a statistically significant difference (P < 0.00). The re-treatment rate was equal in either group. The complication rate was higher with the EHL compared with the EML, although it did not reach statistical significance. Steinstrasse was the most common complication noted. EQ was 66% for the EHL, in comparison with 53% for the EML. The EHL has a better SF and EQ than the EML; however, short-term safety is marginally better with the EML.

Estimating model parameters for an impact-produced shock-wave simulation: Optimal use of partial data with the extended Kalman filter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kao, Jim; Flicker, Dawn; Ide, Kayo

2006-05-20

This paper builds upon our recent data assimilation work with the extended Kalman filter (EKF) method [J. Kao, D. Flicker, R. Henninger, S. Frey, M. Ghil, K. Ide, Data assimilation with an extended Kalman filter for an impact-produced shock-wave study, J. Comp. Phys. 196 (2004) 705-723.]. The purpose is to test the capability of EKF in optimizing a model's physical parameters. The problem is to simulate the evolution of a shock produced through a high-speed flyer plate. In the earlier work, we have showed that the EKF allows one to estimate the evolving state of the shock wave from amore » single pressure measurement, assuming that all model parameters are known. In the present paper, we show that imperfectly known model parameters can also be estimated accordingly, along with the evolving model state, from the same single measurement. The model parameter optimization using the EKF can be achieved through a simple modification of the original EKF formalism by including the model parameters into an augmented state variable vector. While the regular state variables are governed by both deterministic and stochastic forcing mechanisms, the parameters are only subject to the latter. The optimally estimated model parameters are thus obtained through a unified assimilation operation. We show that improving the accuracy of the model parameters also improves the state estimate. The time variation of the optimized model parameters results from blending the data and the corresponding values generated from the model and lies within a small range, of less than 2%, from the parameter values of the original model. The solution computed with the optimized parameters performs considerably better and has a smaller total variance than its counterpart using the original time-constant parameters. These results indicate that the model parameters play a dominant role in the performance of the shock-wave hydrodynamic code at hand.« less

The efficacy of radiographic anatomical measurement methods in predicting success after extracorporeal shockwave lithotripsy for lower pole kidney stones.

PubMed

Arpali, Emre; Altinel, Mert; Sargin, Semih Yasar

2014-01-01

To assess the impact of lower pole calyceal anatomy on clearace of lower pole stones after extracorporeal shockwave lithotripsy (ESWL) by means of a new and previously defined radiographic measurement method. Sixty-four patients with solitary radiopaque lower pole kidney stones were enrolled in the study. Infundibulopelvic angle (IPA), infundibulotransverse angle (ITA), infundibular lenght(IL), and infundibular width (IW) were measured on the intravenous urographies which were taken before the procedure. 48 of 64 patients (75%) were stone-free after a follow-up period of 3 months. The IPA,ITA,IL and IW were determined as statistically significant factors, while age,gender and stone area were found to have no impact on clearance. By the help of radiographic measurement methods related to lower pole kidney anatomy, appropriate patient selection and increment in success after ESWL may be achieved.

Heat-flow equation motivated by the ideal-gas shock wave.

PubMed

Holian, Brad Lee; Mareschal, Michel

2010-08-01

We present an equation for the heat-flux vector that goes beyond Fourier's Law of heat conduction, in order to model shockwave propagation in gases. Our approach is motivated by the observation of a disequilibrium among the three components of temperature, namely, the difference between the temperature component in the direction of a planar shock wave, versus those in the transverse directions. This difference is most prominent near the shock front. We test our heat-flow equation for the case of strong shock waves in the ideal gas, which has been studied in the past and compared to Navier-Stokes solutions. The new heat-flow treatment improves the agreement with nonequilibrium molecular-dynamics simulations of hard spheres under strong shockwave conditions.

Physical insights of cavity confinement enhancing effect in laser-induced breakdown spectroscopy.

PubMed

Fu, Yangting; Hou, Zongyu; Wang, Zhe

2016-02-08

Using cavity confinement to enhance the plasma emission has been proved to be an effective way in LIBS technique while no direct visual evidence has been made to illustrate the physical mechanism of this enhancing effect. In this work, both laser-induced plasma plume images and shockwave images were obtained and synchronized for both flat surface case and rectangular cavity case. Phenomena of shockwave reflection, plasma compression by the reflected shockwave and merge of the reflected shockwave into plasma were observed. Plasma emission intensities recorded by ICCD in both cases were compared and the enhancement effect in the cavity case was identified in the comparison. The enhancement effect could be explained as reflected shockwave "compressing" effect, that is, the reflected shockwave would compress the plasma and result in a more condensed plasma core area with higher plasma temperature. Reflected shockwave also possibly contributed to plasma core position stabilization, which indicated the potential of better plasma signal reproducibility for the cavity case. Both plasma emission enhancement and plasma core position stabilization only exist within a certain temporal window, which indicates that the delay time of spectra acquisition is essential while using cavity confinement as a way to improve LIBS performance.

Waste battery treatment options: comparing their environmental performance.

PubMed

Briffaerts, K; Spirinckx, C; Van der Linden, A; Vrancken, K

2009-08-01

Waste consumer batteries are recycled using different routes based on hydrometallurgical and pyrometallurgical processes. Two hydrometallurgical and two pyrometallurgical treatment scenarios are compared starting from an average composition of Belgian waste batteries. The environmental performance is compared using life cycle analysis (LCA). The recycling rate is studied through mass balance calculation. Each treatment scenario results in a specific recycling rate. The environmental impact and benefits also vary between the treatment options. There is no such thing as a typical hydrometallurgical or pyrometallurgical treatment. When applying a hydrometallurgical treatment scenario, the focus lies on zinc and iron recycling. When allowing manganese recycling, the energy demand of the hydrometallurgical process increases considerably. Both pyrometallurgical options recycle zinc, iron and manganese. According to the LCA, none of the treatment scenarios performs generally better or worse than the others. Each option has specific advantages and disadvantages. The Batteries Directive 2006/66/EC sets out a recycling rate of 50% for consumer waste batteries. Based on metal recycling alone, the mass balances show that the target is difficult to obtain.

The Application of Kidney Injury Molecule-1 to Determine the Duration Between Shockwave Lithotripsy Sessions.

PubMed

Aydin, Hasan R; Irkilata, Lokman; Aydin, Mustafa; Daggulli, Mansur; Taskin, Mehmet H; Demirel, Huseyin C; Adanur, Senol; Moral, Caner; Atilla, Mustafa K; Sancaktutar, Ahmet A

2016-01-01

We aimed to evaluate the role of kidney injury molecule-1 (KIM-1) in determining the intervals between shockwave lithotripsy (SWL) sessions. This was a prospective, controlled study. It included 40 patients with unilateral kidney stones and 40 healthy persons of a similar age group as controls. The patients' midflow urine samples were collected before SWL and 1 hour, 1 day, 1 week, and 1 month after the procedure. The average age in the SWL and control groups was 45 ± 14 and 39 ± 15 years, respectively (P = 0.336). The average KIM-1 value before SWL was 0.74 ± 0.35 ng/mL, which was significantly higher than that of the control group (0.51 ± 0.14 ng/mL) (P < 0.001). Similarly, the average values of the urine samples after SWL were higher than those of the control group (P < 0.001). When the KIM-1 values of the patients given SWL were compared within the group, the KIM-1 values 1 hour (1.06 ± 0.51) and 1 day (0.99 ± 0.67) after the procedure were statistically clearly higher than those before the procedure (P < 0.001) and statistically clearly higher than those of the control group (P = 0.005). The KIM-1 values 1 week and 1 month after the procedure were not significantly different than the preprocedure values (P = 0.652 and P = 0.747, respectively). KIM-1 is a noninvasive biomarker that may be used to show renal damage because of stones and early-stage renal damage linked to SWL. In addition, post-SWL KIM-1 values may be used to determine the interval between SWL sessions.

Dependence of Plastic TATB Shock-Wave Sensitivity on Temperature, Density and Technology Factors

NASA Astrophysics Data System (ADS)

Vlasov, Yu. A.; Kosolapov, V. B.; Fomicheva, L. V.; Khabarov, I. P.

1999-06-01

Mixed TATB-based HE is the most perspective because of the manufacture and exploitation safety of its items. At the same time the safety of these explosive, at high temperatures, which take place at emergencies, causes the certain anxiety. Plastic TATB shock-wave sensitivity (SWS) researches has shown that temperature as one of the important factors of external influence is not always the determining reason of SWS change. It is known that density influence on SWS significantly. At the same time density depends on temperature and technology of details manufacturing. In this connection in this work the temperature dependence of plastic TATB SWS was studied in view of convertible and irreversible changes of density (p) under heating at -50[C up to 90[C . It is shown that during these influences the dependence of threshold pressure of initiation (P) from temperature is explained, first of all, by change of HE density, caused by its thermal expansion (compression), and also by irreversible changes of p and HE structure, arising at heating. It is found also that the share of irreversible change of density depends on technology of HE details manufacturing and is explained by relaxation of residual pressure in them. The mentioned relaxation is finished after the first cycles of thermal influence. The value of density change, caused by this factor, depends on temperature and duration of heating.

Calibration of Wire-Like Manganin Gauges for Use in Planar Shock-Wave Experiments

NASA Astrophysics Data System (ADS)

Chapman, David J.; Braithwaite, Christopher H.; Proud, William G.

2009-12-01

Piezoresistive gauges have been used extensively for many decades as in-material stress transducers during shock wave experiments. Manganin demonstrates a high piezoresistive response which is relatively temperature independent. As such manganin gauges have been widely calibrated by many authors for use during shock-wave experiments. The precise calibration has been demonstrated to depend on both the chemical composition and mechanical history of the manganin, and on the geometry of the gauge. The research presented in this paper refers to the calibration of a commercially available manganin gauge, Micro-measurements J2M-SS-580SF-025, generally referred to as the T-gauge owing to its geometry. The T-gauge has seen widespread use as a pressure transducer to measure lateral stress during plate-impact experiments. It has been previously proposed that T-gauges have a similar response to the grid foil-like manganin gauges extensively calibrated by Rosenberg et al. However, recently it has been suggested that they in fact behave in a wire-like manner. The results presented here demonstrate that the gauges' behaviour is wire-like when mounted to measure longitudinal stress. A modified calibration can be applied successfully to convert the relative resistance change to the stress normal to the gauge element. These results have important ramifications for the reduction of lateral stress measurements previously made using the T-gauge.

Calibration of Wire-Like Manganin Gauges for Use in Planar Shock-Wave Experiments

NASA Astrophysics Data System (ADS)

Chapman, David; Proud, William

2009-06-01

Peizoresistive gauges have been used extensively for many decades as in-material stress transducers during shock wave experiments. Manganin demonstrates a high piezoresistive response which is relatively temperature independent. As such manganin gauges have been widely calibrated by many authors for use during shock-wave experiments. The precise calibration has been demonstrated to depend on both the chemical composition and mechanical history of the manganin, and on the geometry of the gauge. The research presented in this paper refers to the calibration of a commercially available manganin gauge, Micro-measurements J2M-SS-580SF-025, generally referred to as the T-gauge owing to its geometry. The T-gauge has seen widespread use as a pressure transducer to measure lateral stress during plate-impact experiments. It has been previously proposed that T-gauges have a similar response to the grid foil-like manganin gauges extensively calibrated by Rosenberg et. al.. However, recently it has been suggested that they in fact behave in a wire-like manner. The results presented here demonstrate that the gauges behaviour is wire-like when mounted to measure longitudinal stress. A modified calibration can be applied successfully to convert the relative resistance change to the stress normal to the gauge element. These results have important ramifications for the reduction of lateral stress measurements previously made using the T-gauge.

Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination.

PubMed

Geng, Jiun-Hung; Tu, Hung-Pin; Shih, Paul Ming-Chen; Shen, Jung-Tsung; Jang, Mei-Yu; Wu, Wen-Jen; Li, Ching-Chia; Chou, Yii-Her; Juan, Yung-Shun

2015-01-01

Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL) has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT) to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD) were analyzed. In all, 197 (60%) were classified as stone-free and 132 (40%) as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA), abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals): 9.49 (3.72-24.20), 2.25 (1.22-4.14), 2.20 (1.10-4.40), and 2.89 (1.35-6.21) respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these predictors for selecting

Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi.

PubMed

Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

2016-04-01

We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841-0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994-0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008-1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility.

Combination of low-energy shock-wave therapy and bone marrow mesenchymal stem cell transplantation to improve the erectile function of diabetic rats.

PubMed

Shan, Hai-Tao; Zhang, Hai-Bo; Chen, Wen-Tao; Chen, Feng-Zhi; Wang, Tao; Luo, Jin-Tai; Yue, Min; Lin, Ji-Hong; Wei, An-Yang

2017-01-01

Stem cell transplantation and low-energy shock-wave therapy (LESWT) have emerged as potential and effective treatment protocols for diabetic erectile dysfunction. During the tracking of transplanted stem cells in diabetic erectile dysfunction models, the number of visible stem cells was rather low and decreased quickly. LESWT could recruit endogenous stem cells to the cavernous body and improve the microenvironment in diabetic cavernous tissue. Thus, we deduced that LESWT might benefit transplanted stem cell survival and improve the effects of stem cell transplantation. In this research, 42 streptozotocin-induced diabetic rats were randomized into four groups: the diabetic group (n = 6), the LESWT group (n = 6), the bone marrow-derived mesenchymal stem cell (BMSC) transplantation group (n = 15), and the combination of LESWT and BMSC transplantation group (n = 15). One and three days after BMSC transplantation, three rats were randomly chosen to observe the survival numbers of BMSCs in the cavernous body. Four weeks after BMSC transplantation, the following parameters were assessed: the surviving number of transplanted BMSCs in the cavernous tissue, erectile function, real-time polymerase chain reaction, and penile immunohistochemical assessment. Our research found that LESWT favored the survival of transplanted BMSCs in the cavernous body, which might be related to increased stromal cell-derived factor-1 expression and the enhancement of angiogenesis in the diabetic cavernous tissue. The combination of LESWT and BMSC transplantation could improve the erectile function of diabetic erectile function rats more effectively than LESWT or BMSC transplantation performed alone.

Comparing epidemiologically estimated treatment need with treatment provided in two dental schemes in Ireland

PubMed Central

2012-01-01

Background Valid estimation of dental treatment needed at population level is important for service planning. In many instances, planning is informed by survey data, which provide epidemiologically estimated need from the dental fieldworkers’ perspective. The aim of this paper is to determine the validity of this type of information for planning. A comparison of normative (epidemiologically estimated) need for selected treatments, as measured on a randomly-selected representative sample, is compared with treatment actually provided in the population from which the sample was drawn. Methods This paper compares dental treatment need-estimates, from a national survey, with treatment provided within two choice-of-dentist schemes: Scheme 1, a co-payment scheme for employed adults, and Scheme 2, a ‘free’ service for less-well-off adults. Epidemiologically estimated need for extractions, restorations, advanced restorations and denture treatments was recorded for a nationally representative sample in 2000/02. Treatments provided to employed and less-well-off adults were retrieved from the claims databases for both schemes. We used the chi-square test to compare proportions, and the student’s t-test to compare means between the survey and claims databases. Results Among employed adults, the proportion of 35-44-year-olds whose teeth had restorations was greater than estimated as needed in the survey (55.7% vs. 36.7%;p <0.0001). Mean number of teeth extracted was less than estimated as needed among 35-44 and 65+ year-olds. Among less-well-off adults, the proportion of 16-24-year-olds who had teeth extracted was greater than estimated as needed in the survey (27.4% vs. 7.9%;p <0.0001). Mean number of restorations provided was greater than estimated as needed in the survey for 16-24-year-olds (3.0 vs. 0.9; p <0.0001) and 35-44-year-olds (2.7 vs. 1.4;p <0.01). Conclusions Significant differences were found between epidemiologically estimated need and treatment provided

Reduced Pain and Anxiety with Music and Noise-Canceling Headphones During Shockwave Lithotripsy.

PubMed

Karalar, Mustafa; Keles, Ibrahim; Doğantekin, Engin; Kahveci, Orhan Kemal; Sarici, Hasmet

2016-06-01

We assessed the effects of music and noise-canceling headphones (NCHs) on perceived patient pain and anxiety from extracorporeal shockwave lithotripsy (SWL). Patients with renal calculi scheduled for SWL were prospectively enrolled. All 89 patients between the ages of 19 and 80 years were informed about this study and then randomized into three groups: Group 1 (controls), no headphones and music; Group 2, music with NCHs (patients listened to Turkish classical music with NCHs during SWL); and Group 3, music with non-NCHs (patients listened to Turkish classical music with non-NCHs during SWL). Hemodynamic and respiratory parameters were recorded before and just after the SWL session. All patient visual analog scale (VAS) and State-Trait Anxiety Inventory (STAI) scores were recorded just after the SWL procedure. There were significant differences in VAS scores among the groups (5.1, 3.6, and 4.5, respectively, p < 0.001), including between Groups 2 and 3 (p = 0.018). There were also significant differences in STAI-State anxiety scores among the groups (43.1, 33.5, and 38.9, respectively, p = 0.001), including between Groups 2 and 3 (p = 0.04). Music therapy during SWL reduced pain and anxiety. Music therapy with NCHs was more effective for pain and anxiety reduction. To reduce pain and anxiety, nonpharmacologic therapies such as music therapy with NCHs during SWL should be investigated further and used routinely.

Extracorporeal shock wave therapy for sacroiliac joint pain: A prospective, randomized, sham-controlled short-term trial.

PubMed

Moon, Young Eun; Seok, Hyun; Kim, Sang-Hyun; Lee, Seung Yeol; Yeo, Jung Ho

2017-01-01

Sacroiliac joint (SIJ) pain can cause lower back pain and pelvic discomfort. However, there is no established standard treatment for SIJ pain. Extracorporeal shock wave therapy (ESWT) is a novel, non-invasive therapeutic modality for musculoskeletal disorders. The mechanism underlying shockwave therapy is not fully understood, but the frequency with which ESWT is applied clinically has increased over the years. We evaluated the efficacy of using ESWT to treating SIJ pain. Thirty patients with SIJ pain were assigned randomly to ESWT (n = 15) and sham control (n = 15) groups. The ESWT group received 2,000 shockwaves with energy set to the maximum level tolerable by the patient (energy density = 0.09-0.25 mJ/mm2). The probe was oriented perpendicular to the posterior SIJ line, and moved up and down along the joint line. The sham control group received 2,000 shockwaves with the probe oriented parallel to the posterior SIJ line. A 10-cm numeric rating scale (NRS) and the Oswestry Disability Index (ODI) scores were assessed before the intervention, and 1 and 4 weeks post-intervention. Participants were instructed to refrain from using any other conservative treatment, including anti-inflammatory medication and other physical modalities during the study. In the ESWT group, NRS decreased significantly at post-treatment week 4 (3.64 (95% confidence interval, 2.29-4.99)) compared to baseline (6.42 (5.19-7.66); P < 0.05). ODI improved at 1 and 4 weeks compared to baseline, but not significantly. In the sham group, NRS and ODI did not differ at any post-treatment time point. There was a significant group difference in NRS at week 4 post-treatment (3.64 (2.29-4.99) in the ESWT group vs. 6.18 (5.34-7.02) in the sham control group; P < 0.05), but this was not the case for ODI. ESWT represents a potential therapeutic option for decreasing SIJ pain.

Early effects of extracorporeal shock wave treatment on osteoblast-like cells: a comparative study between electromagnetic and electrohydraulic devices.

PubMed

Martini, Lucia; Giavaresi, Gianluca; Fini, Milena; Borsari, Veronica; Torricelli, Paola; Giardino, Roberto

2006-11-01

Extracorporeal shockwave therapy (ESWT) has been increasingly applied to treat orthopedic and musculoskeletal pathologies. ESWT involves mechanical perturbations that, as with other physical therapies, can result in mechanical stimuli to a large number of cells, including bone cells. The aim of this study was to evaluate the effects of shock waves on osteoblast-like cells (MG63) when using two different generators of shock waves (electrohydraulic and electromagnetic devices), in terms of cell damage, cell viability, osteogenic phenotype expression, and cytokine production. MG63 cells were suspended in 1.5 mL screw-cap cryotubes (1 x 10 cells/mL), containing phosphate buffer solution (PBS), which were maintained at 37 degrees C during all the experimental times. Two levels of energy flux density (EFD) were evaluated for each device: 0.15 to 0.18 mJ/mm2 and 0.40 mJ/mm2. Cells were then cultivated for 72 hours starting from a concentration of 1 x 10 cells/mL, and biological activity and viability were evaluated 24 and 72 hours after treatment. The results obtained demonstrate that the factors most affecting osteoblast activity involve both the device and the level of EFD selected, and they must be considered all together. The use of the electromagnetic device and a level of EFD lower than 0.40 mJ/mm2 would appear to induce fewer immediate cytodestructive effects and better stimulate subsequent proliferation and the synthetic activity of MG63.

Extracorporeal shockwave myocardial therapy is efficacious in improving symptoms in patients with refractory angina pectoris--a multicenter study.

PubMed

Prasad, Megha; Wan Ahmad, Wan Azman; Sukmawan, Renan; Magsombol, Edward-Bengie L; Cassar, Andrew; Vinshtok, Yuri; Ismail, Muhammad Dzafir; Mahmood Zuhdi, Ahmad Syadi; Locnen, Sue Ann; Jimenez, Rodney; Callleja, Homobono; Lerman, Amir

2015-05-01

Medically refractory angina remains a significant health concern despite major advances in revascularization techniques and emerging medical therapies. We aimed to determine the safety and efficacy of extracorporeal shockwave myocardial therapy (ESMT) in managing angina pectoris. A single-arm multicenter prospective study was designed aiming to determine the safety and efficacy of ESMT. Patients of functional Canadian Cardiovascular Society class II-IV, despite stable and optimal medical management, with documented myocardial segments with reversible ischemia and/or hibernation on the basis of echocardiography/single-photon emission computerized tomography (SPECT) were enrolled from 2010 to 2012. A total of 111 patients were enrolled, 33 from Indonesia, 21 from Malaysia, and 57 from Philippines. Patients underwent nine cycles of ESMT over 9 weeks. Patients were followed up for 3-6 months after ESMT treatment. During follow-up, patients were subjected to clinical evaluation, the Seattle Angina Questionnaire, assessment of nitrate intake, the 6-min walk test, echocardiography, and SPECT. The mean age of the population was 62.9±10.9 years. The summed difference score on pharmacologically induced stress SPECT improved from 9.53±17.87 at baseline to 7.77±11.83 at follow-up (P=0.0086). Improvement in the total Seattle Angina Questionnaire score was seen in 83% of patients (P<0.0001). Sublingual nitroglycerin use significantly decreased (1.14±1.01 tablets per week at baseline to 0.52±0.68 tablets per week at follow-up; P=0.0215). There were no changes in left ventricular function on echocardiography (0.33±9.97, P=0.93). The Canadian Cardiovascular Society score improved in 74.1% of patients. This multicenter prospective trial demonstrated that ESMT is both a safe and an efficacious means of managing medically refractory angina.

[Asymptomatic kidney stones: active surveillance vs. treatment].

PubMed

Neisius, A; Thomas, C; Roos, F C; Hampel, C; Fritsche, H-M; Bach, T; Thüroff, J W; Knoll, T

2015-09-01

The prevalence of kidney stones is increasing worldwide. Asymptomatic non-obstructing kidney stones are increasingly detected as an incidental finding on radiologic imaging, which has been performed more frequently over the last decades. Beside the current interventional treatment modalities such as extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL), active surveillance of asymptomatic kidney stones has been a focus of discussion lately, not only for attending physicians, but even more so for patients. The current German and European guidelines recommend active surveillance for patients with asymptomatic kidney stones if no interventional therapy is mandatory because of pain or medical factors. Herein we review the current literature on risks and benefits of active surveillance of asymptomatic non-obstructing kidney stones. © Georg Thieme Verlag KG Stuttgart · New York.

Comparative Analysis of Treatment Costs in EUROHOPE.

PubMed

Iversen, Tor; Aas, Eline; Rosenqvist, Gunnar; Häkkinen, Unto

2015-12-01

This study examines the challenges of estimating risk-adjusted treatment costs in international comparative research, specifically in the European Health Care Outcomes, Performance, and Efficiency (EuroHOPE) project. We describe the diverse format of resource data and challenges of converting these data into resource use indicators that allow meaningful cross-country comparisons. The three cost indicators developed in EuroHOPE are then described, discussed, and applied. We compare the risk-adjusted mean treatment costs of acute myocardial infarction for four of the seven countries in the EuroHOPE project, namely, Finland, Hungary, Norway, and Sweden. The outcome of the comparison depends on the time perspective as well as on the particular resource use indicator. We argue that these complementary indicators add to our understanding of the variation in resource use across countries. Copyright © 2015 John Wiley & Sons, Ltd.

Comparative tolerability of treatments for acute migraine: A network meta-analysis.

PubMed

Thorlund, Kristian; Toor, Kabirraaj; Wu, Ping; Chan, Keith; Druyts, Eric; Ramos, Elodie; Bhambri, Rahul; Donnet, Anne; Stark, Richard; Goadsby, Peter J

2017-09-01

Introduction Migraine headache is a neurological disorder whose attacks are associated with nausea, vomiting, photophobia and phonophobia. Treatments for migraine aim to either prevent attacks before they have started or relieve attacks (abort) after onset of symptoms and range from complementary therapies to pharmacological interventions. A number of treatment-related adverse events such as somnolence, fatigue, and chest discomfort have previously been reported in association with triptans. The comparative tolerability of available agents for the abortive treatment of migraine attacks has not yet been systematically reviewed and quantified. Methods We performed a systematic literature review and Bayesian network meta-analysis for comparative tolerability of treatments for migraine. The literature search targeted all randomized controlled trials evaluating oral abortive treatments for acute migraine over a range of available doses in adults. The primary outcomes of interest were any adverse event, treatment-related adverse events, and serious adverse events. Secondary outcomes were fatigue, dizziness, chest discomfort, somnolence, nausea, and vomiting. Results Our search yielded 141 trials covering 15 distinct treatments. Of the triptans, sumatriptan, eletriptan, rizatriptan, zolmitriptan, and the combination treatment of sumatriptan and naproxen were associated with a statistically significant increase in odds of any adverse event or a treatment-related adverse event occurring compared with placebo. Of the non-triptans, only acetaminophen was associated with a statistically significant increase in odds of an adverse event occurring when compared with placebo. Overall, triptans were not associated with increased odds of serious adverse events occurring and the same was the case for non-triptans. For the secondary outcomes, with the exception of vomiting, all triptans except for almotriptan and frovatriptan were significantly associated with increased risk for all

Treatment for insertional Achilles tendinopathy: a systematic review.

PubMed

Wiegerinck, J I; Kerkhoffs, G M; van Sterkenburg, M N; Sierevelt, I N; van Dijk, C N

2013-06-01

Systematically search and analyse the results of surgical and non-surgical treatments for insertional Achilles tendinopathy. A structured systematic review of the literature was performed to identify surgical and non-surgical therapeutic studies reporting on ten or more adults with insertional Achilles tendinopathy. MEDLINE, CINAHL, EMBASE (Classic) and the Cochrane database of controlled trials (1945-March 2011) were searched. The Coleman methodology score was used to assess the quality of included articles, and these were analysed with an emphasis on change in pain score, patient satisfaction and complication rate. Of 451 reviewed abstracts, 14 trials met our inclusion criteria evaluating 452 procedures in 433 patients. Five surgical techniques were evaluated; all had a good patient satisfaction (avg. 89 %). The complication ratio differed substantially between techniques. Two studies analysed injections showing significant decrease in visual analogue scale (VAS). Eccentric exercises showed a significant decrease in VAS, but a large group of patients was unsatisfied. Extracorporeal shockwave therapy (ESWT) was superior to both wait-and-see and an eccentric training regime. One study evaluated laser CO(2), TECAR and cryoultrasound, all with significant decrease in VAS. Despite differences in outcome and complication ratio, the patient satisfaction is high in all surgical studies. It is not possible to draw conclusions regarding the best surgical treatment for insertional Achilles tendinopathy. ESWT seems effective in patients with non-calcified insertional Achilles tendinopathy. Although both eccentric exercises resulted in a decrease in VAS score, full range of motion eccentric exercises shows a low patient satisfaction compared to floor level exercises and other conservative treatment modalities.

Third prize: the impact of fluid environment manipulation on shockwave lithotripsy artificial calculi fragmentation rates.

PubMed

Méndez-Probst, Carlos E; Fernadez, Alfonso; Erdeljan, Petar; Vanjecek, Maaike; Cadieux, Peter A; Razvi, Hassan

2011-03-01

Studies have suggested that shockwave lithotripsy (SWL) stone fragmentation rates can be affected by characteristics of the fluid media surrounding the stone, although evidence to implicate the impact of urine specific gravity (SG) is limited and inconclusive. Our aim is to further explore the impact fluid media and SGs have on stone fragmentation using a variable focus lithotripter. Artificial stones were presoaked for 24 hours in urine and then shocked in various fluid media including artificial urine (SG 1.010 control, 1.020, and 1.07), human pooled urine (HPU), degassed HPU, Pentastarch, 100% and 30% contrast, degassed 30% contrast, 100% ethanol, deionized water (dH(2)O), degassed dH(2)O, 5% glucose, Ringer lactate, 0.9% saline, glycerol, whole blood, and lubricating gel. After soaking, SWL using the Modulith SLX-F2 electromagnetic lithotripter was performed. Fragments were dried and sieved using a 4-mm diameter opening grid. Fragments >4 mm were weighed and fragmentation coefficients (FCs) calculated (pre-SWL weight - post-SWL weight)/(pre-SWL weight) × 100. Fifteen stones were shocked for each fluid group. Fluid type, viscosity, and degassing all significantly impacted stone fragmentation. While the solutions' SG, per se, did not appear to affect stone fragmentation, the use of degassed 30% contrast significantly improved stone destruction over the SG 1.010 artificial urine control (95.3% vs 71.4, P < 0.01). Furthermore, degassing improved comminution rates by increasing the number of completely fragmented stones (FC = 100%). Using degassed 30% contrast, 12/15 stones were completely fragmented, compared with only 2/15 in the control group (P = 0.007). Among the whole blood, glycerol, and lubricating gel groups, only 1/15, 0/15, and 1/15 stones reached 100% FC respectively in the narrow focus, possibly because of the detrimental impact of increased viscosity. Different fluid media can significantly affect FC in vitro. Among the various fluids tested, degassed

HETEROGENEITY IN TREATMENT EFFECT AND COMPARATIVE EFFECTIVENESS RESEARCH.

PubMed

Luo, Zhehui

2011-10-01

The ultimate goal of comparative effectiveness research (CER) is to develop and disseminate evidence-based information about which interventions are most effective for which patients under what circumstances. To achieve this goal it is crucial that researchers in methodology development find appropriate methods for detecting the presence and sources of heterogeneity in treatment effect (HTE). Comparing with the typically reported average treatment effect (ATE) in randomized controlled trials and non-experimental (i.e., observational) studies, identifying and reporting HTE better reflect the nature and purposes of CER. Methodologies of CER include meta-analysis, systematic review, design of experiments that encompasses HTE, and statistical correction of various types of estimation bias, which is the focus of this review.

Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi

PubMed Central

Lee, Joo Yong; Kim, Jae Heon; Kang, Dong Hyuk; Chung, Doo Yong; Lee, Dae Hun; Do Jung, Hae; Kwon, Jong Kyou; Cho, Kang Su

2016-01-01

We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841–0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994–0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008–1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility. PMID:27035621

Comparative effectiveness of lipid-lowering treatments to reduce cardiovascular disease.

PubMed

Suh, Dong-Churl; Griggs, Scott K; Henderson, Emmett R; Lee, Seung-Mi; Park, Taehwan

2018-02-01

The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor is a new treatment option for patients with hypercholesterolemia. The objective of this study was to systematically review the cost-effectiveness of lipid-lowering agents. Areas covered: Based on Pubmed, Embase, and Cochrane Database of Systematic Reviews, we identified 29 relevant articles. Studies found statins were cost-effective compared with placebo or no treatment in general. Atorvastatin was reported to be cost-effective against simvastatin. In most cases, rosuvastatin was more cost-effective than atorvastatin or simvastatin. Additionally, ezetimibe was considered to be cost-effective compared with no treatment for statin intolerant patients. For patients not meeting treatment goals with their statins, switching to ezetimibe plus simvastatin was consistently reported cost-effective. The cost-effectiveness of ezetimibe plus a hybrid of a statin varied by the source of clinical data and cost of ezetimibe. Finally, the cost-effectiveness of PCSK9 inhibitor plus a statin against statin monotherapy was uncertain. The PCSK9 inhibitor plus a stain was cost-ineffective compared with ezetimibe plus a statin. Expert commentary: Drug costs and treatment efficacy were the key drivers of the cost-effectiveness results in prior analyses. Future evaluations are warranted to reflect the decreasing drug prices and the long-term treatment effects of PCSK9 inhibitors.

Combination of low-energy shock-wave therapy and bone marrow mesenchymal stem cell transplantation to improve the erectile function of diabetic rats

PubMed Central

Shan, Hai-Tao; Zhang, Hai-Bo; Chen, Wen-Tao; Chen, Feng-Zhi; Wang, Tao; Luo, Jin-Tai; Yue, Min; Lin, Ji-Hong; Wei, An-Yang

2017-01-01

Stem cell transplantation and low-energy shock-wave therapy (LESWT) have emerged as potential and effective treatment protocols for diabetic erectile dysfunction. During the tracking of transplanted stem cells in diabetic erectile dysfunction models, the number of visible stem cells was rather low and decreased quickly. LESWT could recruit endogenous stem cells to the cavernous body and improve the microenvironment in diabetic cavernous tissue. Thus, we deduced that LESWT might benefit transplanted stem cell survival and improve the effects of stem cell transplantation. In this research, 42 streptozotocin-induced diabetic rats were randomized into four groups: the diabetic group (n = 6), the LESWT group (n = 6), the bone marrow-derived mesenchymal stem cell (BMSC) transplantation group (n = 15), and the combination of LESWT and BMSC transplantation group (n = 15). One and three days after BMSC transplantation, three rats were randomly chosen to observe the survival numbers of BMSCs in the cavernous body. Four weeks after BMSC transplantation, the following parameters were assessed: the surviving number of transplanted BMSCs in the cavernous tissue, erectile function, real-time polymerase chain reaction, and penile immunohistochemical assessment. Our research found that LESWT favored the survival of transplanted BMSCs in the cavernous body, which might be related to increased stromal cell-derived factor-1 expression and the enhancement of angiogenesis in the diabetic cavernous tissue. The combination of LESWT and BMSC transplantation could improve the erectile function of diabetic erectile function rats more effectively than LESWT or BMSC transplantation performed alone. PMID:27427555

Advances in the treatment of erectile dysfunction: what’s new and upcoming?

PubMed Central

Patel, Chintan K.; Bennett, Nelson

2016-01-01

Erectile dysfunction adversely affects up to 20% of all men and is the most commonly treated sexual disorder. The public health implications of this condition are significant and represent a challenge for our healthcare system. The physiological pathways responsible for erections have been extensively studied, and much advancement has been made since the introduction of phosphodiesterase 5 inhibitors. Newer agents, such as dopaminergic and melanocortin receptor agonists, which target central erectogenic pathways, are under investigation. Newer formulations and delivery methods of existing medications such as alprostadil will also be introduced in the near future. Furthermore, low-intensity shockwave lithotripsy and stem cell regenerative techniques are innovative approaches to the treatment of erectile dysfunction. PMID:27516878

Comparing Treatment Policies with Assistance from the Structural Nested Mean Model

PubMed Central

Lu, Xi; Lynch, Kevin G.; Oslin, David W.; Murphy, Susan

2015-01-01

Summary Treatment policies, also known as dynamic treatment regimes, are sequences of decision rules that link the observed patient history with treatment recommendations. Multiple, plausible, treatment policies are frequently constructed by researchers using expert opinion, theories and reviews of the literature. Often these different policies represent competing approaches to managing an illness. Here we develop an “assisted estimator” that can be used to compare the mean outcome of competing treatment policies. The term “assisted” refers to the fact estimators from the Structural Nested Mean Model, a parametric model for the causal effect of treatment at each time point, are used in the process of estimating the mean outcome. This work is motivated by our work on comparing the mean outcome of two competing treatment policies using data from the ExTENd study in alcohol dependence. PMID:26363892

Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones.

PubMed

Resorlu, Berkan; Unsal, Ali; Ziypak, Tevfik; Diri, Akif; Atis, Gokhan; Guven, Selcuk; Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir; Bozkurt, Omer Faruk; Oztuna, Derya

2013-12-01

To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10-20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications. A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments <3 mm. The success rates, auxiliary procedures, and complications were compared in each group. Success rates were 66.5, 91.4, and 87% for SWL, PNL, and RIRS (p < 0.001). The need for auxiliary procedures was more common after SWL than PNL and RIRS (21.9 vs 5.7 vs 8.7%, respectively; p < 0.001). The overall complication rates for the SWL, PNL, and RIRS were 7.6, 22.1, and 10.9%, respectively (p < 0.001). Thirteen patients in PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused. Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p < 0.001). Fluoroscopy and operation time were significantly longer in the PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s, and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively). For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure, hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.

Comparing the Costs of Military Treatment Facilities with Private Sector Care

DTIC Science & Technology

2016-02-01

Log: H 15-000527 Comparing the Costs of Military Treatment Facilities with Private Sector Care Philip M. Lurie INSTITUTE FOR DEFENSE ANALYSES 4850 Mark...other national challenges. Comparing the Costs of Military Treatment Facilities with Private Sector Care Philip M. Lurie I N S T I T U T E F O R D...members. The latter benefit, known as TRICARE, serves 9.5 million beneficiaries worldwide, and consists of care in Military Treatment Facilities (MTFs

A randomized trial comparing treatments for varicose veins.

PubMed

Brittenden, Julie; Cotton, Seonaidh C; Elders, Andrew; Ramsay, Craig R; Norrie, John; Burr, Jennifer; Campbell, Bruce; Bachoo, Paul; Chetter, Ian; Gough, Michael; Earnshaw, Jonothan; Lees, Tim; Scott, Julian; Baker, Sara A; Francis, Jill; Tassie, Emma; Scotland, Graham; Wileman, Samantha; Campbell, Marion K

2014-09-25

Ultrasound-guided foam sclerotherapy and endovenous laser ablation are widely used alternatives to surgery for the treatment of varicose veins, but their comparative effectiveness and safety remain uncertain. In a randomized trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of foam, laser, and surgical treatments. Primary outcomes at 6 months were disease-specific quality of life and generic quality of life, as measured on several scales. Secondary outcomes included complications and measures of clinical success. After adjustment for baseline scores and other covariates, the mean disease-specific quality of life was slightly worse after treatment with foam than after surgery (P=0.006) but was similar in the laser and surgery groups. There were no significant differences between the surgery group and the foam or the laser group in measures of generic quality of life. The frequency of procedural complications was similar in the foam group (6%) and the surgery group (7%) but was lower in the laser group (1%) than in the surgery group (P<0.001); the frequency of serious adverse events (approximately 3%) was similar among the groups. Measures of clinical success were similar among the groups, but successful ablation of the main trunks of the saphenous vein was less common in the foam group than in the surgery group (P<0.001). Quality-of-life measures were generally similar among the study groups, with the exception of a slightly worse disease-specific quality of life in the foam group than in the surgery group. All treatments had similar clinical efficacy, but complications were less frequent after laser treatment and ablation rates were lower after foam treatment. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN51995477.).

Comparative study of group treatments for posttraumatic stress disorder.

PubMed

Maxwell, Kendal; Callahan, Jennifer L; Holtz, Pamela; Janis, Beth M; Gerber, Monica M; Connor, Dana R

2016-12-01

Presented herein is a comparative study of group treatments for posttraumatic stress disorder (PTSD). In this study, an emerging intervention, memory specificity training (MeST), was compared with cognitive processing therapy (CPT) using standardized outcome measures of target symptoms (i.e., anxiety and depression from client perspective; memory specificity from independent rater perspective) and global functioning (independent rater perspective), as well as a process measure of expectancy (client perspective). Clients were assessed on 3 separate occasions: at baseline, posttreatment, and 3 months posttreatment. Adherence and treatment fidelity (independent rater perspective) were monitored throughout the course of both treatment conditions. Improvement in PTSD symptoms, depressive symptoms, and global functioning were similar between MeST and CPT; an increase in ability to specify memories upon retrieval was also similar between MeST and CPT. Positive reliable change was observed in both groups on all outcome measures. With respect to the primary target of PTSD symptoms, 88% of participants in both treatment groups moved into the functional distribution by posttreatment and maintained these gains at follow-up. Notably, compared with CPT, MeST required only half the dosage (i.e., number of sessions) to accomplish these gains. Illustrative vignettes from client-therapist exchanges are provided, and results are discussed in terms of the potential mechanisms of action. Implications for both clinical practice and clinical research are also included. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries.

PubMed

Kleiboer, Annet; Smit, Jan; Bosmans, Judith; Ruwaard, Jeroen; Andersson, Gerhard; Topooco, Naira; Berger, Thomas; Krieger, Tobias; Botella, Cristina; Baños, Rosa; Chevreul, Karine; Araya, Ricardo; Cerga-Pashoja, Arlinda; Cieślak, Roman; Rogala, Anna; Vis, Christiaan; Draisma, Stasja; van Schaik, Anneke; Kemmeren, Lise; Ebert, David; Berking, Matthias; Funk, Burkhardt; Cuijpers, Pim; Riper, Heleen

2016-08-03

Effective, accessible, and affordable depression treatment is of high importance considering the large personal and economic burden of depression. Internet-based treatment is considered a promising clinical and cost-effective alternative to current routine depression treatment strategies such as face-to-face psychotherapy. However, it is not clear whether research findings translate to routine clinical practice such as primary or specialized mental health care. The E-COMPARED project aims to gain knowledge on the clinical and cost-effectiveness of blended depression treatment compared to treatment-as-usual in routine care. E-COMPARED will employ a pragmatic, multinational, randomized controlled, non-inferiority trial in eight European countries. Adults diagnosed with major depressive disorder (MDD) will be recruited in primary care (Germany, Poland, Spain, Sweden, and the United Kingdom) or specialized mental health care (France, The Netherlands, and Switzerland). Regular care for depression is compared to "blended" service delivery combining mobile and Internet technologies with face-to-face treatment in one treatment protocol. Participants will be followed up at 3, 6, and 12 months after baseline to determine clinical improvements in symptoms of depression (primary outcome: Patient Health Questionnaire-9), remission of depression, and cost-effectiveness. Main analyses will be conducted on the pooled data from the eight countries (n = 1200 in total, 150 participants in each country). The E-COMPARED project will provide mental health care stakeholders with evidence-based information and recommendations on the clinical and cost-effectiveness of blended depression treatment. France: ClinicalTrials.gov NCT02542891 . Registered on 4 September 2015; Germany: German Clinical Trials Register DRKS00006866 . Registered on 2 December 2014; The Netherlands: Netherlands Trials Register NTR4962 . Registered on 5 January 2015; Poland: ClinicalTrials.Gov NCT02389660

Early interventional treatment with intranasal corticosteroids compared with postonset treatment in pollinosis.

PubMed

Higaki, Takaya; Okano, Mitsuhiro; Makihara, Seiichiro; Fujiwara, Tazuko; Haruna, Takenori; Noda, Yohei; Kariya, Shin; Nishizaki, Kazunori

2012-12-01

The usefulness of early interventional treatment (EIT) with intranasal corticosteroids (INSs) compared with postonset treatment (POT) has not been clarified. To study the efficacy and safety of EIT with INSs compared with POT and placebo in Japanese cedar/cypress pollinosis. We designed a 3-armed, double-blinded, randomized, placebo-controlled trial. Patients received mometasone furoate nasal spray (EIT group: n = 25), placebo (n = 25), or 4 weeks of placebo followed by 8 weeks of mometasone (POT group: n = 25) for a 12-week period starting on February 1, 2011. The primary end point was the comparison of the total nasal symptom score (TNSS) among the 3 groups. Total ocular symptom score (TOSS), total naso-ocular symptom score (TSS), Allergic Rhinitis and Its Impact (ARIA) on Asthma classification, and safety were the main secondary end points. The placebo and POT groups, but not the EIT group, had a significant exacerbation of TNSS and TOSS soon after the start of pollen counts being high on consecutive days. The 12-week mean TSS in the EIT group (score, 2.3) was significantly lower than in the placebo (5.0; P < .01) and POT (3.9; P = .03) groups. All patients in the placebo and POT groups were classified as having persistent rhinitis, whereas 80% of the EIT group met the ARIA classification criteria (P = .03). The quality-of-life score and nasal eosinophil cationic protein levels were lower in the EIT and POT groups compared with the placebo group. Daytime sleepiness, smell disturbance, and the mean dose of loratadine taken as the rescue medication were similar. Treatment with mometasone was well tolerated. EIT with INSs is superior to POT in controlling pollinosis. Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

A state-of-art review of low intensity extracorporeal shock wave therapy and lithotripter machines for the treatment of erectile dysfunction.

PubMed

Chung, Eric; Wang, Juan

2017-12-01

Current treatment for erectile dysfunction (ED) mostly attempts to improve erectile function with limited impact on altering the underlying pathophysiology of ED. Recent animal experiments have supported the notion that low intensity extracorporeal shockwave therapy (LIESWT) significantly improves penile hemodynamics and might induce structural changes that regenerate penile tissue. Areas covered: This review article provides an overview of the basic mechanics and clinical studies pertaining to LIESWT and its use in the field of ED. We identify several key aspects of LIESWT and compare contemporary LIESWT machines and their clinical outcomes. Expert commentary: There is emerging and strong literature to support the use of LIESWT in men with ED, with many clinical studies reported encouraging results in the use of LIESWT with improved erectile function, good safety records, and short-term durability. However, there is a need to define which subgroup of ED population is best suited and the LIESWT treatment protocol including LIESWT template, modality of shock waves energy, emission frequency, and total energy delivery. More stringent randomised controlled trials are warranted before there is widespread acceptance of this LIESWT technology as the standard of care in ED.

Comparative Review of the Treatment Methodologies of Carotid Stenosis

PubMed Central

Bae, Coney; Szuchmacher, Mauricio; Chang, John B.

2015-01-01

The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Trial (ACST) trials. When CAS is compared with CEA, the CREST resulted in similar rates of ipsilateral stroke and death rates regardless of symptoms. However, CAS not only increased adverse effects in women, it also amplified stroke rates and death in elderly patients compared with CEA. CAS can maximize its utility in treating focal restenosis after CEA and patients with overwhelming cardiac risk or prior neck irradiation. When performing CEA, using a patch was equated to a more durable result than primary closure, whereas eversion technique is a new methodology deserving a spotlight. Comparing the three major treatment strategies of carotid stenosis has intrinsic drawbacks, as most trials are outdated and they vary in their premises, definitions, and study designs. With the newly codified best medical management including antiplatelet therapies with aspirin and clopidogrel, statin, antihypertensive agents, strict diabetes control, smoking cessation, and life style change, the current trials may demonstrate that asymptomatic carotid stenosis is best treated with best medical therapy. The ongoing trials will illuminate and reshape the treatment paradigm for symptomatic and asymptomatic carotid stenosis. PMID:26417191

Comparing Treatment Plan in All Locations of Esophageal Cancer

PubMed Central

Lin, Jang-Chun; Tsai, Jo-Ting; Chang, Chih-Chieh; Jen, Yee-Min; Li, Ming-Hsien; Liu, Wei-Hsiu

2015-01-01

Abstract The aim of this study was to compare treatment plans of volumetric modulated arc therapy (VMAT) with intensity-modulated radiotherapy (IMRT) for all esophageal cancer (EC) tumor locations. This retrospective study from July 2009 to June 2014 included 20 patients with EC who received definitive concurrent chemoradiotherapy with radiation doses >50.4 Gy. Version 9.2 of Pinnacle3 with SmartArc was used for treatment planning. Dosimetric quality was evaluated based on doses to several organs at risk, including the spinal cord, heart, and lung, over the same coverage of gross tumor volume. In upper thoracic EC, the IMRT treatment plan had a lower lung mean dose (P = 0.0126) and lung V5 (P = 0.0037) compared with VMAT; both techniques had similar coverage of the planning target volumes (PTVs) (P = 0.3575). In middle thoracic EC, a lower lung mean dose (P = 0.0010) and V5 (P = 0.0145), but higher lung V20 (P = 0.0034), spinal cord Dmax (P = 0.0262), and heart mean dose (P = 0.0054), were observed for IMRT compared with VMAT; IMRT provided better PTV coverage. Patients with lower thoracic ECs had a lower lung mean dose (P = 0.0469) and V5 (P = 0.0039), but higher spinal cord Dmax (P = 0.0301) and heart mean dose (P = 0.0020), with IMRT compared with VMAT. PTV coverage was similar (P = 0.0858) for the 2 techniques. IMRT provided a lower mean dose and lung V5 in upper thoracic EC compared with VMAT, but exhibited different advantages and disadvantages in patients with middle or lower thoracic ECs. Thus, choosing different techniques for different EC locations is warranted. PMID:25929910

Indirect Treatment Comparison of Talimogene Laherparepvec Compared with Ipilimumab and Vemurafenib for the Treatment of Patients with Metastatic Melanoma.

PubMed

Quinn, Casey; Ma, Qiufei; Kudlac, Amber; Palmer, Stephen; Barber, Beth; Zhao, Zhongyun

2016-04-01

Few randomized controlled trials have compared new treatments for metastatic melanoma. We sought to examine the relative treatment effect of talimogene laherparepvec compared with ipilimumab and vemurafenib. A systematic literature review of treatments for metastatic melanoma was undertaken but a valid network of evidence could not be established because of a lack of comparative data or studies with sufficient common comparators. A conventional adjusted indirect treatment comparison via network meta-analysis was, therefore, not feasible. Instead, a meta-analysis of absolute efficacy was undertaken, adjusting overall survival (OS) data for differences in prognostic factors between studies using a published algorithm. Four trials were included in the final indirect treatment comparison: two of ipilimumab, one of vemurafenib, and one of talimogene laherparepvec. Median OS for ipilimumab and vemurafenib increased significantly when adjustment was applied, demonstrating that variation in disease and patient characteristics was biasing OS estimates; adjusting for this made the survival data more comparable. For both ipilimumab and vemurafenib, the adjustments improved Kaplan-Meier OS curves; the observed talimogene laherparepvec OS curve remained above the adjusted OS curves for ipilimumab and vemurafenib, showing that long-term survival could differ from the observed medians. Even with limited data, talimogene laherparepvec, ipilimumab, and vemurafenib could be compared following adjustments, thereby providing a more reliable understanding of the relative effect of treatment on survival in a more comparable patient population. The results of this analysis suggest that OS with talimogene laherparepvec is at least as good as with ipilimumab and vemurafenib and improvement was more pronounced in patients with no bone, brain, lung or other visceral metastases. Amgen Inc.

High-Speed Synchrotron X-ray Imaging Studies of the Ultrasound Shockwave and Enhanced Flow during Metal Solidification Processes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tan, Dongyue; Lee, Tung Lik; Khong, Jia Chuan

2015-03-31

The highly dynamic behavior of ultrasonic bubble implosion in liquid metal, the multiphase liquid metal flow containing bubbles and particles, and the interaction between ultrasonic waves and semisolid phases during solidification of metal were studied in situ using the complementary ultrafast and high-speed synchrotron X-ray imaging facilities housed, respectively, at the Advanced Photon Source, Argonne National Laboratory, US, and Diamond Light Source, UK. Real-time ultrafast X-ray imaging of 135,780 frames per second revealed that ultrasonic bubble implosion in a liquid Bi-8 wt pctZn alloy can occur in a single wave period (30 kHz), and the effective region affected by themore » shockwave at implosion was 3.5 times the original bubble diameter. Furthermore, ultrasound bubbles in liquid metal move faster than the primary particles, and the velocity of bubbles is 70 similar to 100 pct higher than that of the primary particles present in the same locations close to the sonotrode. Ultrasound waves can very effectively create a strong swirling flow in a semisolid melt in less than one second. The energetic flow can detach solid particles from the liquid-solid interface and redistribute them back into the bulk liquid very effectively.« less

A Theoretical Investigation of Radial Lateral Wells with Shockwave Completion in Shale Gas Reservoirs

NASA Astrophysics Data System (ADS)

Shan, Jia

As its role in satisfying the energy demand of the U.S. and as a clean fuel has become more significant than ever, the shale gas production in the U.S. has gained increasing momentum over recent years. Thus, effective and environmentally friendly methods to extract shale gas are critical. Hydraulic fracturing has been proven to be efficient in the production of shale gas. However, environmental issues such as underground water contamination and high usage of water make this technology controversial. A potential technology to eliminate the environmental issues concerning water usage and contamination is to use blast fracturing, which uses explosives to create fractures. It can be further aided by HEGF and multi-pulse pressure loading technology, which causes less crushing effect near the wellbore and induces longer fractures. Radial drilling is another relatively new technology that can bypass damage zones due to drilling and create a larger drainage area through drilling horizontal wellbores. Blast fracturing and radial drilling both have the advantage of cost saving. The successful combination of blast fracturing and radial drilling has a great potential for improving U.S. shale gas production. An analytical productivity model was built in this study, considering linear flow from the reservoir rock to the fracture face, to analyze factors affecting shale gas production from radial lateral wells with shockwave completion. Based on the model analyses, the number of fractures per lateral is concluded to be the most effective factor controlling the productivity index of blast-fractured radial lateral wells. This model can be used for feasibility studies of replacing hydraulic fracturing by blast fracturing in shale gas well completions. Prediction of fracture geometry is recommended for future studies.

Treatment of ocular rosacea: comparative study of topical cyclosporine and oral doxycycline.

PubMed

Arman, Aysegul; Demirseren, Duriye Deniz; Takmaz, Tamer

2015-01-01

To compare the effectiveness of topical cyclosporine A emulsion with that of oral doxycycline for rosacea associated ocular changes and dry eye complaints. One hundred and ten patients with rosacea were screened. Thirty-eight patients having rosacea associated eyelid and ocular surface changes and dry eye complaints were included in the study. Patients were randomly divided into two groups: nineteen patients were given topical cyclosporine twice daily and nineteen patients were given oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. Symptom and sign scores, ocular surface disease index questionnarie and tear function tests were evaluated at baseline and monthly for 3mo. Three months after results were compared with that of baseline. Mean values of symptom, eyelid sign and corneal/conjunctival sign scores of each treatment group at baseline and 3mo after treatments were compared and both drugs were found to be effective on rosacea associated ocular changes (P<0.001). Cyclosporine was more effective in symptomatic relief and in the treatment of eyelid signs (P=0.01). There was statistically significant increase in the mean Schirmer score with anesthesia and tear break up time scores in the cyclosporine treatment group compared to the doxycycline treatment group (P<0.05). Cyclosporine as a topical drug can be used in the treatment of rosacea associated ocular complications because it is more effective than doxycycline. In addition ocular rosacea as a chronic disease requires long term treatment and doxycycline has various side effects limiting its long term usage.

[Comparative oncologic and functional outcomes of prostate cancer surgery with other curative treatments].

PubMed

Soulié, M; Salomon, L

2015-11-01

Review of the comparative results of different treatment strategies (surgery, radiotherapy, ultrasound, surveillance) of prostate cancer, in which the main goal is the local control and the second target is the tolerance of the side effects of those treatments. Review of literature using Medline databases selected based on scientific relevance. Clinical keys centered on the oncological and functional outcomes of comparative series between different curative treatments. The numerous comparative series between surgery and other therapeutic modalities are essentially retrospective with significant methodological bias that is difficult to overcome in order to formulate the optimal thesis. However, there is a clear tendency toward surgery usually with young patients who have intermediate risk tumors without important comorbidity. In the absence of randomized comparative series with significant power, the oncological and functional results of the radical prostatectomy with or without adjuvant treatment seem at least the same, in a selected population of patients, compared with the combination of radiotherapy-hormonotherapy in terms of survival, without biochemical recurrence, disease-specific survival and overall survival, for the aggressive tumors necessitating curative local treatments. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

New developments in diagnosis and non-surgical treatment of chronic pancreatitis.

PubMed

Inui, Kazuo; Yoshino, Junji; Miyoshi, Hironao; Yamamoto, Satoshi; Kobayashi, Takashi

2013-12-01

Chronic pancreatitis is progressive and irreversible, leading to digestive and absorptive disorders by destruction of the exocrine pancreas and to diabetes mellitus by destruction of the endocrine pancreas. When complications such as pancreatolithiasis and pseudocyst occur, elevated pancreatic ductal pressure exacerbates pain and induces other complications, worsening the patient's general condition. Combined treatment with extracorporeal shock-wave lithotripsy and endoscopic lithotripsy is a useful, minimally invasive, first-line treatment approach that can preserve pancreatic exocrine function. Pancreatic duct stenosis elevates intraductal pressure and favor both pancreatolithiasis and pseudocyst formation, making effective treatment vitally important. Endoscopic treatment of benign pancreatic duct stenosis stenting frequently decreases pain in chronic pancreatitis. Importantly, stenosis of the main pancreatic duct increases risk of stone recurrence after treatment of pancreatolithiasis. Recently, good results were reported in treating pancreatic duct stricture with a fully covered self-expandable metallic stent, which shows promise for preventing stone recurrence after lithotripsy in patients with pancreatic stricture. Chronic pancreatitis has many complications including pancreatic carcinoma, pancreatic atrophy, and loss of exocrine and endocrine function, as well as frequent recurrence of stones after treatment of pancreatolithiasis. As early treatment of chronic pancreatitis is essential, the new concept of early chronic pancreatitis, including characteristics findings in endoscopic ultrasonograms, is presented. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Combining doxorubicin-nanobubbles and shockwaves for anaplastic thyroid cancer treatment: preclinical study in a xenograft mouse model.

PubMed

Marano, Francesca; Frairia, Roberto; Rinella, Letizia; Argenziano, Monica; Bussolati, Benedetta; Grange, Cristina; Mastrocola, Raffaella; Castellano, Isabella; Berta, Laura; Cavalli, Roberta; Catalano, Maria Graziella

2017-06-01

Anaplastic thyroid cancer is one of the most lethal diseases, and a curative therapy does not exist. Doxorubicin, the only drug approved for anaplastic thyroid cancer treatment, has a very low response rate and causes numerous side effects among which cardiotoxicity is the most prominent. Thus, doxorubicin delivery to the tumor site could be an import goal aimed to improve the drug efficacy and to reduce its systemic side effects. We recently reported that, in human anaplastic thyroid cancer cell lines, combining doxorubicin-loaded nanobubbles with extracorporeal shock waves, acoustic waves used in lithotripsy and orthopedics without side effects, increased the intracellular drug content and in vitro cytotoxicity. In the present study, we tested the efficacy of this treatment on a human anaplastic thyroid cancer xenograft mouse model. After 21 days, the combined treatment determined the greatest drug accumulation in tumors with consequent reduction of tumor volume and weight, and an extension of the tumor doubling time. Mechanistically, the treatment induced tumor apoptosis and decreased cell proliferation. Finally, although doxorubicin caused the increase of fibrosis markers and oxidative stress in animal hearts, loading doxorubicin into nanobubbles avoided these effects preventing heart damage. The improvement of doxorubicin anti-tumor effects together with the prevention of heart damage suggests that the combination of doxorubicin-loaded nanobubbles with extracorporeal shock waves might be a promising drug delivery system for anaplastic thyroid cancer treatment. © 2017 Society for Endocrinology.

Direct numerical simulation of shockwave and turbulent boundary layer interactions

NASA Astrophysics Data System (ADS)

Wu, Minwei

Direct numerical simulations (DNS) of a shockwave/turbulent boundary layer interaction (STBLI) at Mach number 3 and Reynolds number based on the momentum thickness of 2300 are performed. A 4th-order accurate, bandwidth-optimized weighted-essentially-non-oscillatory (WENO) scheme is used and the method is found to be too dissipative for the STBLI simulation due to the over-adaptation properties of this original WENO scheme. In turn, a relative limiter is introduced to mitigate the problem. Tests on the Shu-Osher problem show that the modified WENO scheme decreases the numerical dissipation significantly. By utilizing a combination of the relative limiter and the absolute limiter described by Jiang & Shu [32], the DNS results are improved further. The DNS data agree well with the reference experiments of Bookey et al. [10] in the size of the separation bubble, the separation and reattachment point, the mean wall-pressure distribution, and the velocity profiles both upstream and downstream of the interaction region. The DNS data show that velocity profiles change dramatically along the streamwise direction. Downstream of the interaction, the velocity profiles show a characteristic "dip" in the logarithmic region, as shown by the experiments of Smits & Muck [66] at much higher Reynolds number. In the separation region, the velocity profiles are found to resemble those of a laminar flow, yet the flow does not fully relaminarize. The mass-flux turbulence intensity is amplified by a factor of about 5 throughout the interaction, which is consistent with that found in higher Reynolds experiments of Selig et al. [52]. All Reynolds stress components are greatly amplified by the interaction. Assuming that the ow is still two dimensional downstream of the interaction, the components rhou'u', rhov'v', rho w'w', and rho u'w' are amplified by factors of 6, 6, 12, and 24, respectively, where u is the streamwise and w is the wall-normal velocity. However, analyses of the turbulence

Comparison of shockwave lithotripsy and flexible ureteroscopy for the treatment of kidney stones in patients with a solitary kidney.

PubMed

Yuruk, Emrah; Binbay, Murat; Ozgor, Faruk; Sekerel, Levent; Berberoglu, Yalcin; Muslumanoglu, Ahmet Yaser

2015-04-01

To compare the outcomes of these minimally invasive procedures in this patient population. The database of our institution has been retrospectively reviewed, and medical records of urolithiasis patients with a solitary kidney who underwent flexible ureteroscopy (F-URS) or extracorporeal shock wave lithotripsy (SWL) between January 2009 and December 2012 were examined. Retreatment rates, complications, changes in estimated glomerular filtration rates (eGFRs), chronic kidney disease (CKD) stages, and stone-free rates were compared between the two groups. Stones of 48 patients (mean age: 48.8±15.4, range: 14-76) with solitary kidneys were treated with SWL (n=30, 62.5%) or F-URS (n=18, 37.5%). Patient demographics and stone related parameters were similar. The most common stone location was the pelvis in the SWL group (36.6%), whereas it was the pelvis and a calix in the F-URS group (38.8%). Complications and success rates were similar in both groups, however, patients in the SWL group needed more sessions to achieve stone clearance (2.2±0.89 vs 1.06±0.24, p=0.0001). Preoperative and postoperative eGFR and CKD stage changes were also similar. Both SWL and F-URS are effective and safe techniques, which can be used for the treatment of stones in patients with solitary kidneys. However, patients treated with SWL need more sessions to achieve stone clearance.

Alternating treatments design: one strategy for comparing the effects of two treatments in a single subject.

PubMed Central

Barlow, D H; Hayes, S C

1979-01-01

A little used and often confused design, capable of comparing two treatments within a single subject, has been termed, variously, a multielement baseline design, a multiple schedule design, and a randomization design. The background of these terms is reviewed, and a new, more descriptive term, Alternating Treatments Design, is proposed. Critical differences between this design and a Simultaneous Treatment Design are outlined, and experimental questions answerable by each design are noted. Potential problems with multiple treatment interference in this procedure are divided into sequential confounding, carryover effects, and alternation effects and the importance of these issues vis-a-vis other single-case experimental designs is considered. Methods of minimizing multiple treatment interference as well as methods of studying these effects are outlined. Finally, appropriate uses of Alternating Treatments Designs are described and discussed in the context of recent examples. PMID:489478

Structure, phase content and mechanical properties of aluminium with hard particles after shock-wave compaction

NASA Astrophysics Data System (ADS)

Kulkov, S.; Vorozhtsov, S.; Turuntaev, I.

2015-04-01

The possibilities to combine metal and metal oxide powders in various compositions open a broad range of mechanical and thermal behavior. When using in nanostructured components the resulting materials might exhibit even more interesting properties, like product effectiveness, tensile strength, wear resistance, endurance and corrosion resistance. Intermetallics like TiAl could be obtained as TiAlx in a quality similar to that obtained from melting where only eutectic mixture can be produced. Similar effects are possible when compacting nanoceramic powders whereas these can be combined with intermetallics. Currently, it is very difficult to produce wires and special shaped parts from high temperature superconducting materials. The compacting by explosives could solve this problem.The present paper uses explosion compacting of Al nanoparticles to create nanocomposite with increased physico-mechanical properties. Russian civil explosive Uglenit was chosen as high energy material (HEM) for shock-wave compaction. The different schemes and conditions were suggested to run the explosion process. Al nanoparticles as produced by electric wire explosion contain 8-10% of aluminum oxide. That aluminum oxide can serve as strengthening material in the final nanocomposite which may be generated in various compositions by explosive compacting. Further modifications of nanocomposites were obtained when including nanodiamonds into the mixture with aluminum nanoparticles with different percentages. The addition of nanodiamonds results in a substantial strengthening effect. The experiments with compacting aluminum nanoparticles by explosives are described in detail including the process variations and conditions. The physico-mechanical properties of the nanocomposites are determined and discussed by considering the applied conditions. Especially, microstructure and phases of the obtained nanocomposites are analyzed by X-ray diffraction.

Characterization of Bond Strength of U-Mo Fuel Plates Using the Laser Shockwave Technique: Capabilities and Preliminary Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

J. A. Smith; D. L. Cottle; B. H. Rabin

2013-09-01

This report summarizes work conducted to-date on the implementation of new laser-based capabilities for characterization of bond strength in nuclear fuel plates, and presents preliminary results obtained from fresh fuel studies on as-fabricated monolithic fuel consisting of uranium-10 wt.% molybdenum alloys clad in 6061 aluminum by hot isostatic pressing. Characterization involves application of two complementary experimental methods, laser-shock testing and laser-ultrasonic imaging, collectively referred to as the Laser Shockwave Technique (LST), that allows the integrity, physical properties and interfacial bond strength in fuel plates to be evaluated. Example characterization results are provided, including measurement of layer thicknesses, elastic properties ofmore » the constituents, and the location and nature of generated debonds (including kissing bonds). LST provides spatially localized, non-contacting measurements with minimum specimen preparation, and is ideally suited for applications involving radioactive materials, including irradiated materials. The theoretical principles and experimental approaches employed in characterizing nuclear fuel plates are described, and preliminary bond strength measurement results are discussed, with emphasis on demonstrating the capabilities and limitations of these methods. These preliminary results demonstrate the ability to distinguish bond strength variations between different fuel plates. Although additional development work is necessary to validate and qualify the test methods, these results suggest LST is viable as a method to meet fuel qualification requirements to demonstrate acceptable bonding integrity.« less

Extracorporeal low-energy shock-wave therapy exerts anti-inflammatory effects in a rat model of acute myocardial infarction.

PubMed

Abe, Yuzuru; Ito, Kenta; Hao, Kiyotaka; Shindo, Tomohiko; Ogata, Tsuyoshi; Kagaya, Yuta; Kurosawa, Ryo; Nishimiya, Kensuke; Satoh, Kimio; Miyata, Satoshi; Kawakami, Kazuyoshi; Shimokawa, Hiroaki

2014-01-01

It has been previously demonstrated that extracorporeal low-energy shock-wave (SW) therapy ameliorates left ventricular (LV) remodeling through enhanced angiogenesis after acute myocardial infarction (AMI) in pigs in vivo. However, it remains to be examined whether SW therapy also exerts anti-inflammatory effects on AMI. METHODS AND RESULTS: AMI was created by ligating the proximal left anterior descending coronary artery in rats. They were randomly assigned to 2 groups: with (SW group) or without (control group) SW therapy (0.1 mJ/mm(2), 200 shots, 1 Hz to the whole heart at 1, 3 and 5 days after AMI). Four weeks after AMI, SW therapy significantly ameliorated LV remodeling and fibrosis. Histological examinations showed that SW therapy significantly suppressed the infiltration of neutrophils and macrophages at days 3 and 6, in addition to enhanced capillary density in the border area. Molecular examinations demonstrated that SW therapy enhanced the expression of endothelial nitric oxide synthase and suppressed the infiltration of transforming growth factor-β1-positive cells early after AMI. SW therapy also upregulated anti-inflammatory cytokines and downregulated pro-inflammatory cytokines in general. These results suggest that low-energy SW therapy suppressed post-MI LV remodeling in rats in vivo, which was associated with anti-inflammatory effects in addition to its angiogenic effects, and demonstrated a novel aspect of the therapy for AMI.

Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause

PubMed Central

Brandi, Hugo; Gomez, Valentin; Luque, Daniel

2016-01-01

Objectives The objective of this prospective comparative cohort study was to establish the effectiveness and safety of Erbium:YAG (Er:YAG) laser treatment for genitourinary syndrome of menopause and to compare it with an established topical estriol treatment. Methods Fifty patients with genitourinary syndrome of menopause were divided into two groups. The estriol group received a treatment of 0.5 mg estriol ovules for 8 weeks and the laser group was first treated for 2 weeks with 0.5 mg estriol ovules 3 times per week to hydrate the mucosa and then received three sessions with 2,940 nm Er:YAG laser in non‐ablative mode. Biopsies were taken before and at 1, 3, 6, and 12 months post‐treatment. Maturation index, maturation value and pH where recorded up to 12‐months post‐treatment, while the VAS analysis of symptoms was recorded up to 18 months post‐treatment. Results Statistically significant (P < 0.05), reduction of all assessed symptoms was observed in the laser group at all follow‐ups up to 18 months post‐treatment. Significant improvement in maturation value and a decrease of pH in the laser group was detected up to 12 months after treatment. The improvement in all endpoints was more pronounced and longer lasting in the laser group. Histological examination showed changes in the tropism of the vaginal mucosa and also angiogenesis, congestion, and restructuring of the lamina propria in the laser group. Side effects were minimal and of transient nature in both groups, affecting 4% of patients in the laser group and 12% of patients in the estriol group. Conclusions Our results show that Er:YAG laser treatment successfully relieves symptoms of genitourinary syndrome of menopause and that the results are more pronounced and longer lasting compared to topical estriol treatment. Lasers Surg. Med. 49:160–168, 2017. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc. PMID:27546524

Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause.

PubMed

Gaspar, Adrian; Brandi, Hugo; Gomez, Valentin; Luque, Daniel

2017-02-01

The objective of this prospective comparative cohort study was to establish the effectiveness and safety of Erbium:YAG (Er:YAG) laser treatment for genitourinary syndrome of menopause and to compare it with an established topical estriol treatment. Fifty patients with genitourinary syndrome of menopause were divided into two groups. The estriol group received a treatment of 0.5 mg estriol ovules for 8 weeks and the laser group was first treated for 2 weeks with 0.5 mg estriol ovules 3 times per week to hydrate the mucosa and then received three sessions with 2,940 nm Er:YAG laser in non-ablative mode. Biopsies were taken before and at 1, 3, 6, and 12 months post-treatment. Maturation index, maturation value and pH where recorded up to 12-months post-treatment, while the VAS analysis of symptoms was recorded up to 18 months post-treatment. Statistically significant (P < 0.05), reduction of all assessed symptoms was observed in the laser group at all follow-ups up to 18 months post-treatment. Significant improvement in maturation value and a decrease of pH in the laser group was detected up to 12 months after treatment. The improvement in all endpoints was more pronounced and longer lasting in the laser group. Histological examination showed changes in the tropism of the vaginal mucosa and also angiogenesis, congestion, and restructuring of the lamina propria in the laser group. Side effects were minimal and of transient nature in both groups, affecting 4% of patients in the laser group and 12% of patients in the estriol group. Our results show that Er:YAG laser treatment successfully relieves symptoms of genitourinary syndrome of menopause and that the results are more pronounced and longer lasting compared to topical estriol treatment. Lasers Surg. Med. 49:160-168, 2017. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Treatment satisfaction in type 2 diabetes patients taking empagliflozin compared with patients taking glimepiride.

PubMed

Chirila, Costel; Zheng, Qingyao; Davenport, Eric; Kaschinski, Dagmar; Pfarr, Egon; Hach, Thomas; Palencia, Roberto

2016-05-01

This exploratory analysis assessed and compared patients' treatment satisfaction with empagliflozin plus metformin versus glimepiride plus metformin, using data obtained from the Diabetes Treatment Satisfaction Questionnaire, status version (DTSQs) collected in a randomized, double-blind, double-dummy clinical trial. Observed values for DTSQs scale score and each of its eight items were summarized by visit and treatment arm. Changes from baseline in these scores were analyzed using linear mixed models for repeated measures. The baseline scale score and item scores were comparable between empagliflozin plus metformin (n = 765) and glimepiride plus metformin (n = 780). Compared with baseline, patients reported significant treatment satisfaction increases and significant decreases in perceived hyperglycemia with both treatments at all visits. Also, compared with baseline, a significant increase in perceived frequency of hypoglycemia was observed in the glimepiride treatment group at all visits. No statistically significant treatment difference was observed in DTSQs scale score and its items at week 104. The difference between the treatment groups was significant and in favor of empagliflozin from week 28 onward for perceived frequency of hyperglycemia (P ≤ 0.006) and perceived frequency of hypoglycemia (P ≤ 0.011). Despite positive trends in favor of empagliflozin, there was no significant difference in DTSQs scale score between empagliflozin and glimepiride at 104 weeks. However, when compared with glimepiride, empagliflozin demonstrated significantly lower perceived frequency of hyperglycemia and hypoglycemia at all visits from week 28 onward. This finding is consistent with the clinical results reported for the EMPA-REG H2H-SU trial.

Targeted microbubbles: a novel application for the treatment of kidney stones.

PubMed

Ramaswamy, Krishna; Marx, Vanessa; Laser, Daniel; Kenny, Thomas; Chi, Thomas; Bailey, Michael; Sorensen, Mathew D; Grubbs, Robert H; Stoller, Marshall L

2015-07-01

Kidney stone disease is endemic. Extracorporeal shockwave lithotripsy was the first major technological breakthrough where focused shockwaves were used to fragment stones in the kidney or ureter. The shockwaves induced the formation of cavitation bubbles, whose collapse released energy at the stone, and the energy fragmented the kidney stones into pieces small enough to be passed spontaneously. Can the concept of microbubbles be used without the bulky machine? The logical progression was to manufacture these powerful microbubbles ex vivo and inject these bubbles directly into the collecting system. An external source can be used to induce cavitation once the microbubbles are at their target; the key is targeting these microbubbles to specifically bind to kidney stones. Two important observations have been established: (i) bisphosphonates attach to hydroxyapatite crystals with high affinity; and (ii) there is substantial hydroxyapatite in most kidney stones. The microbubbles can be equipped with bisphosphonate tags to specifically target kidney stones. These bubbles will preferentially bind to the stone and not surrounding tissue, reducing collateral damage. Ultrasound or another suitable form of energy is then applied causing the microbubbles to induce cavitation and fragment the stones. This can be used as an adjunct to ureteroscopy or percutaneous lithotripsy to aid in fragmentation. Randall's plaques, which also contain hydroxyapatite crystals, can also be targeted to pre-emptively destroy these stone precursors. Additionally, targeted microbubbles can aid in kidney stone diagnostics by virtue of being used as an adjunct to traditional imaging methods, especially useful in high-risk patient populations. This novel application of targeted microbubble technology not only represents the next frontier in minimally invasive stone surgery, but a platform technology for other areas of medicine. © 2014 The Authors BJU International © 2014 BJU International Published

[The costs of new drugs compared to current standard treatment].

PubMed

Ujeyl, Mariam; Schlegel, Claudia; Gundert-Remy, Ursula

2013-01-01

Until AMNOG came into effect Germany had free pricing of new drugs. Our exemplary work investigates the costs of new drugs that were licensed in the two years prior to AMNOG, and compares them to the costs of standard treatment that has been used in pivotal trials. Also, the important components of pharmaceutical prices will be illustrated. We retrospectively analysed the European Public Assessment Reports of proprietary medicinal products that the European Medicinal Agency initially approved in 2009 and 2010 and that were tested against an active control in at least one pivotal trial. If the standard treatment was a generic, the average pharmacy retail price of new drugs was 7.4 times (median 7.1) higher than that of standard treatment. If the standard treatment was an originator drug the average price was 1.4 times (median 1.2) higher than that of the new drug. There was no clear correlation of an increase in costs for new drugs and their "grade of innovation" as rated according to the criteria of Fricke. Our study shows that prices of new drugs must be linked to the evidence of comparative benefit; since German drug pricing is complex, cost saving effects obtained thereby will depend on a range of other rules and decisions. Copyright © 2013. Published by Elsevier GmbH.

Comparative trial of endocrine versus cytotoxic treatment in advanced breast cancer.

PubMed Central

Priestman, T; Baum, M; Jones, V; Forbes, J

1977-01-01

Ninety-two women with advanced breast cancer were allocated at random to receive either cytotoxic or endocrine treatment. Out of 45 women included in the cytotoxic treatment group, 22 (49%) achieved complete or partial remission of their disease, whereas of the 47 included in the endocrine treatment group, only 10 (21%) achieved such remission. Significantly longer survival times in the cytotoxic treatment group were most apparent among premenopausal women, 75% of such patients responding to cytotoxic drugs (median survival 46 weeks) compared with only 11% benefiting from ovarian ablation (median survival 12 weeks). In postmenopausal women with predominantly soft-tissue disease, however, additive hormonal treatment with tamoxifen produced remission rates and survival times equivalent to those produced by cytotoxic drugs. PMID:324570

Risk of Suicidal Events With Atomoxetine Compared to Stimulant Treatment: A Cohort Study

PubMed Central

Bussing, Regina; Kubilis, Paul; Gerhard, Tobias; Segal, Richard; Shuster, Jonathan J; Winterstein, Almut G

2016-01-01

BACKGROUND: Antidepressant effects on increased suicidality in children have raised public concern in recent years. Approved in 2002 for attention-deficit/hyperactivity disorder treatment, the selective noradrenalin-reuptake-inhibitor atomoxetine was initially investigated for the treatment of depression. In post-hoc analyses of clinical trial data, atomoxetine has been associated with an increased risk of suicidal ideation in children and adolescents. We analyzed whether the observed increased risk of suicidal ideation in clinical trials translates into an increased risk of suicidal events in pediatric patients treated with atomoxetine compared with stimulants in 26 Medicaid programs. METHODS: Employing a retrospective cohort design, we used propensity score–adjusted Cox proportional hazard models to evaluate the risk of suicide and suicide attempt in pediatric patients initiating treatment with atomoxetine compared with stimulants from 2002 to 2006. RESULTS: The first-line treatment cohort included 279 315 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.95 (95% CI 0.47–1.92, P = .88). The second-line treatment cohort included 220 215 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.71 (95% CI 0.30–1.67, P = .43). CONCLUSIONS: First- and second-line treatment of youths age 5 to 18 with atomoxetine compared with stimulants was not significantly associated with an increased risk of suicidal events. The low incidence of suicide and suicide attempt resulted in wide confidence intervals and did not allow stratified analysis of high-risk groups or assessment of suicidal risk associated with long-term use of atomoxetine. PMID:27244795

Risk of Suicidal Events With Atomoxetine Compared to Stimulant Treatment: A Cohort Study.

PubMed

Linden, Stephan; Bussing, Regina; Kubilis, Paul; Gerhard, Tobias; Segal, Richard; Shuster, Jonathan J; Winterstein, Almut G

2016-05-01

Antidepressant effects on increased suicidality in children have raised public concern in recent years. Approved in 2002 for attention-deficit/hyperactivity disorder treatment, the selective noradrenalin-reuptake-inhibitor atomoxetine was initially investigated for the treatment of depression. In post-hoc analyses of clinical trial data, atomoxetine has been associated with an increased risk of suicidal ideation in children and adolescents. We analyzed whether the observed increased risk of suicidal ideation in clinical trials translates into an increased risk of suicidal events in pediatric patients treated with atomoxetine compared with stimulants in 26 Medicaid programs. Employing a retrospective cohort design, we used propensity score-adjusted Cox proportional hazard models to evaluate the risk of suicide and suicide attempt in pediatric patients initiating treatment with atomoxetine compared with stimulants from 2002 to 2006. The first-line treatment cohort included 279 315 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.95 (95% CI 0.47-1.92, P = .88). The second-line treatment cohort included 220 215 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.71 (95% CI 0.30-1.67, P = .43). First- and second-line treatment of youths age 5 to 18 with atomoxetine compared with stimulants was not significantly associated with an increased risk of suicidal events. The low incidence of suicide and suicide attempt resulted in wide confidence intervals and did not allow stratified analysis of high-risk groups or assessment of suicidal risk associated with long-term use of atomoxetine. Copyright © 2016 by the American Academy of Pediatrics.

Matching weights to simultaneously compare three treatment groups: Comparison to three-way matching

PubMed Central

Yoshida, Kazuki; Hernández-Díaz, Sonia; Solomon, Daniel H.; Jackson, John W.; Gagne, Joshua J.; Glynn, Robert J.; Franklin, Jessica M.

2017-01-01

BACKGROUND Propensity score matching is a commonly used tool. However, its use in settings with more than two treatment groups has been less frequent. We examined the performance of a recently developed propensity score weighting method in the three treatment group setting. METHODS The matching weight method is an extension of inverse probability of treatment weighting (IPTW) that reweights both exposed and unexposed groups to emulate a propensity score matched population. Matching weights can generalize to multiple treatment groups. The performance of matching weights in the three-group setting was compared via simulation to three-way 1:1:1 propensity score matching and IPTW. We also applied these methods to an empirical example that compared the safety of three analgesics. RESULTS Matching weights had similar bias, but better mean squared error (MSE) compared to three-way matching in all scenarios. The benefits were more pronounced in scenarios with a rare outcome, unequally sized treatment groups, or poor covariate overlap. IPTW’s performance was highly dependent on covariate overlap. In the empirical example, matching weights achieved the best balance for 24 out of 35 covariates. Hazard ratios were numerically similar to matching. However, the confidence intervals were narrower for matching weights. CONCLUSIONS Matching weights demonstrated improved performance over three-way matching in terms of MSE, particularly in simulation scenarios where finding matched subjects was difficult. Given its natural extension to settings with even more than three groups, we recommend matching weights for comparing outcomes across multiple treatment groups, particularly in settings with rare outcomes or unequal exposure distributions. PMID:28151746

NASA's F-15B from the Dryden Flight Research Center flew in the supersonic shockwave of a modified U.S. Navy F-5E jet in support of the Shaped Sonic Boom Demonstration (SSBD) project. On Aug. 27, 2003, the F-5 SSBD aircraft demonstrated a method to reduce

NASA Image and Video Library

2003-08-25

NASA's F-15B research testbed jet from NASA's Dryden Flight Research Center flew in the supersonic shockwave of a Northrop Grumman Corp. modified U.S. Navy F-5E jet in support of the Shaped Sonic Boom Demonstration (SSBD) project, which is part of the DARPA's Quiet Supersonic Platform (QSP) program. On Aug. 27, 2003, the F-5 SSBD aircraft demonstrated a method to reduce the intensity of sonic booms.

COMPARING RBF WITH BENCH-SCALE CONVENTIONAL TREATMENT FOR PRECURSOR REDUCTION

EPA Science Inventory

The reduction of disinfection by-product (DBP) precursors upon riverbank filtration (RBF) at three drinking water utilities in the mid-Western United States was compared with that obtained using a bench-scale conventional treatment train on the corresponding river waters. The riv...

Shadowgraphic investigations into the laser-induced forward transfer of different SnO2 precursor films

NASA Astrophysics Data System (ADS)

Mattle, Thomas; Shaw-Stewart, James; Hintennach, Andreas; Schneider, Christof W.; Lippert, Thomas; Wokaun, Alexander

2013-08-01

Laser-induced forward transfer of different SnO2 precursor films for sensor applications were investigated using time resolved imaging, from 0 to 2 μs after the onset of the ablation process. Transfers of SnCl2(acac)2 and SnO2 nano-particles, both with and without a triazene polymer dynamic release layer (DRL), were investigated and compared to transfers of aluminum films with a triazene polymer DRL. Shockwave speed and flyer speeds at high laser fluences of Φ = 650 mJ/cm2 and at the lower fluences, suitable for the transfer of functional and well defined pixels were analyzed. No influence of the use of a triazene polymer DRL on shockwave and flyer speed was observed. Material ejected under transfer condition showed a velocity of around 200 m/s with a weak shockwave.

Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment.

PubMed

Imani, Saeed; Atef Vahid, Mohammad Kazem; Gharraee, Banafsheh; Noroozi, Alireza; Habibi, Mojtaba; Bowen, Sarah

2015-06-01

This study investigated the effectiveness of mindfulness-based group therapy (MBGT) compared to the usual opioid dependence treatment (TAU).Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS) were randomly assigned into experimental (Mindfulness-Based Group Therapy) and control groups (the Usual Treatment).The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program. The Five Factor Mindfulness Questionnaire (FFMQ) and the Addiction Sevier Index (ASI) were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders.

Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment

PubMed Central

Imani, Saeed; Atef Vahid, Mohammad Kazem; Gharraee, Banafsheh; Noroozi, Alireza; Habibi, Mojtaba; Bowen, Sarah

2015-01-01

Objective: This study investigated the effectiveness of mindfulness-based group therapy (MBGT) compared to the usual opioid dependence treatment (TAU).Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS) were randomly assigned into experimental (Mindfulness-Based Group Therapy) and control groups (the Usual Treatment).The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program. Methods: The Five Factor Mindfulness Questionnaire (FFMQ) and the Addiction Sevier Index (ASI) were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. Results: The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. Conclusion: The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders. PMID:26877751

Comparative Effectiveness of Treatments for Chronic Low Back Pain: A Multiple Treatment Comparison Analysis.

PubMed

Rihn, Jeffrey A; Radcliff, Kristen; Norvell, Daniel C; Eastlack, Robert; Phillips, Frank M; Berland, Daniel; Sherry, Ned; Freedman, Mitchell; Vaccaro, Alexander R

2017-06-01

A systematic review and network meta-analysis. To determine current treatment options of chronic low back pain (LBP) as defined by randomized controlled trials (RCTs) and to compare effectiveness of those treatments using a mixed-treatment comparison (MTC). It is important to provide an evidence-based assessment of the treatment options that exist for LBP. A systematic search of RCTs was conducted in MEDLINE and the Cochrane Collaboration Library from 1990 to 2014. From the selected studies, we extracted preoperative and postoperative ODI and VAS back pain scores, additional surgeries, and complications. Standard and network meta-analytic techniques were used. Twelve RCTs were included in the analysis: 5 total disk replacement (TDR) versus fusion; 1 TDR versus exercise and cognitive behavioral therapy (CBT); 5 fusion versus exercise and CBT; and 1 fusion versus physical therapy (PT). On the basis of MTC, with respect to ODI change scores, the pooled mean difference favoring fusion over exercise and CBT was 2.0 points (95% CI, -1.2 to 4.8). The pooled mean difference favoring TDR over exercise and CBT was 6.4 points (95% CI, 3.2-9.3). The pooled mean difference favoring fusion over PT was 8.8 points (95% CI, 4.1-13.6). The pooled mean differences favoring TDR over fusion was 4.4 points (95% CI, 2.37-6.63). For PT versus structured exercise with CBT, the pooled mean difference favoring exercise with CBT over PT was 6.8 points (95% CI, 1.5-12.8). For TDR versus PT, the pooled mean difference favoring TDR over PT was 13.2 points (95% CI, 8.0-18.4). Additional surgery rates were similar between treatment options. All 4 treatments provided some benefit to patients with chronic LBP. According to the MTC analysis, TDR may be the most effective treatment and PT the least effective treatment for chronic LBP. This review is based on a limited number of RCT studies and does not support any 1 treatment modality for all patients.

Comparing Biofouling Control Treatments for Use on Aquaculture Nets

PubMed Central

Swain, Geoffrey; Shinjo, Nagahiko

2014-01-01

Test panels comprised of uncoated, copper coated and silicone coated 7/8'' (22 mm) mesh knitted nylon net were evaluated to compare their properties and the effectiveness to prevent biofouling. This paper describes test procedures that were developed to quantify the performance in terms of antifouling, cleanability, drag and cost. The copper treatment was the most effective at controlling fouling, however, the silicone treated nets were the easiest to clean. The drag forces on the net were a function of twine diameter, twine roughness and fouling. After immersion, the uncoated nets had the most drag followed by the silicone and copper treatments. The cost of applying silicone to nets is high; however, improved formulations may provide a non-toxic alternative to control fouling. PMID:25474085

Worldwide Trends of Urinary Stone Disease Treatment Over the Last Two Decades: A Systematic Review.

PubMed

Geraghty, Robert M; Jones, Patrick; Somani, Bhaskar K

2017-06-01

Numerous studies have reported on regional or national trends of stone disease treatment. However, no article has yet examined the global trends of intervention for stone disease. A systematic review of articles from 1996 to September 2016 for all English language articles reporting on trends of surgical treatment of stone disease was performed. Authors were contacted in the case of data not being clear. If the authors did not reply, data were estimated from graphs or tables. Results were analyzed using SPSS version 21, and trends were analyzed using linear regression. Our systematic review yielded 120 articles, of which 8 were included in the initial review. This reflected outcomes from six countries with available data: United Kingdom, United States, New Zealand, Australia, Canada, and Brazil. Overall ureteroscopy (URS) had a 251.8% increase in total number of treatments performed with the share of total treatments increasing by 17%. While the share of total treatments for percutaneous nephrolithotomy (PCNL) remained static, the share for extracorporeal shockwave lithotripsy and open surgery fell by 14.5% and 12%, respectively. There was significant linear regression between rising trends of total treatments year on year for URS (p < 0.001). In the last two decades, the share of total treatment for urolithiasis across the published literature has increased for URS, stable for PCNL, and decreased for lithotripsy and open surgery.

Patient Perception of Treatment Burden is High in Celiac Disease Compared to Other Common Conditions

PubMed Central

Shah, Sveta; Akbari, Mona; Vanga, Rohini; Kelly, Ciaran P.; Hansen, Joshua; Theethira, Thimmaiah; Tariq, Sohaib; Dennis, Melinda; Leffler, Daniel A.

2014-01-01

Introduction The only treatment for celiac disease (CD) is life-long adherence to a gluten-free diet (GFD). Noncompliance is associated with signs and symptoms of celiac disease, yet long-term adherence rates are poor. It is not known how the burden of the GFD compares to other medical treatments, and there are limited data on the socio-economic factors influencing treatment adherence. In this study we compared treatment burden and health state in CD compared with other chronic illnesses and evaluated the relationship between treatment burden and adherence. Methods A survey was mailed to participants with: CD, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hypertension (HTN), diabetes mellitus (DM), congestive heart failure (CHF), and end stage renal disease on dialysis (ESRD). Surveys included demographic information and visual analog scales measuring treatment burden, importance of treatment, disease-specific and overall health status. Results We collected surveys from 341 celiac and 368 non-celiac participants. Celiac participants reported high treatment burden, greater than participants with GERD or HTN and comparable to ESRD. Conversely, patients with CD reported the highest health state of all groups. Factors associated with high treatment burden in CD included poor adherence, concern regarding food cost, eating outside the home, higher income, lack of college education and time limitations in preparing food. Poor adherence in CD was associated with increased symptoms, income, and low perceived importance of treatment. Discussion Participants with CD have high treatment burden but also excellent overall health status in comparison with other chronic medical conditions. The significant burden of dietary therapy for celiac disease argues for the need for safe adjuvant treatment as well as interventions designed to lower the perceived burden of the GFD. PMID:24980880

Treatment of unicameral bone cyst: a comparative study of selected techniques.

PubMed

Hou, Hsien-Yang; Wu, Karl; Wang, Chen-Ti; Chang, Shun-Min; Lin, Wei-Hsin; Yang, Rong-Sen

2010-04-01

There is a variety of treatment modalities for unicameral bone cysts, with variable outcomes reported in the literature. Although good initial outcomes have been reported, the success rate has often changed with longer-term follow-up. We introduce a novel, minimally invasive treatment method and compare its clinical outcomes with those of other methods of treatment of this lesion. From February 1994 to April 2008, forty patients with a unicameral bone cyst were treated with one of four techniques: serial percutaneous steroid and autogenous bone-marrow injection (Group 1, nine patients); open curettage and grafting with a calcium sulfate bone substitute either without instrumentation (Group 2, twelve patients) or with internal instrumentation (Group 3, seven patients); or minimally invasive curettage, ethanol cauterization, disruption of the cystic boundary, insertion of a synthetic calcium sulfate bone-graft substitute, and placement of a cannulated screw to provide drainage (Group 4, twelve patients). Success was defined as radiographic evidence of a healed cyst or of a healed cyst with some defect according to the modified Neer classification, and failure was defined as a persistent or recurrent cyst that needed additional treatment. Patients who sustained a fracture during treatment were also considered to have had a failure. The outcome parameters included the radiographically determined healing rate, the time to solid union, and the total number of procedures needed. The follow-up time ranged from eighteen to eighty-four months. Group-4 patients had the highest radiographically determined healing rate. Healing was seen in eleven of the twelve patients in that group compared with three of the nine in Group 1, eight of the twelve in Group 2, and six of the seven in Group 3. Group-4 patients also had the shortest mean time to union: 3.7 +/- 2.3 months compared with 23.4 +/- 14.9, 12.2 +/- 8.5, and 6.6 +/- 4.3 months in Groups 1, 2, and 3, respectively. This new

Optimizing results of lithotripsy using robust electromagnetic probe.

PubMed

Keeley, F X; Pye, S D; Smith, G; Tolley, D A

1999-05-01

A significant impediment to the measurement of the pressures and forces created by lithotripter shockwaves has been their destructive properties, which have rendered most measuring devices impractical. We have developed and tested a robust electromagnetic probe to measure cavitational forces in vitro in the focal zones of extracorporeal lithotripters. The probe responds to the pressure gradient generated by the radial motion of cavitation bubbles. The effects of shockwaves from the Dornier MPL 9000 electrohydraulic lithotripter were measured over the lifetime of multiple electrodes. The pulse energy from the electrodes dropped off rapidly after approximately 50% of the lifetime quoted by the manufacturer. The electrodes were more efficient at higher power settings. As a result, we altered our protocol for the treatment of ureteral stones to use a higher kilovoltage and a second electrode whenever necessary. Stone-free rates after shockwave lithotripsy (SWL) in situ for stones < 11 mm have increased from 68.2% to 83.3%, and the retreatment rate has dropped from 23% to 15%. Despite significantly higher power settings (23.7 kV v 18.7 kV; P < 0.0001), the need for sedoanalgesia has remained relatively constant (26% v 31%). Measurement of cavitational forces from lithotripters using a robust electromagnetic probe is useful in planning treatment strategy. We have demonstrated a clinically measurable improvement since implementing our new treatment protocol. Because the probe responds directly to cavitational forces, it should also prove useful for the objective comparison of different SWL machines.

Treatment of tinea capitis - griseofulvin versus fluconazole - a comparative study.

PubMed

Shemer, Avner; Plotnik, Ira Bernstein; Davidovici, Batya; Grunwald, Marcelo H; Magun, Ronen; Amichai, Boaz

2013-08-01

To compare the efficacy and safety of fluconazole and griseofulvin in the treatment of tinea capitis. Patients with tinea capitis (n = 113) with positive fungal cultures entered the study. The patients were divided into four groups with different treatment regimes. Two groups received griseofulvin 15 or 25 mg/kg/day and two groups received fluconazole 4 or 6 mg/kg/day, all for up to 12 weeks. Griseofulvin was found to be slightly better than fluconazole. The lower doses for both griseofulvin and fluconazole required significantly longer treatment duration until mycological cure than the higher doses, independent of the fungus type. Since no significant difference was found between the drugs, it is suggested that the choice should be based on tolerability, availability and cost of the drugs. © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.

Aripiprazole Lauroxil Compared with Paliperidone Palmitate in Patients with Schizophrenia: An Indirect Treatment Comparison.

PubMed

Cameron, Chris; Zummo, Jacqueline; Desai, Dharmik N; Drake, Christine; Hutton, Brian; Kotb, Ahmed; Weiden, Peter J

Aripiprazole lauroxil (AL) is a long-acting injectable atypical antipsychotic recently approved for treatment of schizophrenia on the basis of a large-scale trial of two doses of AL versus placebo. There are no direct-comparison studies with paliperidone palmitate (PP; long-acting antipsychotic used most often in acute settings) for the acute psychotic episode. To indirectly compare efficacy and safety of the pivotal AL study with all PP studies meeting indirect comparison criteria. Systematic searches of MEDLINE, Embase, Cochrane CENTRAL, PsycINFO, ClinicalTrials.gov, International Clinical Trials Registry Platform, and gray literature were performed to identify randomized controlled trials of PP with similar designs to the AL trial. Bayesian network meta-analysis compared treatments with respect to symptom response and tolerability issues including weight gain, akathisia, parkinsonism, and likelihood of treatment-emergent adverse events. Three appropriate PP studies were identified for indirect comparison. Both doses of AL (441 mg and 882 mg monthly) were used and compared with two efficacious doses of PP (156 mg and 234 mg monthly). All four active-treatment conditions were associated with comparable reductions in acute symptoms (Positive and Negative Syndrome Scale) versus placebo and were of similar magnitude (range of mean difference -8.12 to -12.01, with overlapping 95% credible intervals). Between-group comparisons of active-treatment arms were associated with summary estimates of magnitude near 0. No clinically meaningful differences in selected safety or tolerability parameter incidence were found between active treatments. These results suggest that both AL and PP are effective for treatment of adults experiencing acute exacerbation of schizophrenia. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Ejection of Particles from the Free Surface of Shock-Loaded Lead into Vacuum and Gas Medium

NASA Astrophysics Data System (ADS)

Ogorodnikov, V. A.; Mikhailov, A. L.; Erunov, S. V.; Antipov, M. V.; Fedorov, A. V.; Syrunin, M. A.; Kulakov, E. V.; Kleshchevnikov, O. A.; Yurtov, I. V.; Utenkov, A. A.; Finyushin, S. A.; Chudakov, E. A.; Kalashnikov, D. A.; Pupkov, A. S.; Chapaev, A. V.; Mishanov, A. V.; Glushikhin, V. V.; Fedoseev, A. V.; Tagirov, R. R.; Kostyukov, S. A.; Tagirova, I. Yu.; Saprykina, E. V.

2017-12-01

The presence and behavior of a gas-metal interfacial layer at the free surface of shock-wave driven flying vehicles in gases of various compositions and densities has not been sufficiently studied so far. We present new comparative data on "dusting" from the free surface of lead into vacuum and gas as dependent on the surface roughness, pressure amplitude at the shock-wave front, and phase state of the material. Methods of estimating the mass flux of ejected particles in the presence of a gas medium at the free metal surface are proposed.

Quality of Life in 807 Patients with Vestibular Schwannoma: Comparing Treatment Modalities.

PubMed

Soulier, Géke; van Leeuwen, Bibian M; Putter, Hein; Jansen, Jeroen C; Malessy, Martijn J A; van Benthem, Peter Paul G; van der Mey, Andel G L; Stiggelbout, Anne M

2017-07-01

Objective In vestibular schwannoma treatment, the choice among treatment modalities is controversial. The first aim of this study was to examine the quality of life of patients with vestibular schwannoma having undergone observation, radiation therapy, or microsurgical resection. The second aim was to examine the relationship between perceived symptoms and quality of life. Last, the association between quality of life and time since treatment was studied. Study Design Cross-sectional study. Setting Tertiary referral center. Subjects and Methods A total of 1208 patients treated for sporadic vestibular schwannoma between 2004 and 2014 were mailed the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire and additional questions on symptoms associated with vestibular schwannoma. Total and domain scores were calculated and compared among treatment groups. Propensity scores were used, and results were stratified according to tumor size to control for potential confounders. Correlations were calculated to examine the relationship between self-reported symptoms and quality of life, as well as between quality of life and time since treatment. Results Patients with small tumors (≤10 mm) under observation showed a higher PANQOL score when compared with the radiation therapy and microsurgical resection groups. A strong negative correlation was found between self-reported symptoms and quality of life, with balance problems and vertigo having the largest impact. No correlation was found between PANQOL score and time since treatment. Conclusion This study suggests that patients with small vestibular schwannomas experience better quality of life when managed with observation than do patients who have undergone active treatment.

Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis.

PubMed

Sarsan, Ayşe; Akkaya, Nuray; Ozgen, Merih; Yildiz, Necmettin; Atalay, Nilgun Simsir; Ardic, Fusun

2012-01-01

The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis. This study was designed as a prospective, randomized-controlled, and single-blinded clinical trial. Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were randomly assigned into two groups and were treated with mature mud packs (n 15) or hot packs (n=12). Patients were evaluated for pain [based on the visual analog scale (VAS)], function (WOMAC, 6 min walking distance), quality of life [Short Form-36 (SF-36)], and serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and insulin-like growth factor-1 (IGF-1) at baseline, post-treatment, and 3 and 6~months after treatment. The mud pack group shows a significant improvement in VAS, pain, stifness, and physical function domains of WOMAC. The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack. For a 6 min walking distance, mud pack shows significant improvement, and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment. Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment. Significant improvements are found for the social function, vitality/energy, physical role disability, and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment. A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline, and the difference is significant between groups 3 months after the treatment. Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis.

Determination of trajectories of fireballs using seismic network data

NASA Astrophysics Data System (ADS)

Ishihara, Y.

2006-12-01

Fireballs, Bolides, which are caused by high velocity passages of meteoroids through the atmosphere, generate shockwaves. Meteor shockwave provide us very important information (arrival time and amplitude) to study meteor physics. The shockwave arrival time data enable us to determine trajectories of the fireballs. On the other hand, the shockwave amplitude tells us size and ablation history of the meteoroid. Infrasound observation is one of the ways of detecting bolide shockwaves. However, we have no infrasound observational networks extends for large area with enough spatial distribution for determination of trajectories and estimate ablation histories. We have only a few infrasound arrays that have three or four elements, in the Japanese islands. Last decade, digital seismic networks are greatly improved for the purpose of monitoring micro earthquakes. Those seismic networks are quite sensitive for detecting micro ground vibration, and then those networks could detect not only seismic wave generated by earthquakes, but also ground oscillations generated by coupling of meteor shockwave with the ground near station. Last years, I analyses this kind of ground motion data recorded by seismic network, as meteor shockwave signals. For example, we estimate some great fireball's aerial path from arrival times of shockwaves (e.g., Ishihara et. al., 2003 Earth Planets, and Space, 2004 Geophysical Research. Letters.; Pujol et al., 2006 Planetary and Space Science), and we estimate sizes and ablation history of some great fireball and a meteorite fall (Ishihara et al., 2004 Meteoroids2004). In Japan, some great fireball falls occurred during 2004 to 2005. In this presentation, I show the trajectories of these fireballs determined from shockwave analysis. Some fireballs trajectories are also determined from photographic records. The trajectories determined from shockwave and that from photos show good agreement.

Meta-Analysis of Treatment Outcomes Measured by the Y-OQ and Y-OQ-SR Comparing Wilderness and Non-Wilderness Treatment Programs

ERIC Educational Resources Information Center

Gillis, Harold L.; Speelman, Elizabeth; Linville, Noelle; Bailey, Emily; Kalle, Ashley; Oglesbee, Nathan; Sandlin, James; Thompson, Lauren; Jensen, Jennifer

2016-01-01

Background: Monitoring youth treatments requires outcome instruments sensitive to change. The Y-OQ and the Y-OQ-SR measure behavioral change during psychological treatment. Objective: The focus of this study was to compare treatment progress of youth in studies using the Youth Outcome Questionnaire (YOQ) or the Youth Outcome Questionnaire Self…

Granular biochar compared with activated carbon for wastewater treatment and resource recovery.

PubMed

Huggins, Tyler M; Haeger, Alexander; Biffinger, Justin C; Ren, Zhiyong Jason

2016-05-01

Granular wood-derived biochar (BC) was compared to granular activated carbon (GAC) for the treatment and nutrient recovery of real wastewater in both batch and column studies. Batch adsorption studies showed that BC material had a greater adsorption capacity at the high initial concentrations of total chemical oxygen demand (COD-T) (1200 mg L(-1)), PO4 (18 mg L(-1)), and NH4 (50 mg L(-1)) compared to GAC. Conversely the BC material showed a lower adsorption capacity for all concentrations of dissolved chemical oxygen demand (COD-D) and the lower concentrations of PO4 (5 mg L(-1)) and NH4 (10 mg L(-1)). Packed bed column studies showed similar average COD-T removal rate for BC with 0.27 ± 0.01 kg m(-3) d(-1) and GAC with 0.24 ± 0.01 kg m(-3) d(-1), but BC had nearly twice the average removal rate (0.41 ± 0.08 kg m(-3) d(-3)) compared to GAC during high COD-T concentrations (>500 mg L(-1)). Elemental analysis showed that both materials accumulated phosphorous during wastewater treatment (2.6 ± 0.4 g kg(-1) and 1.9 ± 0.1 g kg(-1) for BC and GAC respectively). They also contained high concentrations of other macronutrients (K, Ca, and Mg) and low concentrations of metals (As, Cd, Cr, Pb, Zn, and Cu). The good performance of BC is attributed to its macroporous structure compared with the microporous GAC. These favorable treatment data for high strength wastewater, coupled with additional life-cycle benefits, helps support the use of BC in packed bed column filters for enhanced wastewater treatment and nutrient recovery. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Comparative study of two treatment methods for acute periodontal abscess].

PubMed

Jin, Dong-mei; Wang, Wei-qian

2012-10-01

The aim of this short-term study was to compare the clinical efficacy of 2 different methods to treat acute periodontal abscesses. After patient selection, 100 cases of acute periodontal abscess were randomly divided into two groups. The experimental group was treated by supra- and subgingival scaling, while the control group was treated by incision and drainage. A clinical examination was carried out to record the following variables: subjective clinical variables including pain, edema, redness and swelling; objective clinical variables including gingival index(GI), bleeding index(BI), probing depth(PD),suppuration, lymphadenopathy and tooth mobility. The data was analyzed with SPSS 19.0 software package. RESULES: Subjective clinical variables demonstrated statistically significant improvements with both methods from the first day after treatment and lasted for at least 30 days(P<0.05), but the results of experimental group showed much better than the control group 1 day and 7 days after treatment. 30 days after treatment, there was no significant difference between the two groups in pain and swelling improvement(P>0.05), but the experimental group showed more improvement in edema and redness than the control group(P<0.05).On improving objective variables, the experimental group showed significant improvement in GI,BI,PD and suppuration 1 day after treatment(P<0.05).After 7 days, all objective clinical variables in the experimental group improved significantly(P<0.05) in the control group, there were significant improvements in GI,suppuration,lymphadenopathy and tooth mobility(P<0.05) but the four variables of the experimental group showed more improvement than the control group(P<0.05).After 30 days, all objective clinical variables improved significantly in both groups as compared to baseline, but in the experimental group, improvements were more significant regarding to GI,BI,PD,suppuration and tooth mobility(P<0.05). The method of supra- and subgingival

Cost-effectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy.

PubMed

Widjaja, Elysa; Li, Bing; Schinkel, Corrine Davies; Puchalski Ritchie, Lisa; Weaver, James; Snead, O Carter; Rutka, James T; Coyte, Peter C

2011-03-01

Due to differences in epilepsy types and surgery, economic evaluations of epilepsy treatment in adults cannot be extrapolated to children. We evaluated the cost-effectiveness of epilepsy surgery compared to medical treatment in children with intractable epilepsy. Decision tree analysis was used to evaluate the cost-effectiveness of surgery relative to medical management. Fifteen patients had surgery and 15 had medical treatment. Cost data included inpatient and outpatient costs for the period April 2007 to September 2009, physician fee, and medication costs. Outcome measure was percentage seizure reduction at one-year follow-up. Incremental cost-effectiveness ratio (ICER) was assessed. Sensitivity analysis was performed for different probabilities of surgical and medical treatment outcomes and costs, and surgical mortality or morbidity. More patients managed surgically experienced Engel class I and II outcomes compared to medical treatment at one-year follow-up. Base-case analysis yielded an ICER of $369 per patient for each percentage reduction in seizures for the surgery group relative to medical group. Sensitivity analysis showed robustness for the different probabilities tested. Surgical treatment resulted in greater reduction in seizure frequency compared to medical therapy and was a cost-effective treatment option in children with intractable epilepsy who were evaluated for epilepsy surgery and subsequently underwent surgery compared to continuing medical therapy. However, larger sample size and long-term follow-up are needed to validate these findings. Copyright © 2011 Elsevier B.V. All rights reserved.

Comparing systems for costing hospital treatments. The case of stable angina pectoris.

PubMed

Larsen, Jytte; Skjoldborg, Ulla Slothuus

2004-03-01

This paper demonstrates the basic properties in the systems most commonly considered for costing treatments in the Danish hospitals. The differences between the traditional charge system, the DRG system and the ABC system are analysed, and difficulties encountered in comparing these systems are discussed. A sample of patients diagnosed with stable angina pectoris (SAP) at Odense University Hospital was used to compare the three systems when costing an entire treatment path, costing single hospitalisations and studying the effects of length of stay. Furthermore, it is illustrated that the main idea behind each system is reflected in how the systems over- or underestimate costs. Implications when managing the hospitals, particularly reimbursement, are discussed.

Cultured allogeneic keratinocyte sheets accelerate healing compared to Op-site treatment of donor sites in burns.

PubMed

Duinslaeger, L A; Verbeken, G; Vanhalle, S; Vanderkelen, A

1997-01-01

Donor site treatment is a crucial issue in the treatment of extensive burns. In this single-blind, randomized study treatment of donor sites with a polyurethane dressing, Op-Site (Smith & Nephew, York, U.K.) is compared to treatment with allogeneic cultured keratinocyte sheets. Results show a mean healing time of 6.7 days with use of cultured keratinocyte sheets compared to mean healing time of 13.6 days with Op-Site treatment. Also, improvement in the comfort of patients as the result of less exudate formation and pain attenuation was noted.

Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance.

PubMed

Titov, Nickolai; Andrews, Gavin; Davies, Matthew; McIntyre, Karen; Robinson, Emma; Solley, Karen

2010-06-08

Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided. Would guidance from a technician be as effective as guidance from a clinician? Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health QUESTIONnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (p<0.001) and PHQ-9 (p<0.001) compared to the delayed treatment group but did not differ from each other. Within group effect sizes on the BDI-II were 1.27 and 1.20 for the clinician- and technician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and

Internet Treatment for Depression: A Randomized Controlled Trial Comparing Clinician vs. Technician Assistance

PubMed Central

Titov, Nickolai; Andrews, Gavin; Davies, Matthew; McIntyre, Karen; Robinson, Emma; Solley, Karen

2010-01-01

Background Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided. Question: Would guidance from a technician be as effective as guidance from a clinician? Method Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health Questionnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (p<0.001) and PHQ-9 (p<0.001) compared to the delayed treatment group but did not differ from each other. Within group effect sizes on the BDI-II were 1.27 and 1.20 for the clinician- and technician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program. Conclusions Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to

Comparative Effectiveness of Treatments for Binge-Eating Disorder: Systematic Review and Network Meta-Analysis.

PubMed

Peat, Christine M; Berkman, Nancy D; Lohr, Kathleen N; Brownley, Kimberly A; Bann, Carla M; Cullen, Katherine; Quattlebaum, Mary J; Bulik, Cynthia M

2017-09-01

Psychological and pharmacological interventions for binge-eating disorder have previously demonstrated efficacy (compared with placebo or waitlist control); thus, we aimed to expand that literature with a review of comparative effectiveness. We searched MEDLINE,® EMBASE,® Cochrane Library, Academic OneFile, CINAHL® for binge-eating disorder treatment articles and selected studies using predetermined inclusion and exclusion criteria. Data were sufficient for network meta-analysis comparing two pharmacological interventions; psychological interventions were analysed qualitatively. In all, 28 treatment comparisons were included in this review: one pharmacological comparison (second-generation antidepressants versus lisdexamfetamine) and 26 psychological comparisons. Only three statistically significant differences emerged: lisdexamfetamine was better at increasing binge abstinence than second-generation antidepressants; therapist-led cognitive behavioural therapy was better at reducing binge-eating frequency than behavioural weight loss, but behavioural weight loss was better at reducing weight. The majority of other treatment comparisons revealed few significant differences between groups. Thus, patients and clinicians can choose from several effective treatment options. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Treatment of childhood encopresis: a randomized trial comparing three treatment protocols.

PubMed

Borowitz, Stephen M; Cox, Daniel J; Sutphen, James L; Kovatchev, Boris

2002-04-01

To compare short- and long-term effectiveness of three additive treatment protocols in children experiencing chronic encopresis. Children, 6 to 15 years of age, who experienced at least weekly fecal soiling for 6 months or longer were eligible for the study. Children were randomly assigned to a group that received intensive medical therapy (IMT), a group that received intensive medical therapy plus a behavior management program called enhanced toilet training (ETT), or a group that received intensive medical therapy with enhanced toilet training and external anal sphincter electromyographic biofeedback (BF). Data concerning toileting habits were collected for 14 consecutive days before an initial visit, and at 3, 6, and 12 months after initiation of therapy. All data were collected using a computerized voice-mail system that telephoned the families each day. At 12 months, children were classified as significantly improved (reduction in soiling, P < 0.001) or cured ( 0.90, P < 0.001 in each case). Response to treatment during the first 2 weeks of therapy was highly predictive of outcome at 3, 6, and 12 months (P < 0.0001). Children in the ETT group used less laxative medication (P < 0.04) and required fewer treatment contacts (P = 0.08) than children in the IMM group. All three treatments resulted in significant increases in daily bowel movements passed in the toilet and self-initiated toileting, and resulted in decreases in average daily soiling at 3, 6, and 12 months (P < 0.05). Enhanced toilet training is somewhat

Implementation of a software for REmote COMparison of PARticlE and photon treatment plans: ReCompare.

PubMed

Löck, Steffen; Roth, Klaus; Skripcak, Tomas; Worbs, Mario; Helmbrecht, Stephan; Jakobi, Annika; Just, Uwe; Krause, Mechthild; Baumann, Michael; Enghardt, Wolfgang; Lühr, Armin

2015-09-01

To guarantee equal access to optimal radiotherapy, a concept of patient assignment to photon or particle radiotherapy using remote treatment plan exchange and comparison - ReCompare - was proposed. We demonstrate the implementation of this concept and present its clinical applicability. The ReCompare concept was implemented using a client-server based software solution. A clinical workflow for the remote treatment plan exchange and comparison was defined. The steps required by the user and performed by the software for a complete plan transfer were described and an additional module for dose-response modeling was added. The ReCompare software was successfully tested in cooperation with three external partner clinics and worked meeting all required specifications. It was compatible with several standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow. The ReCompare software can be applied to support non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by remote treatment plan exchange and comparison. Copyright © 2015. Published by Elsevier GmbH.

Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis.

PubMed

Louwerens, Jan K G; Sierevelt, Inger N; van Noort, Arthur; van den Bekerom, Michel P J

2014-08-01

This meta-analysis assessed the short-term to midterm effectiveness of minimally invasive treatments in the management of calcifying tendinopathy of the shoulder cuff, a common source of chronic shoulder pain that leads to pain, a decreased active range of motion, and loss of muscular strength. When conservative therapies fail, minimally invasive treatment options can be considered before resulting to surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this review. A systematic literature search was conducted in May 2013 to identify all studies that examined the short-term to midterm effectiveness of minimally invasive treatments for chronic calcifying tendinopathy. The primary end points were identified as function, pain, and total resorption rates. Grades of Recommendation Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence. Included were 20 studies (1544 participants). Common methodological flaws were related to randomization. In general, there is moderate-quality GRADE evidence that high-energy extracorporeal shockwave therapy has a significant effect on pain relief and functional status compared with other interventions. There is variable-quality GRADE evidence on the efficiency of other interventions. High-energy extracorporeal shockwave therapy is the most thoroughly investigated minimally invasive treatment option in the short-term to midterm and has proven to be a safe and effective treatment. Ultrasound-guided needling is safe but has not been proven to be more effective than an ultrasound-guided subacromial corticosteroid injection in recent level I research, and further research will have to prove its effectiveness. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

[Comparative evaluation of clinical practice guidelines for the treatment of schizophrenia].

PubMed

Delessert, D; Pomini, V; Grasset, F; Baumann, P

2008-01-01

Many clinical practice guidelines (CPG) have been published in reply to the development of the concept of "evidence-based medicine" (EBM) and as a solution to the difficulty of synthesizing and selecting relevant medical literature. Taking into account the expansion of new CPG, the question of choice arises: which CPG to consider in a given clinical situation? It is of primary importance to evaluate the quality of the CPG, but until recently, there has been no standardized tool of evaluation or comparison of the quality of the CPG. An instrument of evaluation of the quality of the CPG, called "AGREE" for appraisal of guidelines for research and evaluation was validated in 2002. The six principal CPG concerning the treatment of schizophrenia are compared with the help of the "AGREE" instrument: (1) "the Agence nationale pour le développement de l'évaluation médicale (ANDEM) recommendations"; (2) "The American Psychiatric Association (APA) practice guideline for the treatment of patients with schizophrenia"; (3) "The quick reference guide of APA practice guideline for the treatment of patients with schizophrenia"; (4) "The schizophrenia patient outcomes research team (PORT) treatment recommendations"; (5) "The Texas medication algorithm project (T-MAP)" and (6) "The expert consensus guideline for the treatment of schizophrenia". The results of our study were then compared with those of a similar investigation published in 2005, structured on 24 CPG tackling the treatment of schizophrenia. The "AGREE" tool was also used by two investigators in their study. In general, the scores of the two studies differed little and the two global evaluations of the CPG converged; however, each of the six CPG is perfectible. The rigour of elaboration of the six CPG was in general average. The consideration of the opinion of potential users was incomplete, and an effort made in the presentation of the recommendations would facilitate their clinical use. Moreover, there was little

Concept for individualized patient allocation: ReCompare--remote comparison of particle and photon treatment plans.

PubMed

Lühr, Armin; Löck, Steffen; Roth, Klaus; Helmbrecht, Stephan; Jakobi, Annika; Petersen, Jørgen B; Just, Uwe; Krause, Mechthild; Enghardt, Wolfgang; Baumann, Michael

2014-02-18

Identifying those patients who have a higher chance to be cured with fewer side effects by particle beam therapy than by state-of-the-art photon therapy is essential to guarantee a fair and sufficient access to specialized radiotherapy. The individualized identification requires initiatives by particle as well as non-particle radiotherapy centers to form networks, to establish procedures for the decision process, and to implement means for the remote exchange of relevant patient information. In this work, we want to contribute a practical concept that addresses these requirements. We proposed a concept for individualized patient allocation to photon or particle beam therapy at a non-particle radiotherapy institution that bases on remote treatment plan comparison. We translated this concept into the web-based software tool ReCompare (REmote COMparison of PARticlE and photon treatment plans). We substantiated the feasibility of the proposed concept by demonstrating remote exchange of treatment plans between radiotherapy institutions and the direct comparison of photon and particle treatment plans in photon treatment planning systems. ReCompare worked with several tested standard treatment planning systems, ensured patient data protection, and integrated in the clinical workflow. Our concept supports non-particle radiotherapy institutions with the patient-specific treatment decision on the optimal irradiation modality by providing expertise from a particle therapy center. The software tool ReCompare may help to improve and standardize this personalized treatment decision. It will be available from our website when proton therapy is operational at our facility.

Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome.

PubMed

Kaya, Erkan; Zinnuroglu, Murat; Tugcu, Ilknur

2011-02-01

The purpose of this study was to determine and compare the efficacy of kinesio tape and physical therapy modalities in patients with shoulder impingement syndrome. Patients (n = 55) were treated with kinesio tape (n = 30) three times by intervals of 3 days or a daily program of local modalities (n = 25) for 2 weeks. Response to treatment was evaluated with the Disability of Arm, Shoulder, and Hand scale. Patients were questioned for the night pain, daily pain, and pain with motion. Outcome measures except for the Disability of Arm, Shoulder, and Hand scale were assessed at baseline, first, and second weeks of the treatment. Disability of Arm, Shoulder, and Hand scale was evaluated only before and after the treatment. Disability of Arm, Shoulder, and Hand scale and visual analog scale scores decreased significantly in both treatment groups as compared with the baseline levels. The rest, night, and movement median pain scores of the kinesio taping (20, 40, and 50, respectively) group were statistically significantly lower (p values were 0.001, 0.01, and 0.001, respectively) at the first week examination as compared with the physical therapy group (50, 70, and 70, respectively). However, there was no significant difference in the same parameters between two groups at the second week (0.109, 0.07, and 0.218 for rest, night, and movement median pain scores, respectively). Disability of Arm, Shoulder, and Hand scale scores of the kinesio taping group were significantly lower at the second week as compared with the physical therapy group. No side effects were observed. Kinesio tape has been found to be more effective than the local modalities at the first week and was similarly effective at the second week of the treatment. Kinesio taping may be an alternative treatment option in the treatment of shoulder impingement syndrome especially when an immediate effect is needed.

Safety of ipsapirone treatment compared with lorazepam: discontinuation effects.

PubMed Central

Busto, U E; Naranjo, C A; Bremner, K E; Peachey, J E; Bologa, M

1998-01-01

OBJECTIVE: To determine discontinuation effects of ipsapirone, a novel azapirone and partial 5-HTIA agonist that has anxiolytic effects clinically and has not caused dependence or withdrawal symptoms in animals, and to compare these effects with those of the benzodiazepine lorazepam, owing to concern about dependence or withdrawal symptoms following use of these drugs. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: Outpatient and inpatient treatment. PARTICIPANTS: Sixty-five healthy male volunteers who had experience with sedative-hypnotics or anxiolytics and did not meet DSM-III-R criteria for abuse or dependence. INTERVENTIONS: Participants were randomized to receive ipsapirone 15 mg per day (n = 17), ipsapirone 22.5 mg per day (n = 16), lorazepam 3 mg per day (n = 16), or placebo (n = 16) as outpatients for 36 days (treatment) followed by single-blind placebo as inpatients for 3 days and as outpatients for 6 days (withdrawal). OUTCOME MEASURES: Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Scale (HAM-D), Spielberger State Anxiety Scale, Sleep Quality Questionnaire, General Symptom Checklist, self-rated intoxication, Clinical Institute Withdrawal Assessment--Benzodiazepines (CIWA-Benzo), psychomotor testing and urine drug screen. RESULTS: Only 45 subjects completed the study; discontinuation rates did not significantly differ among treatment groups. At day 39, fewer and less severe symptoms (e.g., insomnia and fatigue) were found on the CIWA-Benzo scale after treatment with ipsapirone or placebo than after treatment with lorazepam (p < 0.05). Subjects reported longer sleep latency and poorer sleep quality after receiving lorazepam than after receiving ipsapirone or placebo. Scores on the HAM-D, Spielberger State Anxiety and HAM-A scales did not change from baseline. CONCLUSIONS: Withdrawal symptoms were detected after discontinuation of therapeutic doses of lorazepam. Significantly fewer symptoms were observed after

Safety of ipsapirone treatment compared with lorazepam: discontinuation effects.

PubMed

Busto, U E; Naranjo, C A; Bremner, K E; Peachey, J E; Bologa, M

1998-01-01

To determine discontinuation effects of ipsapirone, a novel azapirone and partial 5-HTIA agonist that has anxiolytic effects clinically and has not caused dependence or withdrawal symptoms in animals, and to compare these effects with those of the benzodiazepine lorazepam, owing to concern about dependence or withdrawal symptoms following use of these drugs. Prospective, randomized, double-blind, placebo-controlled trial. Outpatient and inpatient treatment. Sixty-five healthy male volunteers who had experience with sedative-hypnotics or anxiolytics and did not meet DSM-III-R criteria for abuse or dependence. Participants were randomized to receive ipsapirone 15 mg per day (n = 17), ipsapirone 22.5 mg per day (n = 16), lorazepam 3 mg per day (n = 16), or placebo (n = 16) as outpatients for 36 days (treatment) followed by single-blind placebo as inpatients for 3 days and as outpatients for 6 days (withdrawal). Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Scale (HAM-D), Spielberger State Anxiety Scale, Sleep Quality Questionnaire, General Symptom Checklist, self-rated intoxication, Clinical Institute Withdrawal Assessment--Benzodiazepines (CIWA-Benzo), psychomotor testing and urine drug screen. Only 45 subjects completed the study; discontinuation rates did not significantly differ among treatment groups. At day 39, fewer and less severe symptoms (e.g., insomnia and fatigue) were found on the CIWA-Benzo scale after treatment with ipsapirone or placebo than after treatment with lorazepam (p < 0.05). Subjects reported longer sleep latency and poorer sleep quality after receiving lorazepam than after receiving ipsapirone or placebo. Scores on the HAM-D, Spielberger State Anxiety and HAM-A scales did not change from baseline. Withdrawal symptoms were detected after discontinuation of therapeutic doses of lorazepam. Significantly fewer symptoms were observed after withdrawal from anxiolytic doses of ipsapirone.

The comparative effectiveness of clinic, work-site, phone, and Web-based tobacco treatment programs.

PubMed

An, Lawrence C; Betzner, Anne; Schillo, Barbara; Luxenberg, Michael G; Christenson, Matthew; Wendling, Ann; Saul, Jessie E; Kavanaugh, Annette

2010-10-01

Tobacco treatment programs may be offered in clinical settings, at work-sites, via telephone helplines, or over the Internet. Little comparative data exist regarding the real-world effectiveness of these programs. This paper compares the reach, effectiveness, and costs of these different modes of cessation assistance. This is an observational study of cohorts of participants in Minnesota's QUITPLAN programs in 2004. Cessation assistance was provided in person at 9 treatment centers, using group counseling at 68 work-sites, via a telephone helpline, or via the Internet. The main outcomes of the study are enrollment by current smokers, self-reported 30-day abstinence, and cost per quit. Reach was calculated statewide for the helpline and Web site, regionally for the treatment centers, and for the employee population for work-site programs. Enrollment was greatest for the Web site (n = 4,698), followed by the helpline (n = 2,351), treatment centers (n = 616), and work-sites (n = 479). The Web site attracted younger smokers. Smokers at treatment centers had higher levels of nicotine dependence. The helpline reached more socially disadvantaged smokers. Responder 30-day abstinence rates were higher for the helpline (29.3%), treatment centers (25.8%), and work-sites (19.6%) compared with the online program (12.5%). These differences persisted after controlling for baseline differences in participant characteristics and use of pharmacological therapy. The cost per quit was lowest for the Web site program ($291 per quit, 95% CI = $229-$372). Treatment center, work-site, helpline, and Web site programs differ in their reach, effectiveness, and estimated cost per quit. Each program plays a part in assisting populations of tobacco users in quitting.

Comparing drinking water treatment costs to source water protection costs using time series analysis.

EPA Science Inventory

We present a framework to compare water treatment costs to source water protection costs, an important knowledge gap for drinking water treatment plants (DWTPs). This trade-off helps to determine what incentives a DWTP has to invest in natural infrastructure or pollution reductio...

Automatic identification of comparative effectiveness research from Medline citations to support clinicians’ treatment information needs

PubMed Central

Zhang, Mingyuan; Fiol, Guilherme Del; Grout, Randall W.; Jonnalagadda, Siddhartha; Medlin, Richard; Mishra, Rashmi; Weir, Charlene; Liu, Hongfang; Mostafa, Javed; Fiszman, Marcelo

2014-01-01

Online knowledge resources such as Medline can address most clinicians’ patient care information needs. Yet, significant barriers, notably lack of time, limit the use of these sources at the point of care. The most common information needs raised by clinicians are treatment-related. Comparative effectiveness studies allow clinicians to consider multiple treatment alternatives for a particular problem. Still, solutions are needed to enable efficient and effective consumption of comparative effectiveness research at the point of care. Objective Design and assess an algorithm for automatically identifying comparative effectiveness studies and extracting the interventions investigated in these studies. Methods The algorithm combines semantic natural language processing, Medline citation metadata, and machine learning techniques. We assessed the algorithm in a case study of treatment alternatives for depression. Results Both precision and recall for identifying comparative studies was 0.83. A total of 86% of the interventions extracted perfectly or partially matched the gold standard. Conclusion Overall, the algorithm achieved reasonable performance. The method provides building blocks for the automatic summarization of comparative effectiveness research to inform point of care decision-making. PMID:23920677

Particle-based simulations of bilayer membranes: self-assembly, structural analysis, and shock-wave damage

NASA Astrophysics Data System (ADS)

Steinhauser, Martin O.; Schindler, Tanja

2017-01-01

-repairing membranes (reducing their damage after impact) and permanent (irreversible) damage, depending on the shock front speed. The here presented idea of using coarse-grained (CG) particle models for soft matter systems in combination with the investigation of shock-wave effects in these systems is a quite new approach.

Exploring the Use of Cost-Benefit Analysis to Compare Pharmaceutical Treatments for Menorrhagia.

PubMed

Sanghera, Sabina; Frew, Emma; Gupta, Janesh Kumar; Kai, Joe; Roberts, Tracy Elizabeth

2015-09-01

The extra-welfarist theoretical framework tends to focus on health-related quality of life, whilst the welfarist framework captures a wider notion of well-being. EQ-5D and SF-6D are commonly used to value outcomes in chronic conditions with episodic symptoms, such as heavy menstrual bleeding (clinically termed menorrhagia). Because of their narrow-health focus and the condition's periodic nature these measures may be unsuitable. A viable alternative measure is willingness to pay (WTP) from the welfarist framework. We explore the use of WTP in a preliminary cost-benefit analysis comparing pharmaceutical treatments for menorrhagia. A cost-benefit analysis was carried out based on an outcome of WTP. The analysis is based in the UK primary care setting over a 24-month time period, with a partial societal perspective. Ninety-nine women completed a WTP exercise from the ex-ante (pre-treatment/condition) perspective. Maximum average WTP values were elicited for two pharmaceutical treatments, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral treatment. Cost data were offset against WTP and the net present value derived for treatment. Qualitative information explaining the WTP values was also collected. Oral treatment was indicated to be the most cost-beneficial intervention costing £107 less than LNG-IUS and generating £7 more benefits. The mean incremental net present value for oral treatment compared with LNG-IUS was £113. The use of the WTP approach was acceptable as very few protests and non-responses were observed. The preliminary cost-benefit analysis results recommend oral treatment as the first-line treatment for menorrhagia. The WTP approach is a feasible alternative to the conventional EQ-5D/SF-6D approaches and offers advantages by capturing benefits beyond health, which is particularly relevant in menorrhagia.

Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status.

PubMed

Guerrero, Erick G; Villatoro, Jorge Ameth; Kong, Yinfei; Fleiz, Clara; Vega, William A; Strathdee, Steffanie A; Medina-Mora, Maria Elena

2014-07-30

We examined Mexican migrants' perceived barriers to entering substance abuse treatment and potential differences by gender. This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico.

Barriers to accessing substance abuse treatment in Mexico: national comparative analysis by migration status

PubMed Central

2014-01-01

Background We examined Mexican migrants’ perceived barriers to entering substance abuse treatment and potential differences by gender. Methods This study analyzed a subset of household data collected in Mexico in 2011 via the Encuesta Nacional de Adicciones (National Survey of Addictions). A sample of 1,143 individuals who reported using illicit drugs was analyzed using multivariate negative binomial models to determine direct and moderated relationships of gender, migrant status, and drug dependence with perceived barriers to accessing treatment. Results Significant findings included disparities in drug dependence by migrant status. Compared with non-migrant men, women who have traveled to the United States was associated with fewer (1.3) barriers to access treatment. Fewer barriers to access care were associated with individuals residing in other regions of the country, compared to those living in Mexico City. Conclusions Drug dependence, gender, migration status and regional location are factors associated with access to needed treatment. Implications for health care policy to develop treatment services infrastructure and for future research are discussed in the context of ongoing drug policy reform in Mexico. PMID:25074067

Methodological recommendations for comparative research on the treatment of chronic wounds.

PubMed

Sonnad, S S; Goldsack, J C; Mohr, P; Tunis, S

2013-09-01

To provide specific recommendations to product developers and clinical researchers on the design of comparative effectiveness studies for the treatment of chronic wounds, specifically those pertaining to arterial and venous-disease related ulcers, diabetic foot ulcers, pressure ulcers and burn wounds. The recommendations were developed based on a process defined by the Center for Medical Technology Policy (CMTP). After selecting the subject area, semi-structured phone interviews were conducted by one of the authors (SSS) with representatives of payers, manufacturers, clinicians, clinician/researchers and patient advocates. Next, a broad range of stakeholders participated in a meeting convened by CMTP to determine their needs. A technical working group comprising key stakeholders then participated in clarifying recommendations developed by CMTP staff and adding important considerations for their implementation. The resulting draft document was finalised based on public and solicited comment from individual manufacturers; a consortium of product developers and manufacturers; and an alliance of physicians, providers, manufacturers and patient organisations. This article is a summary of the full effectiveness guidance document. To address the needs of patients, clinicians, guideline developers, payers and other post-regulatory decision makers, this work makes ten recommendations to guide comparative effectiveness research for chronic wound care. These recommendations fall into four categories: study design, population, comparators and outcomes. This paper suggests that using the recommendations outlined to conduct comparative effectiveness research on treatments for chronic wound therapies would facilitate trials that provide patients, clinicians, and payers with the information they need to make optimal treatment decisions. These recommendations focus on design changes that would have the largest impact in improving the usability of the results by decision makers and

Why do different criteria for 'cure' yield different conclusions in comparing two treatments for bacterial vaginosis?

PubMed

Thomas, Katherine K; Sanchez, Sixto; Garcia, Patricia J; Holmes, King K

2005-09-01

The objective of this study was to determine why different criteria for response to treatment of bacterial vaginosis (BV) led to markedly different conclusions about treatment efficacy in a randomized trial comparing metronidazole gel versus metronidazole/nystatin ovules. We compared the impact of two treatment regimens on individual components of Amsel and Nugent criteria at follow-up visits 14, 42, and 104 days after initiating treatment. Compared with gel, ovules more effectively eliminated amines, clue cells, and Gardnerella, Prevotella, or Mobiluncus morphotypes from vaginal fluid, thus achieving cure based on "usual" criteria (absence of BV by Amsel or Nugent criteria), but did not more effectively restore Lactobacillus morphotypes or lower vaginal pH, thus not meeting Federal Drug Administration (FDA) criteria for cure. Because early vaginal recolonization by lactobacilli was poor after both gel and ovules, FDA draft criteria for cure missed marked differences in treatment efficacies against Gardnerella, clue cells, and amines. Cure defined more "usually" may give more useful information.

A conservative finite difference algorithm for the unsteady transonic potential equation in generalized coordinates

NASA Technical Reports Server (NTRS)

Bridgeman, J. O.; Steger, J. L.; Caradonna, F. X.

1982-01-01

An implicit, approximate-factorization, finite-difference algorithm has been developed for the computation of unsteady, inviscid transonic flows in two and three dimensions. The computer program solves the full-potential equation in generalized coordinates in conservation-law form in order to properly capture shock-wave position and speed. A body-fitted coordinate system is employed for the simple and accurate treatment of boundary conditions on the body surface. The time-accurate algorithm is modified to a conventional ADI relaxation scheme for steady-state computations. Results from two- and three-dimensional steady and two-dimensional unsteady calculations are compared with existing methods.

Endoscopic treatments for Barrett's esophagus: a systematic review of safety and effectiveness compared to esophagectomy

PubMed Central

2010-01-01

Background Recently, several new endoscopic treatments have been used to treat patients with Barrett's esophagus with high grade dysplasia. This systematic review aimed to determine the safety and effectiveness of these treatments compared with esophagectomy. Methods A comprehensive literature search was undertaken to identify studies of endoscopic treatments for Barrett's esophagus or early stage esophageal cancer. Information from the selected studies was extracted by two independent reviewers. Study quality was assessed and information was tabulated to identify trends or patterns. Results were pooled across studies for each outcome. Safety (occurrence of adverse events) and effectiveness (complete eradication of dysplasia) were compared across different treatments. Results The 101 studies that met the selection criteria included 8 endoscopic techniques and esophagectomy; only 12 were comparative studies. The quality of evidence was generally low. Methods and outcomes were inconsistently reported. Protocols, outcomes measured, follow-up times and numbers of treatment sessions varied, making it difficult to calculate pooled estimates. The surgical mortality rate was 1.2%, compared to 0.04% in 2831 patients treated endoscopically (1 death). Adverse events were more severe and frequent with esophagectomy, and included anastomotic leaks (9.4%), wound infections (4.1%) and pulmonary complications (4.1%). Four patients (0.1%) treated endoscopically experienced bleeding requiring transfusions. The stricture rate with esophagectomy (5.3%) was lower than with porfimer sodium photodynamic therapy (18.5%), but higher than aminolevulinic acid (ALA) 60 mg/kg PDT (1.4%). Dysphagia and odynophagia varied in frequency across modalities, with the highest rates reported for multipolar electrocoagulation (MPEC). Photosensitivity, an adverse event that occurs only with photodynamic therapy, was experienced by 26.4% of patients who received porfimer sodium. Some radiofrequency

Specific phobias in youth: a randomized controlled trial comparing one-session treatment to a parent-augmented one-session treatment.

PubMed

Ollendick, Thomas H; Halldorsdottir, Thorhildur; Fraire, Maria G; Austin, Kristin E; Noguchi, Ryoichi J P; Lewis, Krystal M; Jarrett, Matthew A; Cunningham, Natoshia R; Canavera, Kristin; Allen, Kristy B; Whitmore, Maria J

2015-03-01

Examine the efficacy of a parent-augmented One-Session Treatment (A-OST) in treating specific phobias (SP) in youth by comparing this novel treatment to child-focused OST, a well-established treatment. A total of 97 youth (ages 6-15, 51.5% female, 84.5% White) who fulfilled diagnostic criteria for SP were randomized to either A-OST or OST. SPs were assessed with semistructured diagnostic interviews, clinician improvement ratings, and parent and child improvement ratings. In addition, measures of treatment satisfaction and parental self-efficacy were obtained. Blind assessments were completed pretreatment, posttreatment, and 1month and 6months following treatment. Analyses were undertaken using mixed models. In addition, gender, age, internalizing/externalizing problems, parent overprotection, and parent anxiety were examined as potential predictors and moderators of treatment outcome. Both treatment conditions produced similar outcomes with approximately 50% of youth in both treatments diagnosis free and judged to be much or very much improved at posttreatment and 1-month follow-up. At 6-month follow-up, however, the treatments diverged with OST resulting in marginally superior outcomes to A-OST, contrary to predictions. Only age of child predicted treatment outcome across the two treatments (older children did better); unexpectedly, none of the variables moderated treatment outcomes. Parent augmentation of OST produced no appreciable gains in treatment outcomes. Directions for future research are highlighted. Copyright © 2014. Published by Elsevier Ltd.

Significance of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy in nonobstructive isolated renal pelvic stones.

PubMed

Sozen, Sinan; Kupeli, Bora; Acar, Cenk; Gurocak, Serhat; Karaoglan, Ustunol; Bozkirli, Ibrahim

2008-05-01

To investigate the probable effect of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy (SWL) in patients with nonobstructive renal pelvic stones. The clinical records of patients with isolated renal pelvic stones who underwent SWL between 1996 and 2005 were reviewed. After excluding patients with obstruction leading to dilatation, major anatomic abnormalities, noncalcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones, and previous renal surgery, 153 patients were enrolled in the study. Lower pole infundibulopelvic angle (IPA) and infundibular length and width were measured from intravenous urography. Patients were classified into three groups according to stone burden (group 1, <100 mm(2); group 2, 101-200 mm(2); group 3, 201-400 mm(2)). The mean stone size was 142.08+/-86.3 mm(2). Overall stone-free rate was 53.6%. Localization of clinically significant or insignificant residual fragments was in the lower calix, renal pelvis, and both in 50 (32.6%), 29 (18.9%), and 8 (5.2%) patients, respectively. There was no statistically significant difference in pelvicaliceal anatomic features except narrower IPA (P=0.02) in group 1 patients with residual stones. The falling of stone fragments to the lower calix in spite of the ureter whether clinically significant or not after SWL of pelvic stones initially seems to be related to stone burden rather than lower caliceal anatomy. However, existence of a more narrow IPA in group 1 patients with residual fragments led us to believe that lower-pole IPA can play a role in stone clearance, especially for smaller stones, probably because of smaller residual fragment size or the more mobile nature of the primary stone.

Guideline for diagnosis and treatment of subacromial pain syndrome

PubMed Central

Diercks, Ron; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

2014-01-01

Treatment of “subacromial impingement syndrome” of the shoulder has changed drastically in the past decade. The anatomical explanation as “impingement” of the rotator cuff is not sufficient to cover the pathology. “Subacromial pain syndrome”, SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears. PMID:24847788

Specific Phobias in Youth: A Randomized Controlled Trial Comparing One-Session Treatment to a Parent-Augmented One-Session Treatment

PubMed Central

Ollendick, Thomas H.; Halldorsdottir, Thorhildur; Fraire, Maria G; Austin, Kristin E.; Noguchi, Ryoichi J. P.; Lewis, Krystal M.; Jarrett, Matthew A.; Cunningham, Natoshia R.; Canavera, Kristin; Allen, Kristy B.; Whitmore, Maria J.

2015-01-01

Objective Examine the efficacy of a parent-augmented One Session Treatment (A-OST) in treating specific phobias (SP) in youth by comparing this novel treatment to child-focused OST, a well-established treatment. Method A total of 97 youth (ages 6–15, 51.5% female, 84.5% white) who fulfilled diagnostic criteria for SP were randomized to either A-OST or OST. SPs were assessed with semi-structured diagnostic interviews, clinician improvement ratings, and parent and child improvement ratings. In addition, measures of treatment satisfaction and parental self-efficacy were obtained. Blind assessments were completed pretreatment, post-treatment, and 1-month and 6-months following treatment. Analyses were undertaken using mixed models. In addition, gender, age, internalizing/externalizing problems, parent overprotection, and parent anxiety were examined as potential predictors and moderators of treatment outcome. Results Both treatment conditions produced similar outcomes with approximately 50% of youth in both treatments diagnosis free and judged to be much or very much improved at post-treatment and 1-month follow up. At 6-month follow up, however, the treatments diverged with OST resulting in marginally superior outcomes to A-OST, contrary to predictions. Only age of child predicted treatment outcome across the two treatments (older children did better); unexpectedly, none of the variables moderated treatment outcomes. Conclusions Parent augmentation of OST produced no appreciable gains in treatment outcomes. Directions for future research are highlighted. PMID:25645164

Comparative trial of treatment with Prioderm lotion and Kwellada shampoo in children with head lice.

PubMed Central

Mathias, R. G.; Huggins, D. R.; Leroux, S. J.; Proctor, E. M.

1984-01-01

The safety and efficacy of treatment with a new pediculicide lotion, Prioderm (0.5% malathion in isopropanol), were compared with those of treatment with Kwellada (1% lindane) shampoo in a randomized trial of children with head lice. The children's scalps were examined for live lice immediately, 7 days and 4 to 6 weeks following treatment. To determine the in-vitro ovicidal effect of treatment, samples of hair with nits were removed before and immediately following treatment; the subsequent rates of hatching were compared. No live lice were present immediately following either treatment. At 7 days after treatment 2 of the 29 children treated with Prioderm lotion and 4 of the 33 children treated with Kwellada shampoo were infested with live lice, whereas at 4 to 6 weeks after treatment 5 and 3 children respectively were infested. The initial effectiveness of treatment was 93% in the children treated with Prioderm lotion and 88% in those treated with Kwellada shampoo; however, a large difference in efficacy could have been missed owing to the small number of children in the study. Both preparations demonstrated in-vitro ovicidal activity, but neither totally abolished post-treatment hatching. No side effects were reported from either preparation. Because ovicidal activity was incomplete two treatments with the same pediculicides should be given about 7 days apart. PMID:6198057

A randomised controlled trial evaluating renal protective effects of selenium with vitamins A, C, E, verapamil, and losartan against extracorporeal shockwave lithotripsy-induced renal injury.

PubMed

El-Nahas, Ahmed R; Elsaadany, Mohamed M; Taha, Diaa-Eldin; Elshal, Ahmed M; El-Ghar, Mohamed Abo; Ismail, Amani M; Elsawy, Essam A; Saleh, Hazem H; Wafa, Ehab W; Awadalla, Amira; Barakat, Tamer S; Sheir, Khaled Z

2017-01-01

To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)-induced renal injury. A randomised controlled trial was conducted between August 2012 and February 2015. Inclusion criteria were adult patients with a single renal stone (<2 cm) suitable for ESWL. Patients with diabetes, hypertension, congenital renal anomalies, moderate or marked hydronephrosis, or preoperative albuminuria (>300 mg/L) were excluded. ESWL was performed using the electromagnetic DoLiS lithotripter. Eligible patients were randomised into one of four groups using sealed closed envelopes: Group1, control; Group 2, selenium ACE; Group 3, losartan; and Group 4, verapamil. Albuminuria and urinary neutrophil gelatinase-associated lipocalin (uNGAL) were estimated after 2-4 h and 1 week after ESWL. The primary outcome was differences between albuminuria and uNGAL. Dynamic contrast-enhanced magnetic resonance imaging was performed before ESWL, and at 2-4 h and 1 week after ESWL to compare changes in renal perfusion. Of 329 patients assessed for eligibility, the final analysis comprised 160 patients (40 in each group). Losartan was the only medication that showed significantly lower levels of albuminuria after 1 week (P < 0.001). For perfusion changes, there was a statistically significant decrease in the renal perfusion in patients with obstructed kidneys in comparison to before ESWL (P = 0.003). These significant changes were present in the control or antioxidant group, whilst in the losartan and verapamil groups renal perfusion was not significantly decreased. Losartan was found to protect the kidney against ESWL-induced renal injury by significantly decreasing post-ESWL albuminuria. Verapamil and losartan maintained renal perfusion in patients with post-ESWL renal obstruction. © 2016 The Authors BJU International �

Recent developments in SWL physics research.

PubMed

Zhong, P; Xi, X; Zhu, S; Cocks, F H; Preminger, G M

1999-11-01

Two projects in our laboratory highlight some recent developments in shockwave lithotripsy (SWL) physics research. In the first project, we developed a prototype of a piezoelectric annular array (PEAA) shockwave generator that can be retrofitted on a Dornier HM-3 lithotripter for active control of cavitation during SWL. The PEAA generator, operating at 15 kV, produces a peak positive pressure of approximately 8 MPa with a -6-dB beam diameter of 5 mm. The shockwave generated by the PEAA was used to control and force the collapse of cavitation bubbles induced by a laboratory electrohydraulic shockwave lithotripter with a truncated HM-3 reflector. With optimal time delay between the lithotripter pulse and the PEAA-generated shockwave, the collapse of cavitation bubbles near the stone surface could be intensified, and the resultant stone fragmentation in vitro could be significantly improved. In the second project, high-speed shadowgraph imaging was used to visualize the dynamics of lithotripter-induced bubble oscillation in a vascular phantom. Compared with the free bubble oscillation in water, the expansion of cavitation bubble(s) produced in silicone tubes and a 200-microm cellulose hollow fiber by either a Nortech EHL or a Dornier XL-1 lithotripter was found to be significantly constrained. Rupture of the cellulose hollow fiber was observed consistently after about 20 shocks from the XL-1 lithotripter at an output voltage of 20 kV. These results confirm experimentally that SWL-induced cavitation in vivo can be significantly constrained by the surrounding tissue, and large intraluminal bubble expansions could cause rupture of capillaries and small blood vessels.

A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient?

PubMed

Hatzimouratidis, Konstantinos; Hatzichristou, Dimitrios G

2005-01-01

The field of erectile dysfunction (ED) has been revolutionised over the last two decades. Several treatment options are available today, most of which are associated with high efficacy rates and favourable safety profiles. A MEDLINE search was undertaken in order to evaluate all currently available data on treatment modalities for ED. Phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil) are currently the first-choice of most physicians and patients for the treatment of ED. PDE5 inhibitors have differences in their pharmacological profiles, the most obvious being the long duration of action of tadalafil, but there are no data supporting superiority for any one of them in terms of efficacy or safety. Sublingual apomorphine has limited efficacy compared with the PDE5 inhibitors, and its use is limited to patients with mild ED. Treatment failures with oral drugs may be due to medication, clinician and patient issues. The physician needs to address all of these issues in order to identify true treatment failures. Patients who are truly unresponsive to oral drugs may be offered other treatment options.Intracavernous injections of alprostadil alone, or in combination with other vasoactive agents (papaverine and phentolamine), remain an excellent treatment option, with proven efficacy and safety over time. Topical pharmacotherapy is appealing in nature, but currently available formulations have limited efficacy. Vacuum constriction devices may be offered mainly to elderly patients with occasional intercourse attempts, as younger patients show limited preference because of the unnatural erection that is associated with this treatment modality. Penile prostheses are generally the last treatment option offered, because of invasiveness, cost and non-reversibility; however, they are associated with high satisfaction rates in properly selected patients. All treatment options are associated with particular strengths and weaknesses. A patient

Efficacy and Safety of Three Cryotherapy Devices for Wart Treatment: A Randomized, Controlled, Investigator-Blinded, Comparative Study.

PubMed

Walczuk, Imko; Eertmans, Frank; Rossel, Bart; Cegielska, Agnieszka; Stockfleth, Eggert; Antunes, Andre; Adriaens, Els

2018-06-01

Cutaneous warts are common skin lesions, caused by human papillomavirus. For years, liquid nitrogen is the cryogen of choice for wart treatment. Alternatively, several cryogenic devices for home treatment are commercially available. The present trial assessed efficacy and safety of a novel nitrous oxide-based cryogenic device for home use (EndWarts Freeze ® in Europe, Compound W ® Nitro-Freeze in the USA). This investigator-blinded, controlled, randomized study compared the nitrous oxide device (test product) with a dimethylether propane-based product (Wartner ® ; comparator 1). Subjects with common or plantar warts (50/50 ratio) were randomized into two groups (n = 58, test product; n = 40, comparator 1). Sequentially, an extra treatment arm (n = 40) was added to compare with a dimethylether-based product with metal nib (Wortie ® ; comparator 2). Main objective implied comparison of the percentage cured subjects after one to maximum three treatments. Efficacy and safety was evaluated by a blinded investigator. After a maximum of three applications, a significantly (p = 0.001) higher cure rate of 70.7% (Intention-to-Treat analysis) was observed with test product versus 46.2% (comparator 1) and 47.5% (comparator 2). Almost three times more subjects were cured after 1 test product application (29.3%), versus comparator 1 (10.4%) and comparator 2 (12.5%). Reported side effects were transient and typical of cryotherapy. All treatments were well-tolerated. The superior cure rates for the test product versus two comparators can be explained by its design. Combination of nitrous oxide (cooling agent), the specific activation method (holding the liquid coolant in the cap), and skin-conforming polyurethane foam, results in higher cooling efficiency (- 80 °C) and more effective wart freezing. This trial demonstrated that the nitrous oxide device is a safe, user-friendly and effective wart treatment for home use, comparing favourably to dimethylether (propane

Infrasound and Seismic Observation of Hayabusa Reentry as An Artificial Meteorite Fall

NASA Astrophysics Data System (ADS)

Ishihara, Y.; Hiramatsu, Y.; Yamamoto, M.; Furumoto, M.; Fujita, K.

2011-12-01

signals from the disrupted fragments as optically identified fragments of the H-S/C. In comparison between the infrasonic pressure waves and the video image analyses, the generation of sonic boom type shockwaves by the both of the H-SRC and fragmented parts of the H-S/C at an altitude of 40±1 km was confirmed with one-to-one correspondence with each other. The incident vectors of the shockwave from the H-SRC at all the three arrays are estimated by F-K spectrum and agree well with predicted ones. Particle motions of ground motions excited by the shockwave from the H-SRC show characteristics of typical Rayleigh wave. In addition, we examine the relationship between amplitudes of those ground motions and overpressure values correspond to the H-SRC. We compare amplitudes of ground motions detected by seismometers to theoretical estimations of air-to-ground coupling. In calculations, we have used amplitudes of observed overpressures by infrasound sensors as incident pressure waves and elastic moduli of each site are obtained by H/V spectrum analysis. The observed amplitudes of the ground motions are almost consistent with the theoretical estimations.

Comparative performance evaluation of full-scale anaerobic and aerobic wastewater treatment processes in Brazil.

PubMed

von Sperling, M; Oliveira, S C

2009-01-01

This article evaluates and compares the actual behavior of 166 full-scale anaerobic and aerobic wastewater treatment plants in operation in Brazil, providing information on the performance of the processes in terms of the quality of the generated effluent and the removal efficiency achieved. The observed results of effluent concentrations and removal efficiencies of the constituents BOD, COD, TSS (total suspended solids), TN (total nitrogen), TP (total phosphorus) and FC (faecal or thermotolerant coliforms) have been compared with the typical expected performance reported in the literature. The treatment technologies selected for study were: (a) predominantly anaerobic: (i) septic tank + anaerobic filter (ST + AF), (ii) UASB reactor without post-treatment (UASB) and (iii) UASB reactor followed by several post-treatment processes (UASB + POST); (b) predominantly aerobic: (iv) facultative pond (FP), (v) anaerobic pond followed by facultative pond (AP + FP) and (vi) activated sludge (AS). The results, confirmed by statistical tests, showed that, in general, the best performance was achieved by AS, but closely followed by UASB reactor, when operating with any kind of post-treatment. The effluent quality of the anaerobic processes ST + AF and UASB reactor without post-treatment was very similar to the one presented by facultative pond, a simpler aerobic process, regarding organic matter.

[Critical analysis of classical conservative treatments of tendinopathies].

PubMed

Kaux, J F; Croisier, J L; Forthomme, B; Crielaard, J M

2015-09-01

Classic "passive" therapeutics (anti-inflammatory drugs, infiltrations of corticosteroids...) of tendinopathies, which are used relatively empirically, reduce pain and inflammation, without fundamentally changing the tendon structure. The eccentric rehabilitation has been applied to chronic tendinopathies, not only due to the failure of conventional therapies but also due to a better pathophysiological understanding of tendinopathies. Various studies underscore the effectiveness of eccentric rehabilitation which, after 20-30 sessions, leads to healing and especially prevents the risk of chronicity. Shockwave therapy, amending the tendinous structure, would lead to a long term healing.

Comparing drinking water treatment costs to source water protection costs using time series analysis

NASA Astrophysics Data System (ADS)

Heberling, Matthew T.; Nietch, Christopher T.; Thurston, Hale W.; Elovitz, Michael; Birkenhauer, Kelly H.; Panguluri, Srinivas; Ramakrishnan, Balaji; Heiser, Eric; Neyer, Tim

2015-11-01

We present a framework to compare water treatment costs to source water protection costs, an important knowledge gap for drinking water treatment plants (DWTPs). This trade-off helps to determine what incentives a DWTP has to invest in natural infrastructure or pollution reduction in the watershed rather than pay for treatment on site. To illustrate, we use daily observations from 2007 to 2011 for the Bob McEwen Water Treatment Plant, Clermont County, Ohio, to understand the relationship between treatment costs and water quality and operational variables (e.g., turbidity, total organic carbon [TOC], pool elevation, and production volume). Part of our contribution to understanding drinking water treatment costs is examining both long-run and short-run relationships using error correction models (ECMs). Treatment costs per 1000 gallons (per 3.79 m3) were based on chemical, pumping, and granular activated carbon costs. Results from the ECM suggest that a 1% decrease in turbidity decreases treatment costs by 0.02% immediately and an additional 0.1% over future days. Using mean values for the plant, a 1% decrease in turbidity leads to $1123/year decrease in treatment costs. To compare these costs with source water protection costs, we use a polynomial distributed lag model to link total phosphorus loads, a source water quality parameter affected by land use changes, to turbidity at the plant. We find the costs for source water protection to reduce loads much greater than the reduction in treatment costs during these years. Although we find no incentive to protect source water in our case study, this framework can help DWTPs quantify the trade-offs.

Predictors of treatment with dialysis modalities in observational studies for comparative effectiveness research*

PubMed Central

Kuttykrishnan, Sooraj; Kalantar-Zadeh, Kamyar; Arah, Onyebuchi A.; Cheung, Alfred K.; Brunelli, Steve; Heagerty, Patrick J.; Katz, Ronit; Molnar, Miklos Z.; Nissenson, Allen; Ravel, Vanessa; Streja, Elani; Himmelfarb, Jonathan; Mehrotra, Rajnish

2015-01-01

Background The Institute of Medicine has identified the comparative effectiveness of renal replacement therapies as a kidney-related topic among the top 100 national priorities. Given the importance of ensuring internal and external validity, the goal of this study was to identify potential sources of bias in observational studies that compare outcomes with different dialysis modalities. Methods This observational cohort study used data from the electronic medical records of all patients that started maintenance dialysis in the calendar years 2007–2011 and underwent treatment for at least 60 days in any of the 2217 facilities operated by DaVita Inc. Each patient was assigned one of six dialysis modalities for each 91-day period from the date of first dialysis (thrice weekly in-center hemodialysis (HD), peritoneal dialysis (PD), less-frequent HD, home HD, frequent HD and nocturnal in-center HD). Results Of the 162 644 patients, 18% underwent treatment with a modality other than HD for at least one 91-day period. Except for PD, patients started treatment with alternative modalities after variable lengths of treatment with HD; the time until a change in modality was shortest for less-frequent HD (median time = 6 months) and longest for frequent HD (median time = 15 months). Between 30 and 78% of patients transferred to another dialysis facility prior to change in modality. Finally, there were significant differences in baseline and time-varying clinical characteristics associated with dialysis modality. Conclusions This analysis identified numerous potential sources of bias in studies of the comparative effectiveness of dialysis modalities. PMID:25883196

Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions.

PubMed

Johns, Claire; Seav, Susan M; Dominick, Sally A; Gorman, Jessica R; Li, Hongying; Natarajan, Loki; Mao, Jun James; Irene Su, H

2016-04-01

Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions.

Treatment of complex sleep apnea syndrome: a retrospective comparative review.

PubMed

Pusalavidyasagar, Snigdha S; Olson, Eric J; Gay, Peter C; Morgenthaler, Timothy I

2006-09-01

Some patients with obstructive sleep apnea syndrome (OSAS) develop problematic central apneas or Cheyne-Stokes pattern with acute application of continuous positive airway pressure (CPAP), herein called complex sleep apnea syndrome (CompSAS). This response makes it difficult to be certain that CPAP will be a successful treatment strategy. We sought to compare treatments between patients with CompSAS vs. OSAS and hypothesized that CompSAS patients would find CPAP less effective and have more problems with adherence than patients with OSAS. We performed a retrospective review of patients studied in our sleep disorders center over 1 month. There were 133 patients with OSAS (mean age=57.6+/-12.2 years; males=63.9%) and 34 with CompSAS (mean age=54.4+/-16 years; males=82.35%). CPAP was prescribed in 93.7 and 87.9% of OSAS and CompSAS patients, respectively (P=0.284), with no significant difference in required CPAP pressures (P=0.112). There was no difference in prescription frequency of alternative therapies. Mean time to the first follow-up was shorter in CompSAS patients (46.2+/-47.3 vs. 53.8+/-36.8 days; P=0.022). CPAP compliance in OSAS and CompSAS patients (5.1+/-1.6 vs. 6.1+/-1.5h, P=0.156) and improvement in Epworth Sleepiness Scale (ESS) (-4.6+/-4.8 vs. -5.9+/-6.9, P=0.483) was similar. However, interface problems were more common in CompSAS patients, especially air hunger/dyspnea (0.8 vs. 8.8%) and inadvertent mask removal (2.6 vs. 17.7%) (all P<0.050). CompSAS patients have more CPAP interface problems and require more follow-up than OSAS patients but with intervention may have similar treatment results compared to patients with OSAS.

The comparability of solicited versus clinic subjects in alcohol treatment research.

PubMed

Pearlman, S; Zweben, A; Li, S

1989-05-01

The increasing use of media advertisements to recruit subjects in alcohol treatment research has raised concerns about the comparability of such solicited subjects and subjects drawn from more traditional clinic populations. This paper, based on a study that involved both solicited and clinic subjects, identifies differences between the two types of subjects in terms of sociodemographic variables; pre-treatment drinking and marital adjustment; several dimensions of 'self-definition'; and three outcome measures. These findings suggest that there may be significant differences between solicited and clinic subjects and that these differences should be taken into account in the design of studies utilizing solicited subjects in order to determine the generalizability of the results.

Comparative Therapeutic Effects of Minocycline Treatment and Bone Marrow Mononuclear Cell Transplantation following Striatal Stroke

PubMed Central

Souza, Celice C.; da Silva, Michelle Castro; Lopes, Rosana Telma; Cardoso, Marcelo M.; Santos, Adriano Guimarães; dos Santos, Ijair Rogério

2017-01-01

We explored the comparative effects of minocycline treatment and intrastriatal BMMC transplantation after experimental striatal stroke in adult rats. Male Wistar adult rats were divided as follows: saline-treated (N = 5), minocycline-treated (N = 5), and BMMC-transplanted (N = 5) animals. Animals received intrastriatal microinjections of 80 pmol of endothelin-1 (ET-1). Behavioral tests were performed at 1, 3, and 7 days postischemia. Animals were treated with minocycline (50 mg/kg, i.p.) or intrastriatal transplants of 106 BMMCs at 24 h postischemia. Animals were perfused at 7 days after ischemic induction. Coronal sections were stained with cresyl violet for gross histopathological analysis and immunolabeled for the identification of neuronal bodies (NeuN), activated microglia/macrophages (ED1), and apoptotic cells (active caspase-3). BMMC transplantation and minocycline reduced the number of ED1+ cells (p < 0.05, ANOVA-Tukey), but BMMC afforded better results. Both treatments afforded comparable levels of neuronal preservation compared to control (p > 0.05). BMMC transplantation induced a higher decrease in the number of apoptotic cells compared to control and minocycline treatment. Both therapeutic approaches improved functional recovery in ischemic animals. The results suggest that BMMC transplantation is more effective in modulating microglial activation and reducing apoptotic cell death than minocycline, although both treatments are equally efficacious on improving neuronal preservation. PMID:28713482

Comparative Therapeutic Effects of Minocycline Treatment and Bone Marrow Mononuclear Cell Transplantation following Striatal Stroke.

PubMed

Souza, Celice C; da Silva, Michelle Castro; Lopes, Rosana Telma; Cardoso, Marcelo M; de Souza, Lucas Lacerda; Santos, Adriano Guimarães; Dos Santos, Ijair Rogério; Franco, Edna C S; Gomes-Leal, Walace

2017-01-01

We explored the comparative effects of minocycline treatment and intrastriatal BMMC transplantation after experimental striatal stroke in adult rats. Male Wistar adult rats were divided as follows: saline-treated ( N = 5), minocycline-treated ( N = 5), and BMMC-transplanted ( N = 5) animals. Animals received intrastriatal microinjections of 80 pmol of endothelin-1 (ET-1). Behavioral tests were performed at 1, 3, and 7 days postischemia. Animals were treated with minocycline (50 mg/kg, i.p.) or intrastriatal transplants of 106 BMMCs at 24 h postischemia. Animals were perfused at 7 days after ischemic induction. Coronal sections were stained with cresyl violet for gross histopathological analysis and immunolabeled for the identification of neuronal bodies (NeuN), activated microglia/macrophages (ED1), and apoptotic cells (active caspase-3). BMMC transplantation and minocycline reduced the number of ED1+ cells ( p < 0.05, ANOVA-Tukey), but BMMC afforded better results. Both treatments afforded comparable levels of neuronal preservation compared to control ( p > 0.05). BMMC transplantation induced a higher decrease in the number of apoptotic cells compared to control and minocycline treatment. Both therapeutic approaches improved functional recovery in ischemic animals. The results suggest that BMMC transplantation is more effective in modulating microglial activation and reducing apoptotic cell death than minocycline, although both treatments are equally efficacious on improving neuronal preservation.

Pressure ulcer treatment strategies: a systematic comparative effectiveness review.

PubMed

Smith, M E Beth; Totten, Annette; Hickam, David H; Fu, Rongwei; Wasson, Ngoc; Rahman, Basmah; Motu'apuaka, Makalapua; Saha, Somnath

2013-07-02

Pressure ulcers affect as many as 3 million Americans and are major sources of morbidity, mortality, and health care costs. To summarize evidence comparing the effectiveness and safety of treatment strategies for adults with pressure ulcers. MEDLINE, EMBASE, CINAHL, Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database for English- or foreign-language studies; reference lists; gray literature; and individual product packets from manufacturers (January 1985 to October 2012). Randomized trials and comparative observational studies of treatments for pressure ulcers in adults and noncomparative intervention series (n > 50) for surgical interventions and evaluation of harms. Data were extracted and evaluated for accuracy of the extraction, quality of included studies, and strength of evidence. 174 studies met inclusion criteria and 92 evaluated complete wound healing. In comparison with standard care, placebo, or sham interventions, moderate-strength evidence showed that air-fluidized beds (5 studies [n = 908]; high consistency), protein-containing nutritional supplements (12 studies [n = 562]; high consistency), radiant heat dressings (4 studies [n = 160]; moderate consistency), and electrical stimulation (9 studies [n = 397]; moderate consistency) improved healing of pressure ulcers. Low-strength evidence showed that alternating-pressure surfaces, hydrocolloid dressings, platelet-derived growth factor, and light therapy improved healing of pressure ulcers. The evidence about harms was limited. Applicability of results is limited by study quality, heterogeneity in methods and outcomes, and inadequate duration to assess complete wound healing. Moderate-strength evidence shows that healing of pressure ulcers in adults is improved with the use of air-fluidized beds, protein supplementation, radiant heat dressings, and

Predictors of treatment with dialysis modalities in observational studies for comparative effectiveness research.

PubMed

Kuttykrishnan, Sooraj; Kalantar-Zadeh, Kamyar; Arah, Onyebuchi A; Cheung, Alfred K; Brunelli, Steve; Heagerty, Patrick J; Katz, Ronit; Molnar, Miklos Z; Nissenson, Allen; Ravel, Vanessa; Streja, Elani; Himmelfarb, Jonathan; Mehrotra, Rajnish

2015-07-01

The Institute of Medicine has identified the comparative effectiveness of renal replacement therapies as a kidney-related topic among the top 100 national priorities. Given the importance of ensuring internal and external validity, the goal of this study was to identify potential sources of bias in observational studies that compare outcomes with different dialysis modalities. This observational cohort study used data from the electronic medical records of all patients that started maintenance dialysis in the calendar years 2007-2011 and underwent treatment for at least 60 days in any of the 2217 facilities operated by DaVita Inc. Each patient was assigned one of six dialysis modalities for each 91-day period from the date of first dialysis (thrice weekly in-center hemodialysis (HD), peritoneal dialysis (PD), less-frequent HD, home HD, frequent HD and nocturnal in-center HD). Of the 162 644 patients, 18% underwent treatment with a modality other than HD for at least one 91-day period. Except for PD, patients started treatment with alternative modalities after variable lengths of treatment with HD; the time until a change in modality was shortest for less-frequent HD (median time = 6 months) and longest for frequent HD (median time = 15 months). Between 30 and 78% of patients transferred to another dialysis facility prior to change in modality. Finally, there were significant differences in baseline and time-varying clinical characteristics associated with dialysis modality. This analysis identified numerous potential sources of bias in studies of the comparative effectiveness of dialysis modalities. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Matching on the Disease Risk Score in Comparative Effectiveness Research of New Treatments

PubMed Central

Wyss, Richard; Ellis, Alan R.; Brookhart, M. Alan; Funk, Michele Jonsson; Girman, Cynthia J.; Simpson, Ross J.; Stürmer, Til

2016-01-01

Purpose We use simulations and an empirical example to evaluate the performance of disease risk score (DRS) matching compared with propensity score (PS) matching when controlling large numbers of covariates in settings involving newly introduced treatments. Methods We simulated a dichotomous treatment, a dichotomous outcome, and 100 baseline covariates that included both continuous and dichotomous random variables. For the empirical example, we evaluated the comparative effectiveness of dabigatran versus warfarin in preventing combined ischemic stroke and all-cause mortality. We matched treatment groups on a historically estimated DRS and again on the PS. We controlled for a high-dimensional set of covariates using 20% and 1% samples of Medicare claims data from October 2010 through December 2012. Results In simulations, matching on the DRS versus the PS generally yielded matches for more treated individuals and improved precision of the effect estimate. For the empirical example, PS and DRS matching in the 20% sample resulted in similar hazard ratios (0.88 and 0.87) and standard errors (0.04 for both methods). In the 1% sample, PS matching resulted in matches for only 92.0% of the treated population and a hazard ratio and standard error of 0.89 and 0.19, respectively, while DRS matching resulted in matches for 98.5% and a hazard ratio and standard error of 0.85 and 0.16, respectively. Conclusions When PS distributions are separated, DRS matching can improve the precision of effect estimates and allow researchers to evaluate the treatment effect in a larger proportion of the treated population. However, accurately modeling the DRS can be challenging compared with the PS. PMID:26112690

Matching on the disease risk score in comparative effectiveness research of new treatments.

PubMed

Wyss, Richard; Ellis, Alan R; Brookhart, M Alan; Jonsson Funk, Michele; Girman, Cynthia J; Simpson, Ross J; Stürmer, Til

2015-09-01

We use simulations and an empirical example to evaluate the performance of disease risk score (DRS) matching compared with propensity score (PS) matching when controlling large numbers of covariates in settings involving newly introduced treatments. We simulated a dichotomous treatment, a dichotomous outcome, and 100 baseline covariates that included both continuous and dichotomous random variables. For the empirical example, we evaluated the comparative effectiveness of dabigatran versus warfarin in preventing combined ischemic stroke and all-cause mortality. We matched treatment groups on a historically estimated DRS and again on the PS. We controlled for a high-dimensional set of covariates using 20% and 1% samples of Medicare claims data from October 2010 through December 2012. In simulations, matching on the DRS versus the PS generally yielded matches for more treated individuals and improved precision of the effect estimate. For the empirical example, PS and DRS matching in the 20% sample resulted in similar hazard ratios (0.88 and 0.87) and standard errors (0.04 for both methods). In the 1% sample, PS matching resulted in matches for only 92.0% of the treated population and a hazard ratio and standard error of 0.89 and 0.19, respectively, while DRS matching resulted in matches for 98.5% and a hazard ratio and standard error of 0.85 and 0.16, respectively. When PS distributions are separated, DRS matching can improve the precision of effect estimates and allow researchers to evaluate the treatment effect in a larger proportion of the treated population. However, accurately modeling the DRS can be challenging compared with the PS. Copyright © 2015 John Wiley & Sons, Ltd.

Prospective observational study comparing three different treatment regimes in patients with Clostridium difficile infection.

PubMed

Wenisch, Judith M; Schmid, Daniela; Kuo, Hung-Wei; Allerberger, Franz; Michl, Verena; Tesik, Philip; Tucek, Gerhard; Laferl, Hermann; Wenisch, Christoph

2012-04-01

In a hospital-based, prospective cohort study, the effects of the three standard treatment regimens for mild Clostridium difficile infection (CDI), oral (p.o.) metronidazole at 500 mg three times/day, intravenous (i.v.) metronidazole at 500 mg three times/day, and oral (p.o.) vancomycin at 250 mg four times/day, were compared with respect to the risk of occurrence of complications, sequelae, and all-cause death within 30 days after the date of starting treatment. Differences in the incidence of these outcomes were tested by χ² or Fisher's exact tests. A Poisson regression model was performed to control for possible confounding effects of sex, age, and severity of comorbidity categorized according to the Charlson comorbidity index. The highest mortality was observed in the metronidazole i.v. group, with a mortality rate 38.1% (16/42) compared to mortality rates of 7.4% (9/121) in the metronidazole p.o. group and 9.5% (4/42) in the vancomycin p.o. group (P < 0.001). After adjustment for possible effects of sex, age (> 65 years), and severity of comorbidity, the relative risk of a 30-day fatal outcome for patients receiving metronidazole i.v. was 4.3 (95% confidence interval [CI] = 1.92 to 10; P < 0.0001) compared to patients treated with metronidazole p.o. and 4.0 (95% CI = 1.31 to 5.0; P < 0.015) compared to patients treated with vancomycin p.o. There were no significant differences in the risk of complications between the three treatment groups. This study generates the hypothesis that treatment with i.v. metronidazole is inferior to the oral alternatives metronidazole and vancomycin.

Prospective Observational Study Comparing Three Different Treatment Regimes in Patients with Clostridium difficile Infection

PubMed Central

Wenisch, Judith M.; Schmid, Daniela; Kuo, Hung-Wei; Allerberger, Franz; Michl, Verena; Tesik, Philip; Tucek, Gerhard; Laferl, Hermann

2012-01-01

In a hospital-based, prospective cohort study, the effects of the three standard treatment regimens for mild Clostridium difficile infection (CDI), oral (p.o.) metronidazole at 500 mg three times/day, intravenous (i.v.) metronidazole at 500 mg three times/day, and oral (p.o.) vancomycin at 250 mg four times/day, were compared with respect to the risk of occurrence of complications, sequelae, and all-cause death within 30 days after the date of starting treatment. Differences in the incidence of these outcomes were tested by χ2 or Fisher's exact tests. A Poisson regression model was performed to control for possible confounding effects of sex, age, and severity of comorbidity categorized according to the Charlson comorbidity index. The highest mortality was observed in the metronidazole i.v. group, with a mortality rate 38.1% (16/42) compared to mortality rates of 7.4% (9/121) in the metronidazole p.o. group and 9.5% (4/42) in the vancomycin p.o. group (P < 0.001). After adjustment for possible effects of sex, age (>65 years), and severity of comorbidity, the relative risk of a 30-day fatal outcome for patients receiving metronidazole i.v. was 4.3 (95% confidence interval [CI] = 1.92 to 10; P < 0.0001) compared to patients treated with metronidazole p.o. and 4.0 (95% CI = 1.31 to 5.0; P < 0.015) compared to patients treated with vancomycin p.o. There were no significant differences in the risk of complications between the three treatment groups. This study generates the hypothesis that treatment with i.v. metronidazole is inferior to the oral alternatives metronidazole and vancomycin. PMID:22252830

Efficacy of treatment of trochanteric bursitis: a systematic review.

PubMed

Lustenberger, David P; Ng, Vincent Y; Best, Thomas M; Ellis, Thomas J

2011-09-01

Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of nonoperative treatment or surgical intervention may be necessary in refractory cases. The purpose of this systematic review was to evaluate the efficacy of the treatment of TB. A literature search in the PubMed, MEDLINE, CINAHL, and ISI Web of Knowledge databases was performed for all English language studies up to April 2010. Terms combined in a Boolean search were greater trochanteric pain syndrome, trochanteric bursitis, trochanteric, bursitis, surgery, therapy, drug therapy, physical therapy, rehabilitation, injection, Z-plasty, Z-lengthening, aspiration, bursectomy, bursoscopy, osteotomy, and tendon repair. All studies directly involving the treatment of TB were reviewed by 2 authors and selected for further analysis. Expert opinion and review articles were excluded, as well as case series with fewer than 5 patients. Twenty-four articles were identified. According to the system described by Wright et al, 2 studies, each with multiple arms, qualified as level I evidence, 1 as level II, 1 as level III, and the rest as level IV. More than 950 cases were included. The authors extracted data regarding the type of intervention, level of evidence, mean age of patients, patient gender, number of hips in the study, symptom duration before the study, mean number of injections before the study, prior hip surgeries, patient satisfaction, length of follow-up, baseline scores, and follow-up scores for the visual analog scale (VAS) and Harris Hip Scores (HHS). Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be superior to other nonoperative modalities. Multiple surgical options for

A comparative study of single-dose treatment of chancroid using thiamphenicol versus Azithromycin.

PubMed

Belda, Walter; Di Chiacchio, Nilton G; Di Chiacchio, Nilton; Romiti, Ricardo; Criado, Paulo R; Velho, Paulo Eduardo N Ferreira

2009-06-01

A study was conducted in São Paulo, Brazil, to compare azithromycin with thiamphenicol for the single-dose treatment of chancroid. In all, 54 men with chancroid were tested. The etiology was determined by clinical characterization and direct bacterioscopy with Gram staining. None of the patients had positive serology or dark-field examination indicating active infection with Treponema pallidum. Genital infections due to Neisseria gonorrhoeae and herpes simplex virus were excluded by polymerase chain reaction testing. For 54 patients with chancroid, cure rates with single-dose treatment were 73% with azithromycin and 89% with thiamphenicol. HIV seropositivity was found to be associated with treatment failure (p=0.001). The treatment failed in all HIV positive patients treated with azithromycin (p=0.002) and this drug should be avoided in these co-infected patients. In the view of the authors, thiamphenicol is the most indicated single-dose regimen for chancroid treatment.

Greater occipital nerve block in the treatment of triptan-overuse headache: A randomized comparative study.

PubMed

Karadaş, Ö; Özön, A Ö; Özçelik, F; Özge, A

2017-04-01

This study aims to investigate the efficiency of a single and repeated greater occipital nerve (GON) block using lidocaine in the treatment of triptan-overuse headache (TOH), whose importance has increased lately. In the study, 105 consecutive subjects diagnosed with TOH were evaluated. The subjects were randomized into three groups. In Group 1 (n=35), only triptan was abruptly withdrawn. In Group 2 (n=35), triptan was abruptly withdrawn and single GON block was performed. In Group 3 (n=35), triptan was abruptly withdrawn and three-stage GON block was performed. All patients were injected bilaterally with a total amount of 5 cc 1% lidocaine in each stage. During follow-up, the number of headache days per month, the severity of pain (VAS), the number of triptans used, and hsCRP and IL-6 levels were recorded three times; in the pretreatment period, in the second month post-treatment, and in the fourth month post-treatment. They were then compared. There was a statistically significant difference in the post-treatment fourth month in comparison with the pretreatment period in Group 3 (P<.05). Compared to Group 1, the number of headache days, VAS, and decrease in triptan need in Group 3 was statistically significant compared to Group 2 (P<.05). Compared to pretreatment, in the fourth month post-treatment, both hsCRP and IL-6 levels were lower only in Group 3 (P<.05). We are of the opinion that repeated GON block in addition to the discontinuation of medication has significant efficacy for TOH cases. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance.

PubMed

Robinson, Emma; Titov, Nickolai; Andrews, Gavin; McIntyre, Karen; Schwencke, Genevieve; Solley, Karen

2010-06-03

Internet-based cognitive behavioural therapy (iCBT) for generalized anxiety disorder (GAD) has been shown to be effective when guided by a clinician. The present study sought to replicate this finding, and determine whether support from a technician is as effective as guidance from a clinician. Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program and 150 participants with GAD were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for GAD comprising six online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 10 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Penn State Worry Questionnaire (PSWQ) and the Generalized Anxiety Disorder-7 Item (GAD-7). Completion rates were high, and both treatment groups reduced scores on the PSWQ (p<0.001) and GAD-7 (p<0.001) compared to the delayed treatment group, but did not differ from each other. Within group effect sizes on the PSWQ were 1.16 and 1.07 for the clinician- and technician-assisted groups, respectively, and on the GAD-7 were 1.55 and 1.73, respectively. At 3 month follow-up participants in both treatment groups had sustained the gains made at post-treatment. Participants in the clinician-assisted group had made further gains on the PSWQ. Approximately 81 minutes of clinician time and 75 minutes of technician time were required per participant during the 10 week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment/control group did not improve. These results provide

Internet Treatment for Generalized Anxiety Disorder: A Randomized Controlled Trial Comparing Clinician vs. Technician Assistance

PubMed Central

Robinson, Emma; Titov, Nickolai; Andrews, Gavin; McIntyre, Karen; Schwencke, Genevieve; Solley, Karen

2010-01-01

Background Internet-based cognitive behavioural therapy (iCBT) for generalized anxiety disorder (GAD) has been shown to be effective when guided by a clinician. The present study sought to replicate this finding, and determine whether support from a technician is as effective as guidance from a clinician. Method Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program and 150 participants with GAD were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for GAD comprising six online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 10 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Penn State Worry Questionnaire (PSWQ) and the Generalized Anxiety Disorder-7 Item (GAD-7). Completion rates were high, and both treatment groups reduced scores on the PSWQ (p<0.001) and GAD-7 (p<0.001) compared to the delayed treatment group, but did not differ from each other. Within group effect sizes on the PSWQ were 1.16 and 1.07 for the clinician- and technician-assisted groups, respectively, and on the GAD-7 were 1.55 and 1.73, respectively. At 3 month follow-up participants in both treatment groups had sustained the gains made at post-treatment. Participants in the clinician-assisted group had made further gains on the PSWQ. Approximately 81 minutes of clinician time and 75 minutes of technician time were required per participant during the 10 week treatment program. Conclusions Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment/control group did not

Comparing Spoken Language Treatments for Minimally Verbal Preschoolers with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Paul, Rhea; Campbell, Daniel; Gilbert, Kimberly; Tsiouri, Ioanna

2013-01-01

Preschoolers with severe autism and minimal speech were assigned either a discrete trial or a naturalistic language treatment, and parents of all participants also received parent responsiveness training. After 12 weeks, both groups showed comparable improvement in number of spoken words produced, on average. Approximately half the children in…

Hepatitis C Treatment Regimens Are Cost-Effective: But Compared With What?

PubMed

Mattingly, T Joseph; Slejko, Julia F; Mullins, C Daniel

2017-11-01

Numerous economic models have been published evaluating treatment of chronic hepatitis C virus (HCV) infection, but none provide a comprehensive comparison among new antiviral agents. Evaluate the cost-effectiveness of all recommended therapies for treatment of genotypes 1 and 4 chronic HCV. Using data from clinical trials, observational analyses, and drug pricing databases, Markov decision models were developed for HCV genotypes 1 and 4 to compare all recommended drugs from the perspective of the third-party payer over a 5-, 10-, and 50-year time horizon. A probabilistic sensitivity analysis (PSA) was conducted by assigning distributions for clinical cure, age entering the model, costs for each health state, and quality-adjusted life years (QALYs) for each health state in a Monte Carlo simulation of 10 000 repetitions of the model. In the lifetime model for genotype 1, effects ranged from 18.08 to 18.40 QALYs and total costs ranged from $88 107 to $184 636. The lifetime model of genotype 4 treatments had a range of effects from 18.23 to 18.43 QALYs and total costs ranging from $87 063 to $127 637. Grazoprevir/elbasvir was the optimal strategy followed by velpatasvir/sofosbuvir as the second-best strategy in most simulations for both genotypes 1 and 4, with drug costs and efficacy of grazoprevir/elbasvir as the primary model drivers. Grazoprevir/elbasvir was cost-effective compared with all strategies for genotypes 1 and 4. Effects for all strategies were similar with cost of drug in the initial year driving the results.

Acoustic Wave Treatment For Cellulite—A New Approach

NASA Astrophysics Data System (ADS)

Russe-Wilflingseder, Katharina; Russe, Elisabeth

2010-05-01

Background and Objectives: Cellulite is a biological caused modification of the female connective tissue. In extracorporeal shockwave therapy (ESWT) pulses are penetrating into the tissue without causing a thermal effect or micro lesions, but leading to a stimulation of tissue metabolism and blood circulation, inducing a natural repair process with cell activation and stem cells proliferation. Recently ESWT treatment showed evidence of remodelling collagen within the dermis and of stimulating microcirculation in fatty tissue. Study Design and Methods: The study was designed to assess acoustic wave treatment for cellulite by comparison treated vs. untreated side (upper-leg and buttock). Each individual served as its own control. 11 females with a BMI less then 30 and an age over 18 years were included. 6 treatments were given weekly with radial acoustic waves. Documentation was done before and 1, 4, 12 weeks after last treatment by standardized photo documentation, relaxed and with muscle contraction, measurement of body weight and circumference of the thigh, pinch test, and evaluation of hormonal status and lifestyle. The efficacy of AWT/EPAT was evaluated before and 1, 4, 12 weeks after last treatment. Patients rated the improvement of cellulite, overall satisfaction and acceptance. The therapist assessed improvement of cellulite, side effects and photo documentation treated vs. untreated side, before vs. after treatment. The blinded investigator evaluated the results using photo documentation right vs. left leg, before vs. after treatment in a frontal, lateral and dorsal view, relaxed and with muscle contraction. Results: The improvement of cellulite at the treated side was rated by patients with 27,3% at week 4 and 12, by the therapist with 34,1% at week 4 and 31,2% at week 12 after the last treatment The blinded investigator could verify an improvement of cellulite in an increasing number of patients with increasing time interval after treatment. No side

[Comparative study on effects of manipulation treatment and transcutaneous electrical nerve stimulation on patients with cervicogenic headache].

PubMed

Li, Chen; Zhang, Xiu-ling; Ding, Hong; Tao, Yue-qiang; Zhan, Hong-sheng

2007-07-01

To compare the effects of manipulation treatment and transcutaneous electrical nerve stimulation (TENS) on patients with cervicogenic headache. Seventy patients with cervicogenic headache were randomly allocated to receive manipulation treatment and TENS treatment, which were given every other day respectively for total 40 days. The headache degree (numeric rating scale, NRS), frequency, lasting time and the range of motion (ROM) of the cervical spine 2 weeks before treatment and 4 weeks after treatment, were compared. Before treatment, there were no significant differences in the headache NRS scores , frequency, lasting time and the ROM scores between the two groups (P>0.05). After treatment, the headache NRS score, frequency, lasting time in the manipulation group decreased significantly (P<0.01), while in the TENS group just the headache NRS score decreased significantly (P<0.05). The ROM scores in both groups showed no significant changes (P>0.05). The response rate of manipulation treatment is 94.5%, significantly higher than 64.5% of TENS treatment (P<0.05). The manipulation treatment is an effective method for patients with cervicogenic headache.

Comparative analysis of 11 different radioisotopes for palliative treatment of bone metastases by computational methods

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guerra Liberal, Francisco D. C., E-mail: meb12020@fe.up.pt, E-mail: adriana-tavares@msn.com; Tavares, Adriana Alexandre S., E-mail: meb12020@fe.up.pt, E-mail: adriana-tavares@msn.com; Tavares, João Manuel R. S., E-mail: tavares@fe.up.pt

Purpose: Throughout the years, the palliative treatment of bone metastases using bone seeking radiotracers has been part of the therapeutic resources used in oncology, but the choice of which bone seeking agent to use is not consensual across sites and limited data are available comparing the characteristics of each radioisotope. Computational simulation is a simple and practical method to study and to compare a variety of radioisotopes for different medical applications, including the palliative treatment of bone metastases. This study aims to evaluate and compare 11 different radioisotopes currently in use or under research for the palliative treatment of bonemore » metastases using computational methods. Methods: Computational models were used to estimate the percentage of deoxyribonucleic acid (DNA) damage (fast Monte Carlo damage algorithm), the probability of correct DNA repair (Monte Carlo excision repair algorithm), and the radiation-induced cellular effects (virtual cell radiobiology algorithm) post-irradiation with selected particles emitted by phosphorus-32 ({sup 32}P), strontium-89 ({sup 89}Sr), yttrium-90 ({sup 90}Y ), tin-117 ({sup 117m}Sn), samarium-153 ({sup 153}Sm), holmium-166 ({sup 166}Ho), thulium-170 ({sup 170}Tm), lutetium-177 ({sup 177}Lu), rhenium-186 ({sup 186}Re), rhenium-188 ({sup 188}Re), and radium-223 ({sup 223}Ra). Results: {sup 223}Ra alpha particles, {sup 177}Lu beta minus particles, and {sup 170}Tm beta minus particles induced the highest cell death of all investigated particles and radioisotopes. The cell survival fraction measured post-irradiation with beta minus particles emitted by {sup 89}Sr and {sup 153}Sm, two of the most frequently used radionuclides in the palliative treatment of bone metastases in clinical routine practice, was higher than {sup 177}Lu beta minus particles and {sup 223}Ra alpha particles. Conclusions: {sup 223}Ra and {sup 177}Lu hold the highest potential for palliative treatment of bone metastases of

Comparative analysis of effluent water quality from a municipal treatment plant and two on-site wastewater treatment systems.

PubMed

Garcia, Santos N; Clubbs, Rebekah L; Stanley, Jacob K; Scheffe, Brian; Yelderman, Joe C; Brooks, Bryan W

2013-06-01

Though decentralized on-site technologies are extensively employed for wastewater treatment around the globe, an understanding of effluent water quality impairments associated with these systems remain less understood than effluent discharges from centralized municipal wastewater treatment facilities. Using a unique experimental facility, a novel comparative analysis of effluent water quality was performed from model decentralized aerobic (ATS) and septic (STS) on-site wastewater treatment systems and a centralized municipal wastewater treatment plant (MTP). The ATS and STS units did not benefit from further soil treatment. Each system received common influent wastewater from the Waco, Texas, USA Metropolitan Area Regional Sewerage System. We tested the hypothesis that MTP effluent would exhibit higher water quality than on-site effluents, based on parameters selected for study. A tiered testing approach was employed to assess the three effluent discharges: select routine water quality parameters (Tier I), whole effluent toxicity (Tier II), and select endocrine-active compounds (Tier III). Contrary to our hypothesis, ATS effluent was not statistically different from MTP effluents, based on Tier I and III parameters, but reproductive responses of Daphnia magna were slightly more sensitive to ATS than MTP effluents. STS effluent water quality was identified as most degraded of the three wastewater treatment systems. Parameters used to assess centralized wastewater treatment plant effluent water quality such as whole effluent toxicity and endocrine active substances appear useful for water quality assessments of decentralized discharges. Aerobic on-site wastewater treatment systems may represent more robust options than traditional septic systems for on-site wastewater treatment in watersheds with appreciable groundwater - surface water exchange. Copyright © 2013 Elsevier Ltd. All rights reserved.

Shock-wave generation and bubble formation in the retina by lasers

NASA Astrophysics Data System (ADS)

Sun, Jinming; Gerstman, Bernard S.; Li, Bin

2000-06-01

The generation of shock waves and bubbles has been experimentally observed due to absorption of sub-nanosecond laser pulses by melanosomes, which are found in retinal pigment epithelium cells. Both the shock waves and bubbles may be the cause of retinal damage at threshold fluence levels. The theoretical modeling of shock wave parameters such as amplitude, and bubble size, is a complicated problem due to the non-linearity of the phenomena. We have used two different approaches for treating pressure variations in water: the Tait Equation and a full Equation Of State (EOS). The Tait Equation has the advantage of being developed specifically to model pressure variations in water and is therefore simpler, quicker computationally, and allows the liquid to sustain negative pressures. Its disadvantage is that it does not allow for a change of phase, which prevents modeling of bubbles and leads to non-physical behavior such as the sustaining of ridiculously large negative pressures. The full EOS treatment includes more of the true thermodynamic behavior, such as phase changes that produce bubbles and avoids the generation of large negative pressures. Its disadvantage is that the usual stable equilibrium EOS allows for no negative pressures at all, since tensile stress is unstable with respect to a transition to the vapor phase. In addition, the EOS treatment requires longer computational times. In this paper, we compare shock wave generation for various laser pulses using the two different mathematical approaches and determine the laser pulse regime for which the simpler Tait Equation can be used with confidence. We also present results of our full EOS treatment in which both shock waves and bubbles are simultaneously modeled.

Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy.

PubMed

Sun, Dongmei; Shehata, Nadine; Ye, Xiang Y; Gregorovich, Sandra; De France, Bryon; Arnold, Donald M; Shah, Prakesh S; Malinowski, Ann Kinga

2016-09-08

Treatment options for immune thrombocytopenia (ITP) in pregnancy are limited, and evidence to guide management decisions is lacking. This retrospective study of singleton pregnancies from 2 tertiary centers compared the effectiveness of intravenous immunoglobulin (IVIg) and corticosteroids in treatment of ITP. Data from 195 women who had 235 pregnancies were reviewed. Treatment was not required in 137 pregnancies (58%). Of the remaining 98 pregnancies in 91 women, 47 (48%) were treated with IVIg and 51 were treated with corticosteroids as the initial intervention. Mean maternal platelet count at birth did not differ between groups (IVIg 69 × 10(9)/L vs corticosteroids 77 × 10(9)/L; P = .71) nor did the proportion of mothers who achieved a platelet count response (IVIg 38% vs corticosteroids 39%; P = .85). There were no fatal or severe maternal, fetal, or neonatal hemorrhages. Of 203 neonates in whom platelet counts were available, 56 (28%) had a birth platelet count <150 × 10(9)/L and 18 (9%) had platelet counts <50 × 10(9)/L. Nadir platelet counts for most affected neonates occurred at birth, although for some neonates, nadir platelet counts occurred up to 6 days postnatally. Intracranial hemorrhage was noted in 2 neonates (nadir platelet counts were 135 and 18 × 10(9)/L). There were no neonatal deaths. The majority of pregnant women with a history of ITP did not require treatment, and neonatal outcomes were comparable for mothers who received IVIg or corticosteroids for treatment of maternal ITP. © 2016 by The American Society of Hematology.

Comparative Evaluation of Pediatric Patients with Mental Retardation undergoing Dental Treatment under General Anesthesia: A Retrospective Analysis.

PubMed

Ahuja, Ravish; Jyoti, Bhuvan; Shewale, Vinod; Shetty, Shridhar; Subudhi, Santosh Kumar; Kaur, Manpreet

2016-08-01

Behavioral management of patients forms one of the foremost components of pediatric dental treatment. Some children readily cooperate with dental treatment, while others require general anesthesia as a part of treatment protocol for carrying out various dental procedures. Hence, we evaluated the pediatric patients with and without mental retardation, who underwent dental treatment under general anesthesia. The present study analyzed the record of 480 pediatric patients reporting in the department of pedodontics from 2008 to 2014. Analysis of the records of the patients who underwent dental treatment under general anesthesia was done and all the patients were divided into two study groups depending upon their mental level. For the purpose of evaluation, the patients were also grouped according to their age; 4 to 7 years, 8 to 12 years, and 13 to 18 years. Measurement of decayed, missing, and filled teeth and scores for both deciduous and permanent dentition was done before and after the commencement of the dental treatment. Chi-square test and independent t-test were used for evaluating the level of significance. While comparing the patients in the two groups, maximum number of patients is present in the age group of 13 to 18 years. While comparing the indices' score between the two study groups in various age intervals, no statistically significant results were obtained. Restorative treatment and dental extractions were the most common dental treatments that were seen at a higher frequency in the intellectual disability study group. In patients with mental retardation, a higher frequency of restorative treatment and extractions occurs as compared to healthy subjects of similar age group. Therefore, they require special attention regarding maintenance of their oral health. Special attention should be given for maintaining the oral health of patients with special health care needs as compared to their physically and mentally normal counterparts.

Complementary approaches to decreasing discomfort during shockwave lithotripsy (SWL).

PubMed

Ngee-Ming, Goh; Tamsin, Drake; Rai, B P; Somani, B K

2014-06-01

Shock wave lithotripsy (SWL) is an established treatment for renal stones. Although non-invasive, it can cause significant pain and anxiety during the procedure. Our purpose was to review the literature to look at the effect of complimentary therapy in patients undergoing SWL and whether it led to a reduction in the requirement of analgesics and anxiolytics. A systematic review was performed on the use of acupuncture, auricular acupressure, transcutaneous electrical nerve stimulation (TENS) and music during SWL. Only prospective randomized controlled trials were selected. Two reviewers independently extracted the data from each study. Outcomes relating to analgesia requirement, anxiety and stone-free rates (SFR) were compared. Seven papers were identified reporting on 591 patients (acupuncture-3, TENS-1 and music-3). Pain control/analgesia requirement was significantly better in four studies (music-2, acupuncture-1, TENS-1). Significantly lower anxiety was noted in one study with music and two using acupuncture. No difference in SFR was noted with the use of complementary therapy. No major or minor side effects were noted. Complementary therapy for SWL can help lower analgesia requirement and the anxiety associated with it. However, it does not have any effect on the SFR.

Treatment dynamics of newly marketed drugs and implications for comparative effectiveness research.

PubMed

Gagne, Joshua J; Bykov, Katsiaryna; Willke, Richard J; Kahler, Kristijan H; Subedi, Prasun; Schneeweiss, Sebastian

2013-01-01

Clinicians and payers require rapid comparative effectiveness (CE) evidence generation to inform decisions for new drugs. We empirically assessed treatment dynamics of newly marked drugs and their implications for conducting CE research. We used claims data to evaluate five drug-outcome pairs: 1) raloxifene (vs. alendronate) and fracture; 2) risedronate (vs. alendronate) and fracture; 3) simvastatin plus ezetimibe fixed-dose combination (simvastatin + ezetimibe) (vs. simvastatin alone) and cardiovascular events; 4) rofecoxib (vs. nonselective nonsteroidal anti-inflammatory drugs [ns-NSAIDs]) and myocardial infarction; and 5) rofecoxib (vs. ns-NSAIDS) and gastrointestinal bleed. We examined utilization dynamics in the early marketing period, including evolving utilization patterns, outcome risk among those treated with new versus established drugs, and prior treatment patterns that may indicate treatment resistance or intolerance. We addressed these challenges by replicating active CE monitoring with sequential matched cohort analysis. Patients initiating new drugs were more likely to have used other drugs for the same indication in the past, but the majority of patients in all new drug cohorts were treatment naive (82.0% overall). Patients initiating rofecoxib had higher predicted baseline risk of gastrointestinal bleed than did patients initiating ns-NSAIDs. Patients initiating risedronate and alendronate had similar predicted baseline risks of fracture, while those initiating raloxifene and simvastatin + ezetimibe had lower risks of outcomes of interest relative to their comparators. Prospective monitoring yielded results consistent with expectation for each example. Many challenges to assessing the CE of new drugs are borne out in empirical data. Attention to these challenges can yield valid CE results. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

Nitrimidazine Compared with Metronidazole in the Treatment of Vaginal Trichomoniasis

PubMed Central

Evans, B. A.; Catterall, R. D.

1971-01-01

A new substituted nitroimidazole, nitrimidazine (Naxogin), is compared with the established drug, metronidazole (Flagyl), for the treatment of vaginal trichomoniasis in a randomized double-blind trial. Nitrimidazine cured 39 (68%) out of 57 patients and showed no undesirable effects other than nausea in one patient. Metronidazole cured 51 (89%) out of 57 patients and also caused nausea in one patient; this cure rate corresponds with that previously reported in other trials. In the recommended dosage nitrimidazine is inferior to metronidazole, but is sufficiently effective to be useful in cases of intolerance to metronidazole. PMID:4939601

Comparing barriers to mental health treatment and substance use disorder treatment among individuals with comorbid major depression and substance use disorders.

PubMed

Mojtabai, Ramin; Chen, Lian-Yu; Kaufmann, Christopher N; Crum, Rosa M

2014-02-01

Barriers to both mental health and substance use disorder treatments have rarely been examined among individuals with comorbid mental health and substance use disorders. In a sample of 393 adults with 12-month major depressive episodes and substance use disorders, we compared perceived barriers to these two types of treatments. Data were drawn from the 2005-2011 U.S. National Surveys on Drug Use and Health. Overall, the same individuals experienced different barriers to mental health treatment versus substance use disorder treatment. Concerns about negative views of the community, effects on job, and inconvenience of services were more commonly reported as reasons for not receiving substance use disorder treatment. Not affording the cost of care was the most common barrier to both types of treatments, but more commonly reported as a barrier to mental health treatment. Improved financial access through the Affordable Care Act and parity legislation and integration of mental health and substance use disorder services may help to reduce treatment barriers among individuals with comorbid mental health and substance disorders. © 2013.

A Comparative Evaluation of Minimal Therapist Contact and 15-Session Treatment for Female Orgasmic Dysfunction.

ERIC Educational Resources Information Center

Morokoff, Patricia J.; LoPiccolo, Joseph

1986-01-01

Compared a four-session minimal therapist contact (MTC) program for treatment of lifelong global orgasmic dysfunction in women to a 15-session full therapist contact (FTC) program. Both programs were effective in producing female orgasm and in improving satisfaction with the sexual relationship and, for women in MTC treatment, happiness in…

Comparison of treatment outcomes according to output voltage during shockwave lithotripsy for ureteral calculi: a prospective randomized multicenter study.

PubMed

Park, Jinsung; Kim, Hong-Wook; Hong, Sungwoo; Yang, Hee Jo; Chung, Hong

2015-05-01

To investigate the effect of fixed versus escalating voltage during SWL on treatment outcomes in patients with ureteral calculi (UC). A prospective, randomized, multicenter trial was conducted on 120 patients who were diagnosed with a single radiopaque UC. The patients were randomized into group C (n = 60, constant 13 kV, 3,000 shock wave, 2 Hz) or group E (n = 60, 11.4-12.0-13 kV per 1,000 shock waves, 2 Hz). They were evaluated by plain abdominal radiography and urinalysis at 1 week after a single session of SWL, and repeat SWL was performed if needed. The primary endpoint was stone-free rate at 1 week (SFR1) after SWL. Secondary endpoints were post-SWL visual pain score (VPS), oral analgesic requirements during 1 week, and cumulative SFRs after the second and third sessions of SWL. Groups C and E were well balanced in terms of baseline patients and stone characteristics, including pre-SWL VPS, stone location, and stone size (6.24 ± 1.92 vs. 6.30 ± 2.13 mm). SFR1s were not significantly different between groups C and E (60.0 vs. 68.3%, p = 0.447). Analyses stratified by stone size (<6 vs. ≥6 mm) showed no difference in SFR1 (p = 0.148 vs. 0.808). In the analyses stratified by stone location, group E tended to be more effective in distal UC (81.0 vs. 50.0%, p = 0.052), whereas no difference was seen in proximal UC (p = 0.487). Secondary endpoints were also similar between the two groups. Our results suggest that voltage escalation during SWL in UC may not provide superior stone fragmentation compared to fixed voltage.

Thermal injury models for optical treatment of biological tissues: a comparative study.

PubMed

Fanjul-Velez, Felix; Ortega-Quijano, Noe; Salas-Garcia, Irene; Arce-Diego, Jose L

2010-01-01

The interaction of optical radiation with biological tissues causes an increase in the temperature that, depending on its magnitude, can provoke a thermal injury process in the tissue. The establishment of laser irradiation pathological limits constitutes an essential task, as long as it enables to fix and delimit a range of parameters that ensure a safe treatment in laser therapies. These limits can be appropriately described by kinetic models of the damage processes. In this work, we present and compare several models for the study of thermal injury in biological tissues under optical illumination, particularly the Arrhenius thermal damage model and the thermal dosimetry model based on CEM (Cumulative Equivalent Minutes) 43°C. The basic concepts that link the temperature and exposition time with the tissue injury or cellular death are presented, and it will be shown that they enable to establish predictive models for the thermal damage in laser therapies. The results obtained by both models will be compared and discussed, highlighting the main advantages of each one and proposing the most adequate one for optical treatment of biological tissues.

The influence of crisis resolution treatment on employment: a retrospective register-based comparative study.

PubMed

Blæhr, Emely Ek; Madsen, Jacob Vagner; Christiansen, Nanna Limskov Stærk; Ankersen, Pia Vedel

2017-11-01

Crisis resolution treatment (CRT) is a short-term acute psychiatric home-based treatment offered as an alternative to hospitalization. The purpose of CRT is to support patient recovery by maintaining and improving competencies in relation to everyday life. Individuals with mental disorders are at increased risk of leaving the labor market, which is a central aspect of everyday life. Thus, a primary outcome of interest is whether CRT enables higher employment compared with traditional hospitalization. The aim of this study was to assess the effectiveness of CRT compared with hospitalization in relation to attempted or committed suicides, admissions, readmissions and employment. This study utilized register-based psychiatric data. The CRT intervention, which was carried out in a psychiatric center (N = 374), was matched to traditional hospitalization treatment in a corresponding area (N = 9460). The outcomes (suicide attempts, suicides, admissions and readmissions) were replicated by applying propensity score matching (PSM) to evaluate the general treatment effect of CRT. The effectiveness of CRT on employment was estimated by applying PSM combined with a difference-in-difference estimator to account for any time trends. Receiving CRT was associated with significantly more employment after 1 year compared with hospitalization. Furthermore, after 1 year, receiving CRT was associated with fewer suicide attempts, admissions and readmissions. The associations were not significant after two years. The results suggest that CRT patients retain a higher employment rate, which could indicate better recovery. Using CRT could lead to savings in the social security system owing to higher employment rates.

[Medical and surgical treatments of congenital and acquired penile curvatures: a review].

PubMed

Guillot-Tantay, C; Phé, V; Chartier-Kastler, E; Mozer, P; Bitker, M-O; Rouprêt, M

2014-03-01

The aim of the current study was to provide an overview about the surgical and medical management of acquired and congenital penile's curvature. [corrected] A systematic review of the literature was done from the PubMed database by searching the following keywords alone or in combination: Congenital penile curvature; Congenital penile deviation; Acquired penile curvature; Acquired penile deviation; Peyronie's disease. The treatment of congenital curvature is only surgical. The most common technique is the Nesbit's technique which consists in making elliptical excisions of the tunica albuginea. There are also incison or plication procedures which are efficient as well. Acquired curvature is most of the time represented by the Peyronie's disease or is post-traumatic. Among oral treatments available, the Potaba is the only drug which has proved a significant reduction in penile plaque size. Injections of interferon and nicardipine have also shown their efficacy. Ionotophoresis and extracorporeal shock-wave therapy may be beneficial for penile pain. Other therapies (vacuum, traction devices, topical Verapamil) can be interesting but other studies are necessary to recommend them. Surgical treatment is recommended during the fibrotic phase. The most common technique is also the Nesbit's technique. In case of severe curvature (curve superior to 60°), small penis, major deformations, graft techniques can be used. Moreover, if there is a sexual dysfunction, penile prosthesis is recommended. Other studies are necessary to prove the efficacy of most of the drugs already available in the treatment of the penile curvature. It seems to be interesting to combine the different treatments to improve the results of those therapies. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review.

PubMed

Bervoets, Diederik C; Luijsterburg, Pim A J; Alessie, Jeroen J N; Buijs, Martijn J; Verhagen, Arianne P

2015-07-01

Is massage therapy effective for people with musculoskeletal disorders compared to any other treatment or no treatment? Systematic review of randomised clinical trials. People with musculoskeletal disorders. Massage therapy (manual manipulation of the soft tissues) as a stand-alone intervention. The primary outcomes were pain and function. The 26 eligible randomised trials involved 2565 participants. The mean sample size was 95 participants (range 16 to 579) per study; 10 studies were considered to be at low risk of bias. Overall, low-to-moderate-level evidence indicated that massage reduces pain in the short term compared to no treatment in people with shoulder pain and osteoarthritis of the knee, but not in those with low back pain or neck pain. Furthermore, low-to-moderate-level evidence indicated that massage improves function in the short term compared to no treatment in people with low back pain, knee arthritis or shoulder pain. Low-to-very-low-level evidence from single studies indicated no clear benefits of massage over acupuncture, joint mobilisation, manipulation or relaxation therapy in people with fibromyalgia, low back pain and general musculoskeletal pain. Massage therapy, as a stand-alone treatment, reduces pain and improves function compared to no treatment in some musculoskeletal conditions. When massage is compared to another active treatment, no clear benefit was evident. Copyright © 2015 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

[Collagen powder dressing in the treatment of pressure ulcer. Multicenter comparative study assessing effectiveness and cost].

PubMed

Bou Torra, Joan-Enric; Soldevilla Agreda, J Javier; Martínez Cuervo, Fernando; Rueda López, Justo

2002-09-01

Pressure ulcers are lesions that usually occur to people to whom the social and economical repercusions are quite serious. Although present treatments with moisture cure dressings are efficient and have a lot of advantages than traditional cure, they do not solve the problem in a significant group of patients, whose ulcers do not heal or need a much longer treatment. Collagen dressings represent an important improvement, since collagen is a key element for wound scarring. We conducted a prospective, comparative and multicentrical study with Catrix, using as a control the same lesion. We compared pressure ulcers that had been previously treated on an average of 6 months without success with Catrix treatment within 7 weeks. We compared different variables, efficacy, opinion on the use of Catrix and economic cost. We included 104 pressure ulcers that fulfilled the inclusion requirements in the study. Three of them were excluded from the efficiency analysis because of a lack of data since they passed away 7 weeks later. We performed a statistical analysis on all the ulcers (GT) and we also analyzed the pressure ulcer subgroup (SG) included in this study because of a deterioration or a stagnation of the lesion despite previous treatments. Seven weeks after the beginning of the treatment with Catrix the healing or the stage change was observed in 73.3% of lesions of GT group and in 77.8% of lesions of SG group (p < 0.0001). The average material cost and nursing cost from all the lesions that scarred within 7 weeks (n = 39) with previous treatment was 17.234, 10 euros and 10.920 euros with Catrix. The average material cost per lesion used in the previous treatments was 441.9 euros and 280 euros with Catrix. These results prove that the treatment with Catrix significantly reduces the treatment length and therefore leads to a reduction of the sanitary cost in this kind of patients. Adding Catrix to the pressure ulcers treatment helps to increase significantly the scarring

Kidney damage in extracorporeal shock wave lithotripsy: a numerical approach for different shock profiles.

PubMed

Weinberg, Kerstin; Ortiz, Michael

2009-08-01

In shock-wave lithotripsy--a medical procedure to fragment kidney stones--the patient is subjected to hypersonic waves focused at the kidney stone. Although this procedure is widely applied, the physics behind this medical treatment, in particular the question of how the injuries to the surrounding kidney tissue arise, is still under investigation. To contribute to the solution of this problem, two- and three-dimensional numerical simulations of a human kidney under shock-wave loading are presented. For this purpose a constitutive model of the bio-mechanical system kidney is introduced, which is able to map large visco-elastic deformations and, in particular, material damage. The specific phenomena of cavitation induced oscillating bubbles is modeled here as an evolution of spherical pores within the soft kidney tissue. By means of large scale finite element simulations, we study the shock-wave propagation into the kidney tissue, adapt unknown material parameters and analyze the resulting stress states. The simulations predict localized damage in the human kidney in the same regions as observed in animal experiments. Furthermore, the numerical results suggest that in first instance the pressure amplitude of the shock wave impulse (and not so much its exact time-pressure profile) is responsible for damaging the kidney tissue.

Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study.

PubMed

Shaheen, Maha Adel; Salem, Samar Abdallah M; Fouad, Dina Adel; El-Fatah, Abeer Aly Abd

2015-01-01

Intralesional purified protein derivative (PPD) or mumps, measles, rubella (MMR) were not previously compared regarding their efficacy or mechanism of action in treatment of warts. We aimed to compare their efficacy in treatment of multiple warts and investigate their effect on serum interleukin (IL)-4 and IL-12. Thirty patients with multiple warts were included (10 treated with PPD, 10 with MMR, and 10 with normal saline (control)). Injection was done every 3 weeks until clearance or maximum of three treatments. Clinical response of target and distant warts was evaluated. Serum ILs-4 and -12 were assessed before and after treatment. A significantly higher rate of complete response was found in target and distant warts with PPD (60% each) and MMR (80%, 40%, respectively) compared with controls (0%), with no significant difference between both treatments. After treatment, the control group showed the lowest serum IL-12 and IL-4 levels compared with the MMR- and PPD-treated groups with statistically significant difference in between. MMR resulted in a significantly higher serum IL-12 than PPD. With PPD, IL-4 was increased with statistically significant change compared with pretreat-ment level. Intralesional PPD and MMR show comparable efficacy and safety in treatment of multiple warts. Serum ILs-4 and-12 increase following antigen injection. © 2015 Wiley Periodicals, Inc.

The effects of low-intensity narrow-band blue-light treatment compared to bright white-light treatment in seasonal affective disorder.

PubMed

Meesters, Ybe; Duijzer, Wianne B; Hommes, Vanja

2018-05-01

Ever since a new photoreceptor was discovered with a highest sensitivity to 470-490 nm blue light, it has been speculated that blue light has some advantages in the treatment of Seasonal Affective Disorder (SAD) over more traditional treatments. In this study we compared the effects of exposure to narrow-band blue light (BLUE) to those of broad-wavelength white light (BLT) in the treatment of SAD. In a 15-day design, 45 patients suffering from SAD completed 30-min sessions of light treatment on 5 consecutive days. 21 subjects received white-light treatment (BLT, broad-wavelength without UV, 10 000 lx, irradiance 31.7 W/m 2 ), 24 subjects received narrow-band blue light (BLUE, 100 lx, irradiance 1.0 W/m 2 ). All participants completed weekly questionnaires concerning mood and energy levels, and were also assessed by means of the SIGH-SAD, which is the primary outcome measure. On day 15, SIGH-SAD ratings were significantly lower than on day 1 (BLT 73.2%, effect size 3.37; BLUE 67%, effect size 2.63), which outcomes were not statistically significant different between both conditions. Small sample size. Light treatment is an effective treatment for SAD. The use of narrow-band blue light is equally effective as a treatment using bright white-light. Copyright © 2018 Elsevier B.V. All rights reserved.

Integrating Tobacco Treatment into Cancer Care: Study Protocol for a Randomized Controlled Comparative Effectiveness Trial

PubMed Central

Park, Elyse R.; Ostroff, Jamie S.; Perez, Giselle K.; Hyland, Kelly A.; Rigotti, Nancy A.; Borderud, Sarah; Regan, Susan; Muzikansky, Alona; Friedman, Emily R.; Levy, Douglas E.; Holland, Susan; Eusebio, Justin; Peterson, Lisa; Rabin, Julia; Miller-Sobel, Jacob; Gonzalez, Irina; Malloy, Laura; O’Brien, Maureen; de León-Sanchez, Suhana; Will Whitlock, C.

2016-01-01

Background Despite the well-established risks of persistent smoking, 10-30% of cancer patients continue to smoke after diagnosis. Evidence based tobacco treatment has yet to be integrated into routine oncology care. This paper describes the protocol, manualized treatment, evaluation plan, and overall study design of comparing the effectiveness and cost of two treatments across two major cancer centers. Methods/Design A two-arm, two-site randomized controlled comparative effectiveness trial is testing the hypothesis that an Intensive Treatment (IT) intervention is more effective than a Standard Treatment (ST) intervention in helping recently diagnosed cancer patients quit smoking. Both interventions include 4 weekly counseling sessions and FDA-approved smoking cessation medication advice. The IT includes an additional 4 biweekly and 3 monthly booster sessions as well as dispensal of the recommended FDA-approved smoking cessation medication at no cost. The trial is enrolling patients with suspected or newly diagnosed cancer who have smoked a cigarette in the past 30 days. Participants are randomly assigned to receive the ST or IT condition. Tobacco cessation outcomes are assessed at 3 and 6 months. The primary study outcome is 7-day point prevalence biochemically-validated tobacco abstinence. Secondary study outcomes include the incremental cost-effectiveness of the IT vs. ST. Discussion This trial will answer key questions about delivering tobacco treatment interventions to newly diagnosed cancer patients. If found to be efficacious and cost-effective, this treatment will serve as a model to be integrated into oncology care settings nation-wide, as we strive to improve treatment outcomes and quality of life for cancer patients. PMID:27444428

Comparative overview of primary sedimentation-based mechanical stage in some Romanian wastewater treatment systems

NASA Astrophysics Data System (ADS)

Zaharia, C.

2017-08-01

Nowadays, wastewater (WW) treatment facilities are considered significant exposure pathways for solid particles, and also significant concerns of any quality conscious manufacturer. Most solid particles have some forms of organic coating either used as active material or to suspend and/or stabilize different present solid materials, having increase in toxicity that must be reduced, or sometimes even totally eliminated, especially if effluent is either discharged directly to surface water, or distributed through industrial water supplies. Representatives providing innovative technologies, comprehensive supports and expertise in wastewater and sludge treatment field are known, each one using modern treatment technology and facilities. Mechanical treatment is indispensable in primary treatment steps of both municipal and industrial WW applications, its main goal being separation of floating, settling and suspended materials (especially into a primary sedimentation-based treatment step). The aim of this work is to present comparatively the performance in solids removal of conventional mechanical WW treatment stages, especially those based on primary sedimentation, or sedimentation-like operations applied for Romanian urban WW treatment plants (serving two towns with ca 18,000 inhabitants), industrial WW treatment plants (deserving industries of vegetal food processing and organic chemicals’ manufacturing) and additional information on valorisation of separated solid material and improvement possibilities.

[Comparative evaluation of the effectiveness of the treatment of gastroduodenal Campylobacter infection in children].

PubMed

Korovina, N A; Levitskaia, S V; Bokser, G V; Spirina, T S; Taranenko, L A; Safonova, T B

1991-01-01

Schemes developed by the authors for antibacterial therapy of gastroduodenal bacterosis caused by Campylobacter spp. in children are described. The data on the treatment of 56 patients with duodenal ulcer and gastroduodenitis are presented. The efficacy of the treatment with medicines under the control of the clinical, endoscopic and microbiological indices was compared. The study showed that De-Nol, furazolidone and combination of trichopol (metronidazole) with vicair were the most efficient drugs for therapy of children with such diseases.

Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments.

PubMed

Heikkinen, Juuso; Lantto, Iikka; Flinkkila, Tapio; Ohtonen, Pasi; Niinimaki, Jaakko; Siira, Pertti; Laine, Vesa; Leppilahti, Juhana

2017-05-01

It remains controversial whether nonsurgical or surgical treatment provides better calf muscle strength recovery after an acute Achilles tendon rupture (ATR). Recent evidence has suggested that surgery might surpass nonsurgical treatment in restoring strength after an ATR. To assess whether magnetic resonance imaging (MRI) findings could explain calf muscle strength deficits and the difference between nonsurgical and surgical treatments in restoring calf muscle strength. Randomized controlled trial; Level of evidence, 1. From 2009 to 2013, 60 patients with acute ATRs were randomized to surgery or nonsurgical treatment with an identical rehabilitation protocol. The primary outcome measure was the volume of calf muscles assessed using MRI at 3 and 18 months. The secondary outcome measures included fatty degeneration of the calf muscles and length of the affected Achilles tendon. Additionally, isokinetic plantarflexion strength was measured in both legs. At 3 months, the study groups showed no differences in muscle volumes or fatty degeneration. However, at 18 months, the mean differences between affected and healthy soleus muscle volumes were 83.2 cm 3 (17.7%) after surgery and 115.5 cm 3 (24.8%) after nonsurgical treatment (difference between means, 33.1 cm 3 ; 95% CI, 1.3-65.0; P = .042). The study groups were not substantially different in the volumes or fatty degeneration of other muscles. From 3 to 18 months, compensatory hypertrophy was detected in the flexor hallucis longus (FHL) and deep flexors in both groups. In the nonsurgical treatment group, the mean difference between affected and healthy FHL muscle volumes was -9.3 cm 3 (12%) and in the surgical treatment group was -8.4 cm 3 (10%) ( P ≤ .001). At 18 months, Achilles tendons were, on average, 19 mm longer in patients treated nonsurgically compared with patients treated surgically ( P < .001). At 18 months, surgically treated patients demonstrated 10% to 18% greater strength results ( P = .037). Calf

[Cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of rheumatoid arthritis].

PubMed

Salinas-Escudero, Guillermo; Vargas-Valencia, Juan; García-García, Erika Gabriela; Munciño-Ortega, Emilio; Galindo-Suárez, Rosa María

2013-01-01

to conduct cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of moderate or severe rheumatoid arthritis in patients with previous unresponse to immune selective anti-inflammatory derivatives failure. a pharmacoeconomic model based on decision analysis to assess the clinical outcome after giving etanercept, infliximab, adalimumab or tocilizumab to treat moderate or severe rheumatoid arthritis was employed. Effectiveness of medications was assessed with improvement rates of 20 % or 70 % of the parameters established by the American College of Rheumatology (ACR 20 and ACR 70). the model showed that etanercept had the most effective therapeutic response rate: 79.7 % for ACR 20 and 31.4 % for ACR 70, compared with the response to other treatments. Also, etanercept had the lowest cost ($149,629.10 per patient) and had the most cost-effective average ($187,740.40 for clinical success for ACR 20 and $476,525.80 for clinical success for ACR 70) than the other biologic therapies. we demonstrated that treatment with etanercept is more effective and less expensive compared to the other drugs, thus making it more efficient therapeutic option both in terms of means and incremental cost-effectiveness ratios for the treatment of rheumatoid arthritis.

Cost–Utility of Angiotensin-Converting Enzyme Inhibitor-Based Treatment Compared With Thiazide Diuretic-Based Treatment for Hypertension in Elderly Australians Considering Diabetes as Comorbidity

PubMed Central

Chowdhury, Enayet K.; Ademi, Zanfina; Moss, John R.; Wing, Lindon M.H.; Reid, Christopher M.

2015-01-01

Abstract The objective of this study was to examine the cost-effectiveness of angiotensin-converting enzyme inhibitor (ACEI)-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly Australians considering diabetes as an outcome along with cardiovascular outcomes from the Australian government's perspective. We used a cost–utility analysis to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained. Data on cardiovascular events and new onset of diabetes were used from the Second Australian National Blood Pressure Study, a randomized clinical trial comparing diuretic-based (hydrochlorothiazide) versus ACEI-based (enalapril) treatment in 6083 elderly (age ≥65 years) hypertensive patients over a median 4.1-year period. For this economic analysis, the total study population was stratified into 2 groups. Group A was restricted to participants diabetes free at baseline (n = 5642); group B was restricted to participants with preexisting diabetes mellitus (type 1 or type 2) at baseline (n = 441). Data on utility scores for different events were used from available published literatures; whereas, treatment and adverse event management costs were calculated from direct health care costs available from Australian government reimbursement data. Costs and QALYs were discounted at 5% per annum. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty around utilities and cost data. After a treatment period of 5 years, for group A, the ICER was Australian dollars (AUD) 27,698 (€ 18,004; AUD 1–€ 0.65) per QALY gained comparing ACEI-based treatment with diuretic-based treatment (sensitive to the utility value for new-onset diabetes). In group B, ACEI-based treatment was a dominant strategy (both more effective and cost-saving). On probabilistic sensitivity analysis, the ICERs per QALY gained were always below AUD 50,000 for group B; whereas for group A

Comparing Offenders against Women and Offenders against Children on Treatment Outcome in Offenders with Intellectual Disability

ERIC Educational Resources Information Center

Lindsay, William R.; Michie, Amanda M.; Steptoe, Lesley; Moore, Fhionna; Haut, Fabian

2011-01-01

Background: Several studies have shown the positive effects of sex offender treatment for men with intellectual disabilities who have perpetrated sex offences or inappropriate sexual behaviour. The present study investigates the process of treatment change and compares two groups of offenders against adults and offenders against children. Method:…

[Comparative analysis: Effectiveness of nicotine addiction treatment in people with psychiatric comorbidity].

PubMed

Godoy, R; Callejas, F J; Cruz, J; Tornero, A I; Tárraga, P J; Rodríguez-Montes, J A

2017-06-20

To determine whether or not nicotine addiction treatment was less effective in psychiatric than in the healthy population. A retrospective, descriptive and comparative cohort study was conducted in Albacete University Hospital during years 2008-2012 on all patients that attended the Tobacco Cessation Unit. The statistical tests used were Chi-squared, likelihood ratio, and the Student t test. Statistical significance P≤.05. The study included a total of 1,484 patients, of which 48.6% were female. The mean age was 46.8 years, and the mean age of starting smoking was 17.6 years. The mean number of previous attempts to quit was 1.48, and mean number of cigarettes smoked was 25.39. They had a mean Fagerström score of 6.04, a Richmond score of 8.13, and a mean carbon monoxide level of 16.65ppm. Most patients were referred from Primary Care (38.7%) and Chest Diseases department (33%), and the type of tobacco smoked was "light" in 75.8%. There was 15% with chronic obstructive pulmonary disease, 8% with asthma, and 9.4% with obstructive sleep apnoea syndrome. Furthermore, there was respiratory disease in 28.7%, cardiovascular disease in 4.6%, and both in 3.5%. Hiatus hernia was present in 7.2%, thyroid disease in 3.8%, hypertension in 19%, diabetes in 10.7%, and dyslipidaemia in 29.4%, Drugs were used by 7.1%, and 12.6% consumed alcohol. There was 39.3% psychiatric comorbidity (PC), and were comparable except in gender, age of onset, Fagerström, Richmond, source of referral, asthma, hiatus hernia, thyroid disease, hypertension, as well as drugs and treatment. Drug treatment was completed by 22.3% in the PC group, with no significant difference. There were differences in success (P=.008), but not in failure and relapse rates. Anti-smoking treatment in psychiatric patients is effective. An increase in the probability of treatment success is observed in patients without psychiatric comorbidity. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria

A randomized controlled study comparing community based with health facility based direct observation of treatment models on patients' satisfaction and TB treatment outcome in Nigeria.

PubMed

Adewole, Olanisun O; Oladele, T; Osunkoya, Arinola H; Erhabor, Greg E; Adewole, Temitayo O; Adeola, Oluwaseun; Obembe, Olufemi; Ota, Martin O C

2015-12-01

Directly observed treatment short-course (DOTS) strategy is an effective mode of treating TB. We aimed to study the cost effectiveness and patients' satisfaction with home based direct observation of treatment (DOT), an innovative approach to community-based DOT (CBDOT) and hospital based DOT (HBDOT). A randomized controlled trial involving 150 newly diagnosed pulmonary TB patients in four TB clinics in Ile Ife , Nigeria, was done. They were randomly assigned to receive treatment with anti TB drugs for the intensive phase administered at home by a TB worker (CBDOT) or at the hospital (HBDOT). Outcome measures were treatment completion/default rates, cost effectiveness and patients' satisfaction with care using a 13 item patients satisfaction questionnaire (PS-13) at 2 months. This trial was registered with pactr.org: number PACTR 201503001058381. At the end of intensive phase, 15/75 (20%) and 2/75 (3%) of patients in the HBDOT and CBDOT, respectively had defaulted from treatment, p= 0.01. Of those with pretreatment positive sputum smear, 97% (68/70) on CBDOT and 54/67 (81%) on HBDOT were sputum negative for AFB at the end of 2 months of treatment, p=0.01. The CBDOT method was associated with a higher patient satisfaction score compared with HBDOT (OR 3.1; 95% CI 1.25-7.70), p=0.001.The total cost for patients was higher in HBDOT (US$159.38) compared with the CBDOT (US$89.52). The incremental cost effectiveness ratio was US$410 per patient who completed the intensive phase treatment with CBDOT. CBDOT is a cost effective approach associated with better compliance to treatment and better patient satisfaction compared to HBDOT. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessment of UASB-DHS technology for sewage treatment: a comparative study from a sustainability perspective.

PubMed

Maharjan, Namita; Nomoto, Naoki; Tagawa, Tadashi; Okubo, Tsutomu; Uemura, Shigeki; Khalil, Nadeem; Hatamoto, Masashi; Yamaguchi, Takashi; Harada, Hideki

2018-04-06

This paper assesses the technical and economic sustainability of a combined system of an up-flow anaerobic sludge blanket (UASB)-down-flow hanging sponge (DHS) for sewage treatment. Additionally, this study compares UASB-DHS with current technologies in India like trickling filters (TF), sequencing batch reactor (SBR), moving bed biofilm reactor (MBBR), and other combinations of UASB with post-treatment systems such as final polishing ponds (FPU) and extended aeration sludge process (EASP). The sustainability of the sewage treatment plants (STPs) was evaluated using a composite indicator, which incorporated environmental, societal, and economic dimensions. In case of the individual sustainability indicator study, the results showed that UASB-FPU was the most economically sustainable system with a score of 0.512 and aeration systems such as MBBR, EASP, and SBR were environmentally sustainable, whereas UASB-DHS system was socially sustainable. However, the overall comparative analysis indicated that the UASB-DHS system scored the highest value of 2.619 on the global sustainability indicator followed by EASP and MBBR with scores of 2.322 and 2.279, respectively. The highlight of this study was that the most environmentally sustainable treatment plants were not economically and socially sustainable. Moreover, sensitivity analysis showed that five out of the seven scenarios tested, the UASB-DHS system showed good results amongst the treatment system.

Comparative evaluation of soft tissue changes one year post-treatment in Twin Block and FORSUS FRD treated patients.

PubMed

Chaudhary, Dinesh Chander; Kumar, Prasanna; Sharma, Mohit; Nehra, Karan

2016-10-01

The objective of this study was to compare and evaluate the effects of two functional treatment modalities, namely, Twin Block (TB) and FORSUS fatigue resistant device (FORSUS FRD) on facial soft tissues before and at one-year post-treatment. This was a retrospective cephalometric study involving 10 patients with skeletal class II abnormalities in each group. The mean age of patients was 12.5 ± 1.5 and 13.5 ± 1 years and treatment duration 20 ± 2 and 18 ± 2 months, respectively for TB and FORSUS FRD groups, respectively. The pre-treatment (T0) and one-year post-treatment cephalograms (T1) were compared for evaluation. Data were analysed using a paired t -test and independent sample t -test for within-group and between-group comparisons, respectively. The groups were compared at T0 and T1, and treatment/observation differences (T1 - T0) were evaluated with paired samples t -test at P  < 0.05 level and unpaired sample t -test for group comparison. Statistically significant treatment changes were found for soft tissue changes in both TB and FORSUS FRD groups. Between the two groups, TB showed significant increase in the LAFH compared to the FORSUS FRD group. Statistically significant soft tissue changes were observed after TB and FORSUS FRD appliance therapy, resulting in improvement of facial balance and aesthetics. Both, TB and FORSUS FRD, have similar effects on soft tissues, but the effect of TB on LAFH and that of FORSUS on mentolabial sulcus was more profound.

Comparative Treatment Failure Rates of Respiratory Fluoroquinolones or β-Lactam + Macrolide Versus β-Lactam Alone in the Treatment for Community-Acquired Pneumonia in Adult Outpatients

PubMed Central

Lee, Meng-Tse Gabriel; Lee, Shih-Hao; Chang, Shy-Shin; Chan, Ya-Lan; Pang, Laura; Hsu, Sue-Ming; Lee, Chien-Chang

2015-01-01

Abstract No comparative effectiveness study has been conducted for the following 3 antibiotics: respiratory fluoroquinolone, β-lactam, and β-lactam + advanced macrolide. To gain insights into the real-world clinical effectiveness of these antibiotics for community-acquired pneumonia in adult outpatients, our study investigated the treatment failure rates in 2 million representative participants from the National Health Informatics Project (NHIP) of Taiwan. A new-user cohort design was used to follow NHIP participants from January 2000 until December 2009. Treatment failure was defined by either one of the following events: a second antibiotic prescription, hospitalization due to CAP, an emergency department visit with a diagnosis of CAP, or 30-day nonaccident-related mortality. From 2006 to 2009, we identified 9256 newly diagnosed CAP outpatients, 1602 of whom were prescribed levofloxacin, 2100 were prescribed moxifloxacin, 5049 were prescribed β-lactam alone, and 505 were prescribed advanced macrolide + β-lactam. Compared with the β-lactam-based regimen, the propensity score-matched odds ratio for composite treatment failure was 0.81 (95% CI, 0.67–0.97) for moxifloxacin, 1.10 (95% CI, 0.90–1.35) for levofloxacin, and 0.95 (95% CI, 0.67–1.35) for macrolide +β-lactam. Moxifloxacin was associated with lower treatment failure rates compared with β-lactam alone, or levofloxacin in Taiwanese CAP outpatients. However, due to inherent limitations in our claims database, more randomized controlled trials are required before coming to a conclusion on which antibiotic is more effective for Taiwanese CAP outpatients. More population-based comparative effectiveness studies are also encouraged and should be considered as an integral piece of evidence in local CAP treatment guidelines. PMID:26426664

Efficacy of Treatment of Trochanteric Bursitis: A Systematic Review

PubMed Central

Lustenberger, David P; Ng, Vincent Y; Best, Thomas M; Ellis, Thomas J

2013-01-01

Objective Trochanteric bursitis (TB) is a self-limiting disorder in the majority of patients and typically responds to conservative measures. However, multiple courses of nonoperative treatment or surgical intervention may be necessary in refractory cases. The purpose of this systematic review was to evaluate the efficacy of the treatment of TB. Data Sources A literature search in the PubMed, MEDLINE, CINAHL, and ISI Web of Knowledge databases was performed for all English language studies up to April 2010. Terms combined in a Boolean search were greater trochanteric pain syndrome, trochanteric bursitis, trochanteric, bursitis, surgery, therapy, drug therapy, physical therapy, rehabilitation, injection, Z-plasty, Z-lengthening, aspiration, bursectomy, bursoscopy, osteotomy, and tendon repair. Study Selection All studies directly involving the treatment of TB were reviewed by 2 authors and selected for further analysis. Expert opinion and review articles were excluded, as well as case series with fewer than 5 patients. Twenty-four articles were identified. According to the system described by Wright et al, 2 studies, each with multiple arms, qualified as level I evidence, 1 as level II, 1 as level III, and the rest as level IV. More than 950 cases were included. Data Extraction The authors extracted data regarding the type of intervention, level of evidence, mean age of patients, patient gender, number of hips in the study, symptom duration before the study, mean number of injections before the study, prior hip surgeries, patient satisfaction, length of follow-up, baseline scores, and follow-up scores for the visual analog scale (VAS) and Harris Hip Scores (HHS). Data Synthesis Symptom resolution and the ability to return to activity ranged from 49% to 100% with corticosteroid injection as the primary treatment modality with and without multimodal conservative therapy. Two comparative studies (levels II and III) found low-energy shock-wave therapy (SWT) to be

Cost-effectiveness of endobronchial valve treatment in patients with severe emphysema compared to standard medical care.

PubMed

Hartman, Jorine E; Klooster, Karin; Groen, Henk; Ten Hacken, Nick H T; Slebos, Dirk-Jan

2018-03-25

Bronchoscopic lung volume reduction using endobronchial valves (EBV) is an effective new treatment option for severe emphysema patients without interlobar collateral ventilation. The objective of this study was to perform an economic evaluation including the costs and cost-effectiveness of EBV treatment compared with standard medical care (SoC) from the hospital perspective in the short term and long term. For the short-term evaluation, incremental cost-effectiveness ratios (ICER) were calculated based on the 6-month end point data from the STELVIO randomized trial. For the long-term evaluation, a Markov simulation model was constructed based on STELVIO and literature. The clinical outcome data were quality-adjusted life-years (QALY) based on the EuroQol5-Dimensions (EQ5D) questionnaire, the 6-min walking distance (6MWD) and the St George's Respiratory Questionnaire (SGRQ). The mean difference between the EBV group and controls was €16 721/patient. In the short-term (6 months), costs per additional QALY was €205 129, the ICER for 6MWD was €160 and for SGRQ was €1241. In the long term, the resulting cost-effectiveness ratios indicate additional costs of €39 000 per QALY gained with a 5-year time horizon and €21 500 per QALY gained at 10 years. In comparison, historical costs per additional QALY 1 year after the coil treatment are €738 400, 5 years after lung volume reduction surgery are €48 415 and 15 years after double-lung transplantation are €29 410. The positive clinical effects of EBV treatment are associated with increased costs compared with SoC. Our results suggest that the EBV treatment has a favourable cost-effectiveness profile, also when compared with other treatment modalities for this patient group. © 2018 Asian Pacific Society of Respirology.

Efficacy of peroral endoscopic myotomy compared with other invasive treatment options for the different esophageal motor disorders.

PubMed

Estremera-Arévalo, Fermín; Albéniz, Eduardo; Rullán, María; Areste, Irene; Iglesias, Rosa; Vila, Juan José

2017-08-01

Peroral endoscopic myotomy (POEM) has been performed since 2008 on more than 5,000 patients. It has proven to be highly effective in the treatment of achalasia and has shown promising outcomes for other esophageal motility spastic disorders. A literature review of the efficacy of POEM compared to the previous invasive treatments for different esophageal motility disorders was performed. The application in the pediatric and elderly populations and its role as a rescue therapy after other procedures are also outlined. Short-term outcomes are similar to laparoscopic Heller myotomy (LHM) and pneumatic endoscopic dilation (PD) (clinical success > 90%) for achalasia subtypes I and II. Mid-term outcomes are comparable to LHM and overcome the results obtained after PD (> 90% vs ~50%). With regard to type III achalasia, POEM efficacy is 98% compared to 80.8% for LHM and the PD success remains at 40%. With regard to spastic esophageal disorders (SED), POEM has an effectiveness of 88% and 70% for distal esophageal spasm (DES) and jackhammer esophagus (JE) respectively. A response of 95% in patients with sigmoid esophagus has been reported. POEM has been performed in pediatric and elderly populations and has obtained a higher efficacy than PD in pediatric series (100% vs 33%) without greater adverse events. Previous treatments do not seem to hinder POEM results with excellent response rates, including 97% in post LHM and 100% in a re-POEM series. Final considerations: POEM has shown excellent short and mid-term results for all subtypes of achalasia but long-term results are not yet available. The promising results in SED may make POEM the first-line treatment for SED. A high-safety profile and efficacy have been shown in elderly and pediatric populations. Previous treatments do not seem to diminish the success rate of POEM. Core tip: POEM has emerged as an efficient treatment option for all subtypes of achalasia and other scenarios (including previous treatments and elderly

Comparative efficacy and safety of mavacoxib and carprofen in the treatment of canine osteoarthritis

PubMed Central

Payne-Johnson, M; Becskei, C; Chaudhry, Y; Stegemann, M R

2015-01-01

A multi-site, masked, randomised parallel group study employing a double dummy treatment design was performed in canine veterinary patients to determine the comparative efficacy and safety of mavacoxib and carprofen in the treatment of pain and inflammation associated with osteoarthritis for a period of 134 days. Treatments were administered according to their respective summaries of product characteristics. Of 139 dogs screened, 124 were suitable for study participation: 62 of which were dosed with mavacoxib and 62 with carprofen. Both treatments resulted in a very similar pattern of considerable improvement as indicated in all parameters assessed by both owner and veterinarian. The primary efficacy endpoint ‘overall improvement’ was a composite score of owner assessments after approximately six weeks of treatment. Both drugs were remarkably effective, with 57/61 (93.4 per cent) of mavacoxib-treated dogs and 49/55 (89.1 per cent) of carprofen-treated dogs demonstrating overall improvement and with mavacoxib's efficacy being non-inferior to carprofen. The treatments had a similar safety profile as evidenced by documented adverse events and summaries of clinical pathology parameters. The positive clinical response to treatment along with the safety and dosing regimen of mavacoxib makes it an attractive therapy for canine osteoarthritis. PMID:25433056

Comparative efficacy and safety of mavacoxib and carprofen in the treatment of canine osteoarthritis.

PubMed

Payne-Johnson, M; Becskei, C; Chaudhry, Y; Stegemann, M R

2015-03-14

A multi-site, masked, randomised parallel group study employing a double dummy treatment design was performed in canine veterinary patients to determine the comparative efficacy and safety of mavacoxib and carprofen in the treatment of pain and inflammation associated with osteoarthritis for a period of 134 days. Treatments were administered according to their respective summaries of product characteristics. Of 139 dogs screened, 124 were suitable for study participation: 62 of which were dosed with mavacoxib and 62 with carprofen. Both treatments resulted in a very similar pattern of considerable improvement as indicated in all parameters assessed by both owner and veterinarian. The primary efficacy endpoint 'overall improvement' was a composite score of owner assessments after approximately six weeks of treatment. Both drugs were remarkably effective, with 57/61 (93.4 per cent) of mavacoxib-treated dogs and 49/55 (89.1 per cent) of carprofen-treated dogs demonstrating overall improvement and with mavacoxib's efficacy being non-inferior to carprofen. The treatments had a similar safety profile as evidenced by documented adverse events and summaries of clinical pathology parameters. The positive clinical response to treatment along with the safety and dosing regimen of mavacoxib makes it an attractive therapy for canine osteoarthritis. British Veterinary Association.

[Urologic interventional therapy of kidney calculi (I)--extracorporeal shockwave lithotripsy].

PubMed

Knoll, Th; Michel, M S; Köhrmann, K U; Alken, P

2003-02-01

With a prevalence of around 5% in western countries, urolithiasis is a frequently occurring disease but with a poorly understood pathogenesis. Effective prevention is not possible for most stone types, in particular for calcium-containing stones, which occur most frequently. Additionally, after occurrence, patient compliance is often inadequate. Interventional therapy becomes necessary after stone manifestation within the urinary tract. Not all stone compositions respond to a drug treatment. Whereas in the seventies, stone treatment meant open surgery newly developed minimally-invasive procedures have displaced this treatment. The clinical introduction of extracorporal shock wave lithotripsy (ESWL) has played a crucial role in this process. Today, more than 80% of all urinary stones can be treated by modern lithotripters. Combination with other minimally-invasive procedures further improve stone free rate. This article provides an overview of technique, application and results of ESWL treatment.

Assessing treatment integrity in cognitive-behavioral therapy: comparing session segments with entire sessions.

PubMed

Weck, Florian; Grikscheit, Florian; Höfling, Volkmar; Stangier, Ulrich

2014-07-01

The evaluation of treatment integrity (therapist adherence and competence) is a necessary condition to ensure the internal and external validity of psychotherapy research. However, the evaluation process is associated with high costs, because therapy sessions must be rated by experienced clinicians. It is debatable whether rating session segments is an adequate alternative to rating entire sessions. Four judges evaluated treatment integrity (i.e., therapist adherence and competence) in 84 randomly selected videotapes of cognitive-behavioral therapy for major depressive disorder, social anxiety disorder, and hypochondriasis (from three different treatment outcome studies). In each case, two judges provided ratings based on entire therapy sessions and two on session segments only (i.e., the middle third of the entire sessions). Interrater reliability of adherence and competence evaluations proved satisfactory for ratings based on segments and the level of reliability did not differ from ratings based on entire sessions. Ratings of treatment integrity that were based on entire sessions and session segments were strongly correlated (r=.62 for adherence and r=.73 for competence). The relationship between treatment integrity and outcome was comparable for ratings based on session segments and those based on entire sessions. However, significant relationships between therapist competence and therapy outcome were only found in the treatment of social anxiety disorder. Ratings based on segments proved to be adequate for the evaluation of treatment integrity. The findings demonstrate that session segments are an adequate and cost-effective alternative to entire sessions for the evaluation of therapist adherence and competence. Copyright © 2014. Published by Elsevier Ltd.

Are the Clinical Characteristics of Anxious Youths Participating in Non-Treatment-Related Research Comparable to Those of Youths Receiving Treatment?

ERIC Educational Resources Information Center

De Los Reyes, Andres; Alfano, Candice A.; Clementi, Michelle A.; Viana, Andres

2017-01-01

Background: A key element of the evidence-based assessment and treatment movements is ensuring an adequate representation of clients across the different settings in which they receive mental health care (e.g., research and routine or usual care settings). Prior work has focused on comparing clients from research settings to those from usual care…

Comparative study of wastewater treatment and nutrient recycle via activated sludge, microalgae and combination systems.

PubMed

Wang, Liang; Liu, Jinli; Zhao, Quanyu; Wei, Wei; Sun, Yuhan

2016-07-01

Algal-bacterial synergistic cultivation could be an optional wastewater treatment technology in temperate areas. In this study, a locally screened vigorous Chlorella strain was characterized and then it was used in a comparative study of wastewater treatment and nutrient recycle assessment via activated sludge (AS), microalgae and their combination systems. Chlorella sp. cultured with AS in light showed the best performance, in which case the removal efficiencies of COD, NH3-N and TP were 87.3%, 99.2% and 83.9%, respectively, within a short period of 1day. Algal-bacterial combination in light had the best settleability. Chlorella sp. contained biomass, could be processed to feed, fertilizer or fuel due to the improved quality (higher C/H/N) compared with sludge. PCR-DGGE analysis shows that two types of rhizobacteria, namely, Pseudomonas putida and Flavobacterium hauense were enriched in sludge when cultured with algae in light, serving as the basics for artificial consortium construction for improved wastewater treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparative assessment of the environmental sustainability of existing and emerging perchlorate treatment technologies for drinking water.

PubMed

Choe, Jong Kwon; Mehnert, Michelle H; Guest, Jeremy S; Strathmann, Timothy J; Werth, Charles J

2013-05-07

Environmental impacts of conventional and emerging perchlorate drinking water treatment technologies were assessed using life cycle assessment (LCA). Comparison of two ion exchange (IX) technologies (i.e., nonselective IX with periodic regeneration using brines and perchlorate-selective IX without regeneration) at an existing plant shows that brine is the dominant contributor for nonselective IX, which shows higher impact than perchlorate-selective IX. Resource consumption during the operational phase comprises >80% of the total impacts. Having identified consumables as the driving force behind environmental impacts, the relative environmental sustainability of IX, biological treatment, and catalytic reduction technologies are compared more generally using consumable inputs. The analysis indicates that the environmental impacts of heterotrophic biological treatment are 2-5 times more sensitive to influent conditions (i.e., nitrate/oxygen concentration) and are 3-14 times higher compared to IX. However, autotrophic biological treatment is most environmentally beneficial among all. Catalytic treatment using carbon-supported Re-Pd has a higher (ca. 4600 times) impact than others, but is within 0.9-30 times the impact of IX with a newly developed ligand-complexed Re-Pd catalyst formulation. This suggests catalytic reduction can be competitive with increased activity. Our assessment shows that while IX is an environmentally competitive, emerging technologies also show great promise from an environmental sustainability perspective.

Comparative Efficacy of Topical Pertmehrin, Crotamiton and Sulfur Ointment in Treatment of Scabies

PubMed Central

Mila-Kierzenkowska, Celestyna; Woźniak, Alina; Krzyżyńska-Malinowska, Ewa; Kałużna, Lucyna; Wesołowski, Roland; Poćwiardowski, Wojciech; Owcarz, Marcin

2017-01-01

Background: Scabies is an ectoparasitic infection, which occurs because of direct skin-to skin contact. The ideal treatment modality is still unclear and further research on this topic is warranted. The aim of the study was to compare the efficacy and safety of the topical scabicides: permethrin, crotamiton and sulfur ointment. Methods: Fifty four patients with diagnosed scabies were randomly divided into three treatment groups. The first group received 5% permethrin cream twice with one week interval, the patients from the second group were given crotamiton lotion for two days twice with one week interval, while the third group received 10% sulfur ointment for two or three weeks. All patients were followed up at 1, 2 and 4 weeks intervals. Results: At one-week follow up the cure rate was significantly higher at permethrin-treated group when compared to crotamiton group (P< 0.001) and sulfur group (P< 0.001). At the end of two-week interval, the cure rate at permethrin group was 100%, while at crotamiton group, 66.7% and in sulfur group 38.9% (P< 0.001). At 4-week follow up the applied treatment was effective in all studied individuals. Conclusion: The topical application of permethrin, crotamiton and sulfur was equally efficacious at 4-week follow up, however permethrin cream showed faster improvement at first and second follow up. Acquiring permethrin is considered as expensive option and crotamiton lotion seems to be cost-less alternative to this cream. PMID:29018829

Comparative Efficacy of Topical Pertmehrin, Crotamiton and Sulfur Ointment in Treatment of Scabies.

PubMed

Mila-Kierzenkowska, Celestyna; Woźniak, Alina; Krzyżyńska-Malinowska, Ewa; Kałużna, Lucyna; Wesołowski, Roland; Poćwiardowski, Wojciech; Owcarz, Marcin

2017-03-01

Scabies is an ectoparasitic infection, which occurs because of direct skin-to skin contact. The ideal treatment modality is still unclear and further research on this topic is warranted. The aim of the study was to compare the efficacy and safety of the topical scabicides: permethrin, crotamiton and sulfur ointment. Fifty four patients with diagnosed scabies were randomly divided into three treatment groups. The first group received 5% permethrin cream twice with one week interval, the patients from the second group were given crotamiton lotion for two days twice with one week interval, while the third group received 10% sulfur ointment for two or three weeks. All patients were followed up at 1, 2 and 4 weeks intervals. At one-week follow up the cure rate was significantly higher at permethrin-treated group when compared to crotamiton group (P< 0.001) and sulfur group (P< 0.001). At the end of two-week interval, the cure rate at permethrin group was 100%, while at crotamiton group, 66.7% and in sulfur group 38.9% (P< 0.001). At 4-week follow up the applied treatment was effective in all studied individuals. The topical application of permethrin, crotamiton and sulfur was equally efficacious at 4-week follow up, however permethrin cream showed faster improvement at first and second follow up. Acquiring permethrin is considered as expensive option and crotamiton lotion seems to be cost-less alternative to this cream.

Pressurized Anneal of Consolidated Powders

NASA Technical Reports Server (NTRS)

Nemir, David Charles (Inventor); Rubio, Edward S. (Inventor); Beck, Jan Bastian (Inventor)

2017-01-01

Systems and methods for producing a dense, well bonded solid material from a powder may include consolidating the powder utilizing any suitable consolidation method, such as explosive shockwave consolidation. The systems and methods may also include a post-processing thermal treatment that exploits a mismatch between the coefficients of thermal expansion between the consolidated material and the container. Due to the mismatch in the coefficients, internal pressure on the consolidated material during the heat treatment may be increased.

Comparing Treatments for Children with ADHD and Word Reading Difficulties: A Randomized Clinical Trial

PubMed Central

Tamm, Leanne; Denton, Carolyn A.; Epstein, Jeffery N.; Schatschneider, Christopher; Taylor, Heather; Arnold, L. Eugene; Bukstein, Oscar; Anixt, Julia; Koshy, Anson; Newman, Nicholas C.; Maltinsky, Jan; Brinson, Patricia; Loren, Richard; Prasad, Mary R.; Ewing-Cobbs, Linda; Vaughn, Aaron

2017-01-01

Objective This randomized clinical trial compared Attention-Deficit/Hyperactivity Disorder (ADHD) treatment alone, intensive reading intervention alone, and their combination for children with ADHD and word reading difficulties and disabilities (RD). Method Children (n=216; predominantly African American males) in grades 2–5 with ADHD and word reading/decoding deficits were randomized to ADHD treatment (carefully-managed medication+parent training), reading treatment (intensive reading instruction), or combined ADHD+reading treatment. Outcomes were parent and teacher ADHD ratings and measures of word reading/decoding. Analyses utilized a mixed models covariate-adjusted gain score approach with post-test regressed onto pretest and other predictors. Results Inattention and hyperactivity/impulsivity outcomes were significantly better in the ADHD (parent Hedges g=.87/.75; teacher g=.67/.50) and combined (parent g=1.06/.95; teacher g=.36/41) treatment groups than reading treatment alone; the ADHD and Combined groups did not differ significantly (parent g=.19/.20; teacher g=.31/.09). Word reading and decoding outcomes were significantly better in the reading (word reading g=.23; decoding g=.39) and combined (word reading g=.32; decoding g=.39) treatment groups than ADHD treatment alone; reading and combined groups did not differ (word reading g=.09; decoding g=.00). Significant group differences were maintained at the three- to five-month follow-up on all outcomes except word reading. Conclusions Children with ADHD and RD benefit from specific treatment of each disorder. ADHD treatment is associated with more improvement in ADHD symptoms than RD treatment, and reading instruction is associated with better word reading and decoding outcomes than ADHD treatment. The additive value of combining treatments was not significant within disorder, but the combination allows treating both disorders simultaneously. PMID:28333510

Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial.

PubMed

Tamm, Leanne; Denton, Carolyn A; Epstein, Jeffery N; Schatschneider, Christopher; Taylor, Heather; Arnold, L Eugene; Bukstein, Oscar; Anixt, Julia; Koshy, Anson; Newman, Nicholas C; Maltinsky, Jan; Brinson, Patricia; Loren, Richard E A; Prasad, Mary R; Ewing-Cobbs, Linda; Vaughn, Aaron

2017-05-01

This trial compared attention-deficit/hyperactivity disorder (ADHD) treatment alone, intensive reading intervention alone, and their combination for children with ADHD and word reading difficulties and disabilities (RD). Children (n = 216; predominantly African American males) in Grades 2-5 with ADHD and word reading/decoding deficits were randomized to ADHD treatment (medication + parent training), reading treatment (reading instruction), or combined ADHD + reading treatment. Outcomes were parent and teacher ADHD ratings and measures of word reading/decoding. Analyses utilized a mixed models covariate-adjusted gain score approach with posttest regressed onto pretest. Inattention and hyperactivity/impulsivity outcomes were significantly better in the ADHD (parent Hedges's g = .87/.75; teacher g = .67/.50) and combined (parent g = 1.06/.95; teacher g = .36/41) treatment groups than reading treatment alone; the ADHD and Combined groups did not differ significantly (parent g = .19/.20; teacher g = .31/.09). Word reading and decoding outcomes were significantly better in the reading (word reading g = .23; decoding g = .39) and combined (word reading g = .32; decoding g = .39) treatment groups than ADHD treatment alone; reading and combined groups did not differ (word reading g = .09; decoding g = .00). Significant group differences were maintained at the 3- to 5-month follow-up on all outcomes except word reading. Children with ADHD and RD benefit from specific treatment of each disorder. ADHD treatment is associated with more improvement in ADHD symptoms than RD treatment, and reading instruction is associated with better word reading and decoding outcomes than ADHD treatment. The additive value of combining treatments was not significant within disorder, but the combination allows treating both disorders simultaneously. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Subjective response to antipsychotic treatment and compliance in schizophrenia. A naturalistic study comparing olanzapine, risperidone and haloperidol (EFESO Study)

PubMed Central

García-Cabeza, Ignacio; Gómez, Juan-Carlos; Sacristán, Jose A; Edgell, Eric; González de Chavez, Manuel

2001-01-01

Background In order to compare the effectiveness of different antipsychotic drugs in the treatment of schizophrenia it is very important to evaluate subjective response and compliance in patient cohorts treated according to routine clinical practice. Method Outpatients with schizophrenia entered this prospective, naturalistic study when they received a new prescription for an antipsychotic drug. Treatment assignment was based on purely clinical criteria, as the study did not include any experimental intervention. Patients treated with olanzapine, risperidone or haloperidol were included in the analysis. Subjective response was measured using the 10-item version of the Drug Attitude Inventory (DAI-10), and treatment compliance was measured using a physician-rated 4 point categorical scale. Results A total of 2128 patients initiated treatment (as monotherapy) with olanzapine, 417 with risperidone, and 112 with haloperidol. Olanzapine-treated patients had significantly higher DAI-10 scores and significantly better treatment compliance compared to both risperidone- and haloperidol-treated patients. Risperidone-treated patients had a significantly higher DAI-10 score compared to haloperidol-treated patients. Conclusion Subjective response and compliance were superior in olanzapine-treated patients, compared to patients treated with risperidone and haloperidol, in routine clinical practice. Differences in subjective response were explained largely, but not completely, by differences in incidence of EPS. PMID:11835695

Comparison of iron status 28 d after provision of antimalarial treatment with iron therapy compared with antimalarial treatment alone in Ugandan children with severe malaria.

PubMed

Cusick, Sarah E; Opoka, Robert O; Ssemata, Andrew S; Georgieff, Michael K; John, Chandy C

2016-03-01

The provision of iron with antimalarial treatment is the standard of care for concurrent iron deficiency and malaria. However, iron that is given during a malaria episode may not be well absorbed or used, particularly in children with severe malaria and profound inflammation. We aimed to 1) determine baseline values of iron and inflammatory markers in children with severe malarial anemia (SMA), children with cerebral malaria (CM), and community children (CC) and 2) compare markers in iron-deficient children in each group who received 28 d of iron supplementation during antimalarial treatment with those in children who did not receive iron during treatment.. Seventy-nine children with CM, 77 children with SMA, and 83 CC who presented to Mulago Hospital, Kampala, Uganda, were enrolled in a 28-d iron-therapy study. Children with malaria received antimalarial treatment. All children with CM or SMA, as well as 35 CC, had zinc protoporphyrin (ZPP) concentrations ≥80 μmol/mol heme and were randomly assigned to receive a 28-d course of iron or no iron. We compared iron markers at day 0 among study groups (CM, SMA, and CC groups) and at day 28 between children in each group who were randomly assigned to receive iron or to not receive iron. At day 0, children with CM and SMA had greater values of C-reactive protein, ferritin, and hepcidin than those of CC. At day 28, interactions between study and treatment group were NS. Children in the no-iron compared with iron groups had similar mean values for hemoglobin (115 compared with 113 g/L, respectively; P = 0.73) and ZPP (124 compared with 124 μmol/mol heme, respectively; P = 0.96) but had lower median ferritin [101.0 μg/L (95% CI: 84.2, 121.0 μg/L) compared with 152.9 μg/L (128.8, 181.6 μg/L), respectively; P ≤ 0.001] and hepcidin [45.8 ng/mL (36.8, 56.9 ng/mL) compared with 83.1 ng/mL (67.6, 102.2 ng/mL), respectively; P < 0.011]. Severe inflammation is a characterization of children with CM and SMA. The withholding

[Treatment of idiopathic varicocele: comparative study of three techniques about 128 cases].

PubMed

Khouni, Hassen; Bouchiba, Nizar; Khelifa, Melik Melek; Ben Ali, Moez; Sebai, Akrem; Dali, Meriem; Charfi, Mehdi; Chouchene, Adnene; El Kateb, Faycel; Bouhaouala, Habib; Balti, Med Hedi

2011-12-01

Several modalities of varicocele treatment are available, however, no therapeutic technique showed its superiority with regard to the other one. To compare the results of three techniques of varicocelecomy. Retrospective Analytical and comparative study of 128 patients treated by of three techniques of varicocelectomy: the open surgery by retro peritoneal way for 42 patients (GI), the varicocelectomie coelioscopique for 41 patients (GII) and the antegrade scrotal sclerotherapy done for 45 patients (GIII), between march 2001 and January 2009.The mean age was 28 years. The main motive for consultation was represented by the painful varicocele in 67 % of the cases, followed by the hypofertility in 20.3 % of the cases and the association both in 12,5 % of the cases. The varicocele was in leftsider in 71.1 % of the cases, to the right side in 5.4 % of the cases and was bilateral in 23.43 % of the cases. Varicocele was infra-clinical at 6 patients, grade 1 in 16 sides, grade 2 in 105 sides and grade 3 in 31 sides. The numeration, the mobility as well as the morphology of sperm cells were comparable between the three groups Results: The global rate success was 81.2 %, with the highest rate found in the group III which was treated by antégrade scrotal sclerotherapy (84.4 %). The improvement of the parameters of the spermogramme was noted in the three groups, however a statistically significant difference was found only in patients treated by antégrade scrotal sclerotherapy; it mainly concerned numeration and the mobility of spermatozoides. The highest rate of pregnancy was recorded in patients treated by antégrade scrotal sclerotherapy (13.3%). The main postoperative complications were hydrocele (16%) followed by testicular hypotrophy (3 patients). Three techniques of varicocele treatment, offer either a similar success rate, and improvement of parameters of the sperm cells. However, antegrade scrotal sclerotherpy seem to be the best treatment of first intention in

[Parenteral S-adenosylmethionine compared to placebos in the treatment of alcoholic liver diseases].

PubMed

Diaz Belmont, A; Dominguez Henkel, R; Uribe Ancira, F

1996-01-01

The improvements in the knowledge of the action of ethanol over the hepatic cell, its direct action over the cell, and the intracytoplasmatic structures membranes, point out the possibilities of use of sulfo-adenosil-L-metionina (SAMe); as an util drug inn the treatment of the altered metilation reactions, that take place in those membranes, facilitating their physiological functions. The primary end point in this study was to demonstrate the therapeutic worth os SAMe, by parenteral route in 45 patients with alcoholic liver disease, which were determined by clinical laboratory and hepatic function test, label qith 32 points or more of the discriminatory function index. Divided into two groups, placebo-SAMe, randomized, double blind. As well as total plasmatic and reduced glutation and lipoperoxidation index, indirect form as malondehaldehyde. Were determined at the first visit anf after 8 and 15 days of treatment. Comparing the results of both groups there were a significative favorable results for the group treatment with SAMe and this confirms the utility of this drug in the treatment of patients with alcoholic liver disease with a discriminatory function index (Maddrey index), of 32 points or more.

[Comparative Cost Effectiveness of Clostridium Histolyticum Collagenase (Xiapex®) and Partial Fasciectomy for the Treatment of Dupuytren's Contracture in Austria].

PubMed

Neuwirth, M; Binter, A; Pipam, W; Rab, M

2016-08-01

Since Dupuytren's contracture is a common disorder, the costs for its surgical treatment impose a considerable burden on the healthcare system. For the first time in the German-speaking area, this study aimed to provide a comparative cost-effectiveness analysis for partial fasciectomy vs. treatment with Clostridium histolyticum collagenase (CCH). A retrospective monocentric study of the period from 2012 to 2014 comprised 40 patients with previously untreated Dupuytren's contracture of one finger. 20 outpatients received one CCH treatment (Group 1), while 20 inpatients underwent partial fasciectomy (Group 2). The direct pre-interventional treatment and post-interventional costs were compared. The direct post-interventional and postoperative results were comparable. Group 1 (CCH) showed a mean reduction in contracture of 96.4%; in Group 2 (partial fasciectomy), this was 97.7%. There were fewer complications in Group 1 than in Group 2. Mean treatment costs in Group 1 were € 1 458.60 and in Group 2, € 5 315.20. Treatment with CCH is more cost effective than with partial fasciectomy. This is due to greater costs for personnel, time and surgical material, as well as the treatment of the more frequent complications in Group 2. Despite the limited comparability, our findings are consistent with the present international literature. © Georg Thieme Verlag KG Stuttgart · New York.

Analysis of the cost-effectiveness of surfactant treatment (Curosurf®) in respiratory distress syndrome therapy in preterm infants: early treatment compared to late treatment.

PubMed

Dani, Carlo; Ravasio, Roberto; Fioravanti, Leonardo; Circelli, Maria

2014-05-02

The best criteria for surfactant treatment in the perinatal period are unknown and this makes it of interest to consider the possible economic implications of lessening the use of more restrictive criteria. The objective of this study is the evaluation of the costs of respiratory care for preterm infants with Respiratory Distress Syndrome (RDS) treated with "early rescue" surfactant compared to a "late rescue" strategy. The study was carried out applying the costs of materials used, of staff and pharmacological therapy calculated in the Neonatal Intensive Care Unit (NICU) of an Italian hospital to the Verder et al. study (Pediatrics 1999) clinical data. The cost for patients treated with early strategy was slightly lower than for patients treated with late strategy (Euro 4,901.70 vs. Euro 4,960.07). The cost of treatment with surfactant was greater in the early group (Euro 458.49 vs. Euro 311.74), but this was compensated by the greater cost of treatment with Mechanical Ventilation (MV) in the late group (respectively Euro 108.85 vs. Euro 259.25). The cost-effectiveness analysis performed in this study shows how early treatment with surfactant in preterm infants with RDS, as well as being clinically more effective, is associated with a slightly lower cost.

Analysis of the cost-effectiveness of surfactant treatment (Curosurf®) in respiratory distress syndrome therapy in preterm infants: early treatment compared to late treatment

PubMed Central

2014-01-01

Background The best criteria for surfactant treatment in the perinatal period are unknown and this makes it of interest to consider the possible economic implications of lessening the use of more restrictive criteria. Objective The objective of this study is the evaluation of the costs of respiratory care for preterm infants with Respiratory Distress Syndrome (RDS) treated with "early rescue" surfactant compared to a "late rescue" strategy. Methods The study was carried out applying the costs of materials used, of staff and pharmacological therapy calculated in the Neonatal Intensive Care Unit (NICU) of an Italian hospital to the Verder et al. study (Pediatrics 1999) clinical data. Results The cost for patients treated with early strategy was slightly lower than for patients treated with late strategy (Euro 4,901.70 vs. Euro 4,960.07). The cost of treatment with surfactant was greater in the early group (Euro 458.49 vs. Euro 311.74), but this was compensated by the greater cost of treatment with Mechanical Ventilation (MV) in the late group (respectively Euro 108.85 vs. Euro 259.25). Conclusions The cost-effectiveness analysis performed in this study shows how early treatment with surfactant in preterm infants with RDS, as well as being clinically more effective, is associated with a slightly lower cost. PMID:24886906

A comparative study of renal care in Brazil and Mexico: hemodialysis treatment from the perspective of ESRD sufferers.

PubMed

Mercado-Martinez, Francisco J; da Silva, Denise Guerreiro V; Correa-Mauricio, Mauricio E

2017-04-01

Renal replacement therapy is the indicated treatment for individuals with chronic kidney disease (CKD) to survive. However, not all sick people have access to the same treatment. This study compares renal care in two developing countries with different health systems. Specifically, it explores hemodialysis treatment from the perspective of low-income individuals. A qualitative, comparative study was performed in Brazil and Mexico. Using purposive sampling, the research was based on open-ended interviews with nineteen participants with kidney failure undergoing hemodialysis treatment in public hospitals and ten relatives. According to our results, Brazilian participants perceived hemodialysis care as satisfactory because of health personnel courtesy as well as free access to dialysis treatment, prescription drugs, hospitalization and transportation. However, they reported deficiencies in the care they were receiving due to shortages of specialists, prescription drugs, laboratory tests and transportation. Mexican participants, in contrast, highlighted the catastrophic costs of medical care because they had no free access to renal therapy, nor adequate financial resources. Our findings suggest that low-income Brazilian CKD sufferers experience renal care differently, as they are more satisfied and face less obstacles with hemodialysis compared with those of Mexico. More studies on the topic are needed. © 2016 John Wiley & Sons Ltd.

Field Placement Treatments: A Comparative Study

ERIC Educational Resources Information Center

Parkison, Paul T.

2008-01-01

Field placement within teacher education represents a topic of interest for all preservice teacher programs. Present research addresses a set of important questions regarding field placement: (1) What pedagogical methodologies facilitate deep learning during field experiences? (2) Is there a significant difference in treatment effect for…

A Retrospective, Single-Center Comparative Cost Analysis of OnabotulinumtoxinA and AbobotulinumtoxinA for Cervical Dystonia Treatment.

PubMed

Trosch, Richard M; Shillington, Alicia C; English, Marci L; Marchese, Dominic

2015-10-01

Chemodenervation with botulinum neurotoxin (BoNT) is recommended as first-line treatment for the management of cervical dystonia. The choice of BoNT for treatment is subject to the consideration of several factors, including cost. To compare the costs incurred by patients and payers for onabotulinumtoxinA (ONA) or abobotulinumtoxinA (ABO) for the treatment of cervical dystonia. We conducted a retrospective, noninterventional closed cohort study of cervical dystonia patients within a single U.S. private neurological practice. Patient and payer incurred costs from medical billing records for patients satisfying inclusion and exclusion criteria treated from November 1, 2009, through January 1, 2013, were de-identified and included in the analysis. Forty-seven patients initially treated with at least 3 consecutive cycles of ONA, followed by at least 3 consecutive cycles of ABO were included, representing 282 injection cycles available for analysis. Patients were required to have had a positive response to treatment with both agents and no concomitant treatment with BoNT for any other condition during the analysis period. The analysis compared the primary endpoint of median overall payer and patient incurred costs reimbursed to the clinic under each treatment regimen. For the purposes of this cost analysis, comparable clinical outcomes on both therapies was assumed.   Switching from ONA to ABO resulted in an overall incurred reimbursement cost savings for payers and patients. Median costs per injection cycle for ONA were $1,925 ($0-$2,814) compared with $1,214 ($229-$2,899; P  less than  0.0001) for ABO, representing an approximate 37% reduction in incurred reimbursement costs inclusive of toxin and procedure. Overall toxin reimbursement costs, patient out-of-pocket toxin costs, and the cost of unavoidable waste were also lower when patients were treated with ABO.  For patients treated for cervical dystonia, switching from ONA to ABO resulted in payer and patient

Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants

PubMed Central

Li, Jun; Han, Tiandong; Tian, Ye; Wang, Wenying; Du, Yuan

2016-01-01

We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fifty-five infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY®) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24–48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1–5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy. PMID:27633576

Flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants.

PubMed

Li, Jun; Xiao, Jing; Han, Tiandong; Tian, Ye; Wang, Wenying; Du, Yuan

2017-01-01

We evaluated the clinical value of flexible ureteroscopic lithotripsy for the treatment of upper urinary tract calculi in infants. Fifty-five infants with upper urinary tract calculi were included in this study: 41 males and 14 females. Retrograde intrarenal surgery was performed by an 8 Fr/30 cm flexible ureterorenoscope (POLY®) combined with a holmium laser. CT scanning or radiography of the kidneys, ureters, and bladder region was performed one month after the operation to confirm the clearance of calculi. All the 55 infants with calculi in 74 sides underwent 66 flexible ureteroscopic lithotripsy procedures. The median operation time was 30 min. The median amount of flushing fluid was 500 mL. The stone-free rate after a single session treatment was 94.6%, within which 10 infants underwent simultaneous bilateral flexible ureteroscopy lithotripsy. Catheters were retained in 45 infants for 24-48 h after the operation. Continuous high fever due to reflux was present in two cases. Flushing fluid extravasation was found in one infant. Some patients with minor complications, such as mild hematuria, irritation symptoms, and low fever, recovered without treatment. The duration of hospitalization time after the operation was approximately 1-5 days. Flexible ureteroscopic lithotripsy is a safe, highly efficient, minimally invasive, and reproducible operation for removal of upper urinary tract calculi in infants. This technique is a convenient method for postoperative management of patients that enhances their rapid recovery. It is a promising option for therapy of infants ineffectively treated by extracorporeal shockwave lithotripsy.

Group treatment for depression in mothers of young children compared to standard individual therapy.

PubMed

Frisch, Ulrike; Hofecker-Fallahpour, Maria; Stieglitz, Rolf-Dieter; Riecher-Rössler, Anita

2013-01-01

Studies on specific psychotherapy for depressed mothers of small children are rare. The aim of the present study was to investigate the effectiveness of a newly developed cognitive-behavioral group intervention for depressed mothers compared to standard individual therapy. In a naturalistic design, 31 mothers suffering from depressive disorders with children aged ≤4 years who had consecutively been admitted to our specialized clinic for mentally ill mothers were assigned to the group treatment, and the following 21 were admitted to the control group receiving standard individual therapy. The group treatment consisted of 12 group sessions and 1 couple session and was administered to five consecutive groups. Participants completed interviews and questionnaires - the Beck Depression Inventory and the Symptom Checklist- 90-R - before and 3 months after therapy. The treatment group and the control group showed a significant improvement in their depression, with no significant differences between the two treatment strategies. The women in group therapy, however, required fewer antidepressants, and group treatment was observed to be more effective in reducing anger and hostility. This form of group treatment for depressed women in early motherhood may have some important advantages over individual therapy; effects were small, however, and should be replicated in a further study. Copyright © 2012 S. Karger AG, Basel.

Comparing the effects of treatment with sildenafil and cognitive-behavioral therapy on treatment of sexual dysfunction in women: a randomized controlled clinical trial

PubMed Central

Omidi, Abdollah; Ahmadvand, Afshin; Najarzadegan, Mohammad Reza; Mehrzad, Fateme

2016-01-01

Background Sexual dysfunction in women is prevalent and common in women after menopause. Many attempts to treat patients with sexual dysfunction by cognitive-behavioral therapy (CBT) methods. But to the best of our knowledge, there has been no study that compared these two methods. Objective The aim of this study was to assess and compare the effects of sildenafil and cognitive-behavioral therapy on treatment of sexual dysfunction in women. Methods In this randomized, controlled, clinical trial, 86 women with arousal and orgasm dysfunction were surveyed. The patients were divided into two groups, i.e., sildenafil and CBT groups. The patients in the sildenafil group were treated by 50 mg of oral sildenafil one hour before intercourse, and the other group had weekly sessions of CBT for eight weeks. Sexual dysfunctions were evaluated by the Female Sexual Function Index (FSFI), a sexual satisfaction questionnaire, and the Enrich marital satisfaction scale. Results The mean age of the participants was 33.14 ± 7.34 years. The mean scores for female sexual function index, sexual satisfaction, and the Enrich marital satisfaction scale were increased in both groups during treatment (p < 0.001). It was found that cognitive-behavioral therapy compared to treatment with sildenafil increased all subscales, except arousal, orgasm, and lubrication. Conclusion Cognitive-behavioral therapy is more effective than treatment with sildenafil for improving female sexual function. Clinical trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2014070318338N1. Funding The authors received no financial support for the research, authorship, and/or publication of this article. PMID:27382439

[Comparative evaluation of the effectiveness of various treatment modalities for accommodation disorders and acquired progressive myopia].

PubMed

Tarutta, E P; Tarasova, N A

2015-01-01

To evaluate the effectiveness of non-surgical treatment of accommodation disorders and progressive myopia in children. A total of 190 patients (380 eyes) with myopia aged from 6 to 18 years (10.79±0.18 years on average) were enrolled and divided into 9 groups depending on the treatment prescribed. Comparative evaluation of different hardware-based treatment modalities for progressive myopia allowed to work out their optimal combination: "Visotronic", "MACDEL 09", and magnetophoresis of Taufon 4%. Such courses, provided twice a year, were associated with optimization of accommodative response and 1.9-2.8 times reduction of the rate of myopia progression. On the contrary, pleoptic therapy showed a negative effect on accommodative tonus and the rate of progression of acquired myopia. Comparative evaluation of different hardware-based treatment modalities for progressive myopia and accommodation disorders allowed to work out their optimal combination: "Visotronic", "MACDEL 09" and magnetophoresis of Taufon 4%. This treatment, provided twice a year, allows to increase accommodative reserves and volume, improve objective accommodative response, and reduce accommodative hypertonus as well as the rate of myopia progression (1.9-2.8 times over a 1.5-year period). Under pleoptic therapy (specialized software, near field speckles, color pulse therapy, Ambliokor device), both accommodative tonus and the rate of myopia progression increased (1.3-1.5 and 1.6 times correspondingly).

Comparing Effects of Biologic Agents in Treating Patients with Rheumatoid Arthritis: A Multiple Treatment Comparison Regression Analysis.

PubMed

Tvete, Ingunn Fride; Natvig, Bent; Gåsemyr, Jørund; Meland, Nils; Røine, Marianne; Klemp, Marianne

2015-01-01

Rheumatoid arthritis patients have been treated with disease modifying anti-rheumatic drugs (DMARDs) and the newer biologic drugs. We sought to compare and rank the biologics with respect to efficacy. We performed a literature search identifying 54 publications encompassing 9 biologics. We conducted a multiple treatment comparison regression analysis letting the number experiencing a 50% improvement on the ACR score be dependent upon dose level and disease duration for assessing the comparable relative effect between biologics and placebo or DMARD. The analysis embraced all treatment and comparator arms over all publications. Hence, all measured effects of any biologic agent contributed to the comparison of all biologic agents relative to each other either given alone or combined with DMARD. We found the drug effect to be dependent on dose level, but not on disease duration, and the impact of a high versus low dose level was the same for all drugs (higher doses indicated a higher frequency of ACR50 scores). The ranking of the drugs when given without DMARD was certolizumab (ranked highest), etanercept, tocilizumab/ abatacept and adalimumab. The ranking of the drugs when given with DMARD was certolizumab (ranked highest), tocilizumab, anakinra/rituximab, golimumab/ infliximab/ abatacept, adalimumab/ etanercept [corrected]. Still, all drugs were effective. All biologic agents were effective compared to placebo, with certolizumab the most effective and adalimumab (without DMARD treatment) and adalimumab/ etanercept (combined with DMARD treatment) the least effective. The drugs were in general more effective, except for etanercept, when given together with DMARDs.

Comparing Effects of Biologic Agents in Treating Patients with Rheumatoid Arthritis: A Multiple Treatment Comparison Regression Analysis

PubMed Central

Tvete, Ingunn Fride; Natvig, Bent; Gåsemyr, Jørund; Meland, Nils; Røine, Marianne; Klemp, Marianne

2015-01-01

Rheumatoid arthritis patients have been treated with disease modifying anti-rheumatic drugs (DMARDs) and the newer biologic drugs. We sought to compare and rank the biologics with respect to efficacy. We performed a literature search identifying 54 publications encompassing 9 biologics. We conducted a multiple treatment comparison regression analysis letting the number experiencing a 50% improvement on the ACR score be dependent upon dose level and disease duration for assessing the comparable relative effect between biologics and placebo or DMARD. The analysis embraced all treatment and comparator arms over all publications. Hence, all measured effects of any biologic agent contributed to the comparison of all biologic agents relative to each other either given alone or combined with DMARD. We found the drug effect to be dependent on dose level, but not on disease duration, and the impact of a high versus low dose level was the same for all drugs (higher doses indicated a higher frequency of ACR50 scores). The ranking of the drugs when given without DMARD was certolizumab (ranked highest), etanercept, tocilizumab/ abatacept and adalimumab. The ranking of the drugs when given with DMARD was certolizumab (ranked highest), tocilizumab, anakinra, rituximab, golimumab/ infliximab/ abatacept, adalimumab/ etanercept. Still, all drugs were effective. All biologic agents were effective compared to placebo, with certolizumab the most effective and adalimumab (without DMARD treatment) and adalimumab/ etanercept (combined with DMARD treatment) the least effective. The drugs were in general more effective, except for etanercept, when given together with DMARDs. PMID:26356639

Delinquency and Crime Prevention: Overview of Research Comparing Treatment Foster Care and Group Care

ERIC Educational Resources Information Center

Osei, Gershon K.; Gorey, Kevin M.; Jozefowicz, Debra M. Hernandez

2016-01-01

Background: Evidence of treatment foster care (TFC) and group care's (GC) potential to prevent delinquency and crime has been developing. Objectives: We clarified the state of comparative knowledge with a historical overview. Then we explored the hypothesis that smaller, probably better resourced group homes with smaller staff/resident ratios have…

Cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by community health workers compared to treatment provided at an outpatient facility in rural Mali.

PubMed

Rogers, Eleanor; Martínez, Karen; Morán, Jose Luis Alvarez; Alé, Franck G B; Charle, Pilar; Guerrero, Saul; Puett, Chloe

2018-02-20

The Malian Nutrition Division of the Ministry of Health and Action Against Hunger tested the feasibility of integrating treatment of severe acute malnutrition (SAM) into the existing Integrated Community Case Management package delivered by community health workers (CHWs). This study assessed costs and cost-effectiveness of CHW-delivered care compared to outpatient facility-based care. Activity-based costing methods were used, and a societal perspective employed to include all relevant costs incurred by institutions, beneficiaries and communities. The intervention and control arm enrolled different numbers of children so a modelled scenario sensitivity analysis was conducted to assess the cost-effectiveness of the two arms, assuming equal numbers of children enrolled. In the base case, with unequal numbers of children in each arm, for CHW-delivered care, the cost per child treated was 244 USD and cost per child recovered was 259 USD. Outpatient facility-based care was less cost-effective at 442 USD per child and 501 USD per child recovered. The conclusions of the analysis changed in the modelled scenario sensitivity analysis, with outpatient facility-based care being marginally more cost-effective (cost per child treated is 188 USD, cost per child recovered is 214 USD), compared to CHW-delivered care. This suggests that achieving good coverage is a key factor influencing cost-effectiveness of CHWs delivering treatment for SAM in this setting. Per week of treatment, households receiving CHW-delivered care spent half of the time receiving treatment and three times less money compared with those receiving treatment from the outpatient facility. This study supports existing evidence that the delivery of treatment by CHWs is a cost-effective intervention, provided that good coverage is achieved. A major benefit of this strategy was the lower cost incurred by the beneficiary household when treatment is available in the community. Further research is needed on the

Comparative Cost Analysis of Sequential, Adaptive, Behavioral, Pharmacological, and Combined Treatments for Childhood ADHD

PubMed Central

Page, Timothy F.; Fabiano, Gregory A.; Greiner, Andrew R.; Gnagy, Elizabeth M.; Pelham, William E.; Hart, Katie; Coxe, Stefany; Waxmonsky, James G.; Pelham, William E.

2016-01-01

Objective We conducted a cost-analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment randomized, and adaptive trial investigating the sequencing and enhancement of treatment for ADHD children (Pelham et al., under review; N=152, 76% male, 80% Caucasian). Methods The quantity of resources expended on each child’s treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Results Beginning treatment with a low-intensity regimen of behavior modification (group parent training) was less costly for a school-year of treatment ($961) than beginning treatment with a low dose of stimulant medication ($1689), regardless of whether the initial treatment was intensified with a higher “dose” or if the other modality was added. Conclusions Outcome data from the parent study (Pelham et al., under review) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings document that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD. PMID:26808137

Numerical Investigations of the Influence of Unsteady Vane Trailing Edge Shock Wave on Film Cooling Effectiveness of Rotor Blade Leading Edge

NASA Astrophysics Data System (ADS)

Wang, Yufeng; Cai, Le; Wang, Songtao; Zhou, Xun

2018-04-01

Unsteady numerical simulations of a high-load transonic turbine stage have been carried out to study the influences of vane trailing edge outer-extending shockwave on rotor blade leading edge film cooling performance. The turbine stage used in this paper is composed of a vane section and a rotor one which are both near the root section of a transonic high-load turbine stage. The Mach number is 0.94 at vane outlet, and the relative Mach number is above 1.10 at rotor outlet. Various positions and oblique angles of film cooling holes were investigated in this research. Results show that the cooling efficiency on the blade surface of rotor near leading edge is significantly affected by vane trailing edge outer-extending shockwave in some cases. In the cases that film holes are close to leading edge, cooling performance suffers more from the sweeping vane trailing edge outer-extending shockwave. In addition, coolant flow ejected from oblique film holes is harder to separate from the blade surface of rotor, and can cover more blade area even under the effects of sweeping vane trailing edge shockwave. As a result, oblique film holes can provide better film cooling performance than vertical film holes do near the leading edge on turbine blade which is swept by shockwaves.

Stigma, Discrimination, Treatment Effectiveness and Policy Support: Comparing Public Views about Drug Addiction with Mental Illness

PubMed Central

Barry, Colleen L; McGinty, Emma Elizabeth; Pescosolido, Bernice; Goldman, Howard H.

2014-01-01

Objective This study compares current public attitudes about drug addiction with attitudes about mental illness. Methods A web-based national public opinion survey (N=709) was conducted to compare attitudes about stigma, discrimination, treatment effectiveness, and policy support. Results Respondents hold significantly more negative views toward persons with drug addiction compared to those with mental illness. More respondents were unwilling to have a person with drug addiction marry into their family or work closely with them on a job. Respondents were more willing to accept discriminatory practices, more skeptical about the effectiveness of available treatments, and more likely to oppose public policies aimed at helping persons with drug addiction. Conclusions Drug addiction is often treated as a sub-category of mental illness, and health insurance benefits group these conditions together under the rubric of behavioral health. Given starkly different public views about drug addiction and mental illness, advocates may need to adopt differing approaches for advancing stigma reduction and public policy. PMID:25270497

Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a noninferiority trial.

PubMed

Clegg, Herbert W; Ryan, Amy G; Dallas, Steven D; Kaplan, Edward L; Johnson, Dwight R; Norton, H James; Roddey, Oliver F; Martin, Edward S; Swetenburg, Raymond L; Koonce, Elizabeth W; Felkner, Mary M; Giftos, P Michael

2006-09-01

Two relatively small previous studies comparing once-daily amoxicillin with conventional therapy for group A streptococcal (GAS) pharyngitis reported similar rates of bacteriologic success for each treatment group. The purpose of this study was to further evaluate once-daily amoxicillin for GAS pharyngitis in a larger study. In a single pediatric practice, from October through May for 2 consecutive years (2001-2003), we recruited children 3 to 18 years of age who had symptoms and signs suggestive of GAS pharyngitis. Patients with a positive rapid test for GAS were stratified by weight (<40 kg or >or=40 kg) and then randomly assigned to receive once-daily (750 mg or 1000 mg) or twice-daily (2 doses of 375 mg or 500 mg) amoxicillin for 10 days. We determined bacteriologic failure rates for GAS in the pharynx from subsequent swabs taken at 14 to 21 (visit 2) and 28 to 35 (visit 3) days after treatment initiation. We conducted a randomized, controlled, investigator-blinded, noninferiority trial to evaluate whether amoxicillin given once daily would have a bacteriologic failure rate no worse than that of amoxicillin given twice daily within a prespecified margin of 10%. GAS isolates were characterized to distinguish bacteriologic failures from new acquisitions. Adverse events were described and adherence was evaluated by review of returned daily logs and dosage bottles. Of 2139 potential study patients during the 2-year period, we enrolled 652 patients, 326 into each treatment group. Children in the 2 groups were comparable with respect to all demographic and clinical characteristics except that children <40 kg more often presented with rash in each treatment group. At visit 2, failure rates were 20.1% (59 of 294) for the once-daily group and 15.5% (46 of 296) for the twice-daily group (difference, 4.53%; 90% confidence interval [CI], -0.6 to 9.7). At visit 3, failure rates were 2.8% (6 of 216) for the once-daily group and 7.1% (16 of 225) for the twice-daily group

Comparing Dynamic Treatment Regimes Using Repeated-Measures Outcomes: Modeling Considerations in SMART Studies

PubMed Central

Lu, Xi; Nahum-Shani, Inbal; Kasari, Connie; Lynch, Kevin G.; Oslin, David W.; Pelham, William E.; Fabiano, Gregory; Almirall, Daniel

2016-01-01

A dynamic treatment regime (DTR) is a sequence of decision rules, each of which recommends a treatment based on a patient’s past and current health status. Sequential, multiple assignment, randomized trials (SMARTs) are multi-stage trial designs that yield data specifically for building effective DTRs. Modeling the marginal mean trajectories of a repeated-measures outcome arising from a SMART presents challenges, because traditional longitudinal models used for randomized clinical trials do not take into account the unique design features of SMART. We discuss modeling considerations for various forms of SMART designs, emphasizing the importance of considering the timing of repeated measures in relation to the treatment stages in a SMART. For illustration, we use data from three SMART case studies with increasing level of complexity, in autism, child attention deficit hyperactivity disorder (ADHD), and adult alcoholism. In all three SMARTs we illustrate how to accommodate the design features along with the timing of the repeated measures when comparing DTRs based on mean trajectories of the repeated-measures outcome. PMID:26638988

Comparing dynamic treatment regimes using repeated-measures outcomes: modeling considerations in SMART studies.

PubMed

Lu, Xi; Nahum-Shani, Inbal; Kasari, Connie; Lynch, Kevin G; Oslin, David W; Pelham, William E; Fabiano, Gregory; Almirall, Daniel

2016-05-10

A dynamic treatment regime (DTR) is a sequence of decision rules, each of which recommends a treatment based on a patient's past and current health status. Sequential, multiple assignment, randomized trials (SMARTs) are multi-stage trial designs that yield data specifically for building effective DTRs. Modeling the marginal mean trajectories of a repeated-measures outcome arising from a SMART presents challenges, because traditional longitudinal models used for randomized clinical trials do not take into account the unique design features of SMART. We discuss modeling considerations for various forms of SMART designs, emphasizing the importance of considering the timing of repeated measures in relation to the treatment stages in a SMART. For illustration, we use data from three SMART case studies with increasing level of complexity, in autism, child attention deficit hyperactivity disorder, and adult alcoholism. In all three SMARTs, we illustrate how to accommodate the design features along with the timing of the repeated measures when comparing DTRs based on mean trajectories of the repeated-measures outcome. Copyright © 2015 John Wiley & Sons, Ltd.

Multimodal compared to pharmacologic treatments for chronic tension-type headache in adolescents.

PubMed

Przekop, Peter; Przekop, Allison; Haviland, Mark G

2016-10-01

Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). A fifth outcome, number of bilateral tender points, was recorded at baseline and 6 months. All five were evaluated statistically with a linear mixed model. Although both multimodal and pharmacologic treatments were effective for CTTH (time effects for all measures were significant at p < .001), results from each analysis favored multimodal treatment (the five group by time interaction effects were significant at or below the p < .001 level). Headache frequency in the pharmacologic group, for example, reduced from a monthly average (95% Confidence Interval shown in parentheses) of 23.9 (21.8, 26.0) to 16.4 (14.3, 18.6) and in the multimodal group from 22.3 (20.1, 24.5) to 4.9 (2.6, 7.2) (a substantial group difference). Pain intensity (worst in the last 24 hours, 0-10 scale) was reduced in the pharmacologic group from 6.2 (5.6, 6.9) to 3.4 (2.7, 4.1) and from 6.1 (5.4, 6.8) to 2.0 (1.2, 2.7) in the multimodal group (a less substantial difference). Across the other three assessments, group differences were larger for general health and number of tender points and less so for pain restriction. Multimodal treatment for adolescent CTTH appears to be effective. Randomized controlled trials are needed to confirm these promising results. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical and economic impact of mirabegron compared with antimuscarinics for the treatment of overactive bladder in Canada.

PubMed

Hakimi, Zalmai; Nazir, Jameel; McCrea, Charles; Berling, Malin; Fatoye, Francis; Ramos, Barbara; Wagg, Adrian

2017-06-01

The β 3 -adrenoceptor agonist, mirabegron, and antimuscarinic agents provide similar efficacy for the treatment of overactive bladder (OAB), but mirabegron appears to be associated with better persistence, perhaps due to an absence of anticholinergic side-effects. This study estimated the expected costs associated with the management of OAB in Canada from a societal perspective by utilizing real-world evidence. An economic model with monthly cycles and a 1-year time horizon was developed to depict a treatment pathway for a hypothetical cohort of 100 patients with OAB. At model entry, patients receive mirabegron or an antimuscarinic. Patients who do not persist may switch treatment, undergo a minimally invasive procedure, or remain symptomatic (uncontrolled). The model includes direct costs (e.g. physician visits) and indirect costs (e.g. lost productivity). A one-way univariate sensitivity analysis assessed a ±20% variation in each of the key model inputs. At 1 year, a greater proportion of patients persisted on treatment with mirabegron compared with antimuscarinics (33% vs 15-23%), and a smaller proportion switched treatment (17% vs 20-22%). The number of healthcare visits (292 vs 299-304), pads used (74,098 vs 77,878-81,669), and work hours lost (4,497 vs 5,372-6,249) were all lower for mirabegron vs antimuscarinics. The estimated total annual cost of treatment per patient with mirabegron was $2,127.46 Canadian dollars (CAD) ($5.82 CAD/day) compared with $2,150.20-$2,496.69 CAD ($5.89-$6.84 CAD/day) for antimuscarinics. The one-way sensitivity analysis indicated the results are robust. Improved persistence observed in routine clinical practice with mirabegron appears to translate into benefits of reduced healthcare resource use, and lower direct and indirect costs of treatment compared with antimuscarinics. Overall, these data suggest that mirabegron may offer clinical and economic benefits for the management of patients with OAB in Canada.

On-demand treatment with alverine citrate/simeticone compared with standard treatments for irritable bowel syndrome: results of a randomised pragmatic study.

PubMed

Ducrotte, P; Grimaud, J C; Dapoigny, M; Personnic, S; O'Mahony, V; Andro-Delestrain, M C

2014-02-01

In routine practice, irritable bowel syndrome (IBS) symptoms are often difficult to be relieved and impair significantly patients' quality of life (QoL). A randomised, double-blind, placebo-controlled study has shown the efficacy of alverine citrate/simeticone (ACS) combination for IBS symptom relief. As IBS symptoms are often intermittent, this pragmatic study was designed to compare the efficacy of an on-demand ACS treatment vs. that of usual treatments. Rome III IBS patients were enrolled by 87 general practitioners who were randomly allocated to one of two therapeutic strategies: on-demand ACS or usual treatment chosen by the physician. The primary outcome measure was the improvement of the IBSQoL score between inclusion and month 6. A total of 436 patients (mean age: 54.4 years; women: 73.4%) were included, 222 in the ACS arm and 214 patients in the usual treatment arm, which was mainly antispasmodics. At 6 months, improvement of IBSQoL was greater with ACS than with the usual treatment group (13.8 vs. 8.4; p < 0.0008). The IBS-severity symptom score (IBS-SSS) was lower with ACS than in the usual treatment arm with a mean (SE) decrease of 170.0 (6.6) vs. 110.7 (6.7), respectively (p = 0.0001). An IBS-SSS < 75 was more frequent in the ACS group (37.7% vs. 16.0%; p < 0.0001). Improvement of both abdominal pain and bloating severity was also greater with the on-demand ACS treatment, which was associated with both lower direct and indirect costs. After 6 months, on-demand ACS treatment led to a greater improvement of QoL, reduced the burden of the disease and was more effective for IBS symptom relief than usual treatments. © 2013 The Authors International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

On-demand treatment with alverine citrate/simeticone compared with standard treatments for irritable bowel syndrome: results of a randomised pragmatic study

PubMed Central

Ducrotte, P; Grimaud, J C; Dapoigny, M; Personnic, S; O'Mahony, V; Andro-Delestrain, M C

2014-01-01

Background In routine practice, irritable bowel syndrome (IBS) symptoms are often difficult to be relieved and impair significantly patients’ quality of life (QoL). A randomised, double-blind, placebo-controlled study has shown the efficacy of alverine citrate/simeticone (ACS) combination for IBS symptom relief. Aim As IBS symptoms are often intermittent, this pragmatic study was designed to compare the efficacy of an on-demand ACS treatment vs. that of usual treatments. Methods Rome III IBS patients were enrolled by 87 general practitioners who were randomly allocated to one of two therapeutic strategies: on-demand ACS or usual treatment chosen by the physician. The primary outcome measure was the improvement of the IBSQoL score between inclusion and month 6. Results A total of 436 patients (mean age: 54.4 years; women: 73.4%) were included, 222 in the ACS arm and 214 patients in the usual treatment arm, which was mainly antispasmodics. At 6 months, improvement of IBSQoL was greater with ACS than with the usual treatment group (13.8 vs. 8.4; p < 0.0008). The IBS-severity symptom score (IBS-SSS) was lower with ACS than in the usual treatment arm with a mean (SE) decrease of 170.0 (6.6) vs. 110.7 (6.7), respectively (p = 0.0001). An IBS-SSS < 75 was more frequent in the ACS group (37.7% vs. 16.0%; p < 0.0001). Improvement of both abdominal pain and bloating severity was also greater with the on-demand ACS treatment, which was associated with both lower direct and indirect costs. Conclusions After 6 months, on-demand ACS treatment led to a greater improvement of QoL, reduced the burden of the disease and was more effective for IBS symptom relief than usual treatments. PMID:24147869

Energy implications of mechanical and mechanical-biological treatment compared to direct waste-to-energy.

PubMed

Cimpan, Ciprian; Wenzel, Henrik

2013-07-01

Primary energy savings potential is used to compare five residual municipal solid waste treatment systems, including configurations with mechanical (MT) and mechanical-biological (MBT) pre-treatment, which produce waste-derived fuels (RDF and SRF), biogas and/or recover additional materials for recycling, alongside a system based on conventional mass burn waste-to-energy and ash treatment. To examine the magnitude of potential savings we consider two energy efficiency levels (state-of-the-art and best available technology), the inclusion/exclusion of heat recovery (CHP vs. PP) and three different background end-use energy production systems (coal condensing electricity and natural gas heat, Nordic electricity mix and natural gas heat, and coal CHP energy quality allocation). The systems achieved net primary energy savings in a range between 34 and 140 MJprimary/100 MJinput waste, in the different scenario settings. The energy footprint of transportation needs, pre-treatment and reprocessing of recyclable materials was 3-9.5%, 1-18% and 1-8% respectively, relative to total energy savings. Mass combustion WtE achieved the highest savings in scenarios with CHP production, nonetheless, MBT-based systems had similarly high performance if SRF streams were co-combusted with coal. When RDF and SRF was only used in dedicated WtE plants, MBT-based systems totalled lower savings due to inherent system losses and additional energy costs. In scenarios without heat recovery, the biodrying MBS-based system achieved the highest savings, on the condition of SRF co-combustion. As a sensitivity scenario, alternative utilisation of SRF in cement kilns was modelled. It supported similar or higher net savings for all pre-treatment systems compared to mass combustion WtE, except when WtE CHP was possible in the first two background energy scenarios. Recovery of plastics for recycling before energy recovery increased net energy savings in most scenario variations, over those of full

Exploring methods for comparing the real-world effectiveness of treatments for osteoporosis: adjusted direct comparisons versus using patients as their own control.

PubMed

Karlsson, Linda; Mesterton, Johan; Tepie, Maurille Feudjo; Intorcia, Michele; Overbeek, Jetty; Ström, Oskar

2017-09-21

Using Swedish and Dutch registry data for women initiating bisphosphonates, we evaluated two methods of comparing the real-world effectiveness of osteoporosis treatments that attempt to adjust for differences in patient baseline characteristics. Each method has advantages and disadvantages; both are potential complements to clinical trial analyses. We evaluated methods of comparing the real-world effectiveness of osteoporosis treatments that attempt to adjust for both observed and unobserved confounding. Swedish and Dutch registry data for women initiating zoledronate or oral bisphosphonates (OBPs; alendronate/risedronate) were used; the primary outcome was fracture. In adjusted direct comparisons (ADCs), regression and matching techniques were used to account for baseline differences in known risk factors for fracture (e.g., age, previous fracture, comorbidities). In an own-control analysis (OCA), for each treatment, fracture incidence in the first 90 days following treatment initiation (the baseline risk period) was compared with fracture incidence in the 1-year period starting 91 days after treatment initiation (the treatment exposure period). In total, 1196 and 149 women initiating zoledronate and 14,764 and 25,058 initiating OBPs were eligible in the Swedish and Dutch registries, respectively. Owing to the small Dutch zoledronate sample, only the Swedish data were used to compare fracture incidences between treatment groups. ADCs showed a numerically higher fracture incidence in the zoledronate than in the OBPs group (hazard ratio 1.09-1.21; not statistically significant, p > 0.05). For both treatment groups, OCA showed a higher fracture incidence in the baseline risk period than in the treatment exposure period, indicating a treatment effect. OCA showed a similar or greater effect in the zoledronate group compared with the OBPs group. ADC and OCA each possesses advantages and disadvantages. Combining both methods may provide an estimate of real

Efficacy of terbinafine compared to lanoconazole and luliconazole in the topical treatment of dermatophytosis in a guinea pig model.

PubMed

Ghannoum, M A; Long, L; Kim, H G; Cirino, A J; Miller, A R; Mallefet, P

2010-05-01

The in vivo efficacy of terbinafine was compared to lanoconazole and luliconazole in the topical treatment of dermatophytosis caused by Trichophyton mentagrophytes using a guinea pig model. Topical antifungal treatment commenced three days post-infection, and each agent was applied once daily for seven consecutive days. Upon completion of the treatment period, evaluations of clinical and mycological efficacies were performed, as was scanning electron microscopy (SEM) analyses. Data showed that while all tested antifungals demonstrated significant mycological efficacy in terms of eradicating the fungi over untreated control, terbinafine and luliconazole showed superior clinical efficacy compared to lanoconazole (P-values < 0.001 & 0.003, respectively). Terbinafine demonstrated the highest clinical percent efficacy. SEM analysis revealed hairs from terbinafine and lanoconazole-treated animals had near complete clearance of fungi, while samples from luliconazole-treated animals were covered with debris and few conidia. This study demonstrates that, in general, terbinafine possessed similar efficacy to lanoconazole and luliconazole in the treatment of dermatophytosis. Terbinafine tended to have superior clinical efficacy compared to the azoles tested, although this difference was not statistically significant against luliconazole. This apparent superiority may be due to the fungicidal activity of terbinafine compared to the fungistatic effect of the other two drugs.

Randomized, double-blind, comparative study of levofloxacin and ofloxacin in the treatment of complicated urinary tract infections.

PubMed

Peng, M Y

1999-03-01

Levofloxacin, the optical S-(-) isomer of ofloxacin, was compared with ofloxacin in the treatment of complicated urinary tract infections (UTIs). Patients eligible for the trial were randomly assigned to either a daily 300 mg of levofloxacin or 600 mg of ofloxacin for 10 consecutive days. The double blind design was achieved by a double-dummy technique utilizing placebo of both test drugs. Efficacy variables measured were: urine white blood cell counts for the effects on pyuria, urine cultures for effects on bacteriuria, subjective symptoms, and overall clinical efficacy which combined results from effects on bacteriuria, pyuria and subjective symptoms. Safety endpoints were the incidence of adverse events and laboratory test monitoring after a 10-day treatment. A total of 104 patients were enrolled into this trial and 46 patients were evaluable for efficacy endpoints. Most patients with culture-negative (48 cases), mixed flora (5 cases), and less than 10,000 colony forming units/mL of bacteria (3 cases) were excluded from analyses. None of the demographic and baseline characteristics were significantly different between treatments (p > 0.05). Therapeutic effects upon bacteriuria for both treatment groups were similar with a response rate of 90.0% for levofloacin and 88.5% for ofloxacin. Efficacy on the subjective symptoms revealed response rates of 90.0% in the levofloxacin group and 80.7% in the ofloxacin group, with the overall clinical efficacy of 90% in the levofloxacin and 84.6% in the ofloxacin groups. All the efficacy variables measured between treatments were not statistically different which indicated an equivalent efficacy in the treatment of complicated UTIs (p > 0.05). Of the 104 patients exposed to the test medications, only three having adverse effects. One developed epigastralgia in the levofloxacin group, and 2 developed a headache in the ofloxacin treatment. All events were moderate in severity and were resolved quickly after medication. Four

Comparison of surgical treatment with direct repair versus conservative treatment in young patients with spondylolysis: a prospective, comparative, clinical trial.

PubMed

Lee, Gun Woo; Lee, Sun-Mi; Ahn, Myun-Whan; Kim, Ho-Joong; Yeom, Jin S

2015-07-01

Although direct repair (DR) with screw fixation at the pars defect is a common surgical treatment for lumbar spondylolysis, it is unknown whether DR leads to better outcomes for young patients with spondylolysis than traditional nonsurgical treatment. The purpose of the study was to investigate whether DR was associated with better outcomes for lumbar spondylolysis in young patients than traditional conservative treatment. This is a prospective cohort study. Of 1,784 patients with low back pain in the reference period, 149 young patients with spondylolysis who followed up for at least 1 year were enrolled in the study. The primary outcome was pain intensity at the lower back measured with a Visual Analog Scale. Secondary outcomes included the functional outcome as measured with the Oswestry disability index (ODI) and the 12-item short-form health survey (SF-12) consisting of the physical component summary (PCS) and mental component summary (MCS) scores, the radiologic outcome as measured with lumbar spine radiographs and computed tomography scans, and complications of treatment. This was a prospective comparative study between two groups of patients who were treated with either conservative treatment or surgery for lumbar spondylolysis. Enrolled patients self-selected their own treatment and were allocated to either the traditional care group with conservative treatment (87 patients) or the surgery group (62 patients). All patients were followed up for at least 1 year. Pain intensity at the lower back did not differ significantly between groups at the final follow-up. Likewise, the ODI and SF-12 (PCS and MCS) scores did not differ significantly between groups (p=.13, .71, and .68, respectively). The change in the gap distance of the pars defect at the final follow-up was significantly different between groups (traditional care group: +0.8±0.4 mm; surgery group: -0.7±0.5; p=.01). The union rate at 1 year after surgical treatment was 52% (32/61). The rate of

Comparative effects of denosumab or bisphosphonate treatment on bone mineral density and calcium metabolism in postmenopausal women.

PubMed

Augoulea, A; Tsakonas, E; Triantafyllopoulos, I; Rizos, D; Armeni, E; Tsoltos, N; Tournis, S; Deligeoroglou, E; Antoniou, A; Lambrinoudaki, I

2017-03-01

To clarify potential differences between denosumab (DNS) and bisphosphonates (BIS) in terms of bone density and bone metabolism, in a sample of postmenopausal women. A total of 113 postmenopausal women aged 53-66 years were treated with either DNS or BIS for 12 months. Bone densitometry and laboratory tests were compared between baseline and follow-up. Femoral neck BMD increased in both treatment-arms (FN-BMD, DNS: 0.69±0.07 g/cm 2 to 0.75±0.09 g/cm 2 ; BIS: 0.69±0.06 g/cm 2 to 0.71±0.07 g/cm 2 ; p≤0.001 in both cases). Lumbar spine BMD (LS-BMD) increased significantly only in the DNS-group (0.83±0.14 g/cm 2 to 0.89±0.14 g/cm 2 , p=0.0001). Only women under treatment with DNS had a significant increase in serum parathyroid hormone (PTH: 44.87±17.54 pg/mL to 53.27±15.77 pg/mL, p=0.04), independently of baseline vitamin D levels. DNS-administration resulted in higher increase from baseline in FN-BMD compared to BIS (DNS vs BIS: 8.7%±8.5 vs 3.8%±7.3, p=0.004). Finally, baseline 25OH vitamin D levels did not determine the extent of PTH-increase following administration of DNS- or BIS-treatment. Both treatments increased BMD, however, the effect of DNS on FN-BMD was superior compared to that of BIS. DNS-treatment increased serum PTH. Baseline 25OH vitamin D levels did not predict the extent of PTH increase at follow-up.

Intralesional Mycobacterium w Vaccine Versus Cryotherapy in Treatment of Refractory Extragenital Warts: A Randomized, Open-Label, Comparative Study.

PubMed

Dhakar, Ashok K; Dogra, Sunil; Vinay, Keshavamurthy; Sarangal, Rishu; Kanwar, Amrinder J; Singh, Mini P

2016-01-01

Initial reports of immunotherapy using intralesional Mycobacterium w (Mw) vaccine have documented its useful role in treatment of genital and extragenital warts. To compare the efficacy and safety of intralesional Mw vaccine versus cryotherapy in the treatment of refractory extragenital warts. This was a prospective, randomized, comparative study of 66 patients. The outcome was assessed in terms of complete clearance of warts and change in Dermatology Life Quality Index (DLQI) score. Complete clearance of treated warts was seen in 66.7% (20/30) and 65.5% (19/29) of patients in the Mw and cryotherapy groups, respectively (P = .769). Clearance of distant warts was significantly (P = .004) high in the Mw group. Improvement in DLQI was greater in the Mw group. Both treatment modalities were well tolerated, and no major side effects occurred. Mw vaccine and cryotherapy are equally efficacious in treatment of refractory extragenital warts. Mw vaccine has an added advantage of clearance of distant warts. © The Author(s) 2015.

A comparative study on the activity of TiO2 in pulsed plasma under different discharge conditions

NASA Astrophysics Data System (ADS)

Lijuan, DUAN; Nan, JIANG; Na, LU; Kefeng, SHANG; Jie, LI; Yan, WU

2018-05-01

In the present study, a combination of pulsed discharge plasma and TiO2 (plasma/TiO2) has been developed in order to study the activity of TiO2 by varying the discharge conditions of pulsed voltage, discharge mode, air flow rate and solution conductivity. Phenol was used as the chemical probe to characterize the activity of TiO2 in a pulsed discharge system. The experimental results showed that the phenol removal efficiency could be improved by about 10% by increasing the applied voltage. The phenol removal efficiency for three discharge modes in the plasma-discharge-alone system was found to be highest in the spark mode, followed by the spark–streamer mode and finally the streamer mode. In the plasma/TiO2 system, the highest catalytic effect of TiO2 was observed in the spark–streamer discharge mode, which may be attributed to the favorable chemical and physical effects from the spark–streamer discharge mode, such as ultraviolet light, O3, H2O2, pyrolysis, shockwaves and high-energy electrons. Meanwhile, the optimal flow rate and conductivity were 0.05 m3 l‑1 and 10 μS cm‑1, respectively. The main phenolic intermediates were hydroquinone, catechol, and p-benzoquinone during the discharge treatment process. A different phenol degradation pathway was observed in the plasma/TiO2 system as compared to plasma alone. Analysis of the reaction intermediates demonstrated that p-benzoquinone reduction was selectively catalyzed on the TiO2 surface. The effective decomposition of phenol constant (D e) increased from 74.11% to 79.16% when TiO2 was added, indicating that higher phenol mineralization was achieved in the plasma/TiO2 system.

Comparative study of the efficacy of different treatment options in patients with chronic blepharitis.

PubMed

Arrúa, M; Samudio, M; Fariña, N; Cibils, D; Laspina, F; Sanabria, R; Carpinelli, L; Mino de Kaspar, H

2015-03-01

To compare the efficacy of 3 treatment options in patients with chronic blepharitis. An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Cost effectiveness of denosumab compared with oral bisphosphonates in the treatment of post-menopausal osteoporotic women in Belgium.

PubMed

Hiligsmann, Mickaël; Reginster, Jean-Yves

2011-10-01

Denosumab has recently been shown to be well tolerated, to increase bone mineral density (BMD) and to significantly reduce the risk of hip, vertebral and non-vertebral fractures in the FREEDOM (Fracture REduction Evaluation of Denosumab in Osteoporosis every 6 Months) trial. It is becoming increasingly important to evaluate not only the therapeutic value of a new drug but also the cost effectiveness compared with the most relevant treatment alternatives. The objective of this study was to estimate the cost effectiveness of denosumab compared with oral bisphosphonates (branded and generic drugs) in the treatment of post-menopausal osteoporotic women in Belgium. Cost effectiveness of 3 years of treatment with denosumab was compared with branded risedronate and branded and generic alendronate using an updated version of a previously validated Markov microsimulation model. The model was populated with relevant cost, adherence and epidemiological data for Belgium from a payer perspective and the results were presented as costs per QALY gained (&U20AC;, year 2009 values). Analyses were performed in populations (aged ≥60 years) in which osteoporosis medications are currently reimbursed in many European countries, i.e. those with BMD T-score of -2.5 or less or prevalent vertebral fracture. Patients receiving denosumab were assumed to have a 46% lower risk of discontinuation than those receiving oral bisphosphonates, and the effect of denosumab after treatment cessation was assumed to decline linearly to zero over a maximum of 1 year. Denosumab was cost effective compared with all other therapies, assuming a willingness to pay of &U20AC;40 000 per QALY gained. In particular, denosumab was found to be cost effective compared with branded alendronate and risedronate at a threshold value of &U20AC;30 000 per QALY and denosumab was dominant (i.e. lower cost and greater effectiveness) compared with risedronate from the age of 70 years in women with a T-score of -2.5 or

Comparing azithromycin and doxycycline for the treatment of rectal chlamydial infection: a retrospective cohort study

PubMed Central

Khosropour, Christine M.; Dombrowski, Julia C.; Barbee, Lindley A.; Manhart, Lisa E.; Golden, Matthew R.

2015-01-01

Background Centers for Disease Control and Prevention (CDC) guidelines recommend azithromycin or doxycycline for treatment of rectal chlamydial infection. Methods We created a retrospective cohort of male patients diagnosed with rectal chlamydia 1993-2012 at a sexually transmitted disease clinic in Seattle, Washington. Men were included in the analysis if they were treated with azithromycin (1g single dose) or doxycycline (100mg BID x 7 days) within 60 days of chlamydia diagnosis and returned for repeat testing 14-180 days post-treatment. We compared the risk of persistent/recurrent rectal chlamydial infection among recipients of the two drug regimens using four follow-up testing time intervals (14 to 30, 60, 90, and 180 days). Results Of 1,835 cases of rectal chlamydia diagnosed in the study period, 1,480 (81%) were treated with azithromycin or doxycycline without a second drug active against C. trachomatis. Of these, 407 (33%) of 1231 azithromycin-treated men and 95 (38%) of 249 doxycycline-treated men were re-tested 14-180 days after treatment (P=0.12); 88 (22%) and 8 (8%), respectively, had persistent/recurrent infection (P=0.002). Persistent/recurrent infection was higher among men treated with azithromycin compared to doxycycline at 14-30 days (4/53 (8%) vs. 0/20 (0%)), 14-60 days (23/136 (17%) vs. 0/36 (0%)), and 14-90 days (50/230 (22%) vs. 2/56 (4%)). In multivariate analysis, azithromycin-treated men had a significantly higher risk of persistent/recurrent infection in the 14-90 days (aRR=5.2, 95% CI=1.3-21.0) and 14-180 days (aRR=2.4, 95% CI=1.2-4.8) after treatment. Conclusions These data suggest that doxycycline may be more effective than azithromycin in the treatment of rectal chlamydial infections. PMID:24413484

Energy implications of mechanical and mechanical–biological treatment compared to direct waste-to-energy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cimpan, Ciprian, E-mail: cic@kbm.sdu.dk; Wenzel, Henrik

2013-07-15

Highlights: • Compared systems achieve primary energy savings between 34 and 140 MJ{sub primary}/100 MJ{sub input} {sub waste.} • Savings magnitude is foremost determined by chosen primary energy and materials production. • Energy consumption and process losses can be upset by increased technology efficiency. • Material recovery accounts for significant shares of primary energy savings. • Direct waste-to-energy is highly efficient if cogeneration (CHP) is possible. - Abstract: Primary energy savings potential is used to compare five residual municipal solid waste treatment systems, including configurations with mechanical (MT) and mechanical–biological (MBT) pre-treatment, which produce waste-derived fuels (RDF and SRF), biogasmore » and/or recover additional materials for recycling, alongside a system based on conventional mass burn waste-to-energy and ash treatment. To examine the magnitude of potential savings we consider two energy efficiency levels (state-of-the-art and best available technology), the inclusion/exclusion of heat recovery (CHP vs. PP) and three different background end-use energy production systems (coal condensing electricity and natural gas heat, Nordic electricity mix and natural gas heat, and coal CHP energy quality allocation). The systems achieved net primary energy savings in a range between 34 and 140 MJ{sub primary}/100 MJ{sub input} {sub waste}, in the different scenario settings. The energy footprint of transportation needs, pre-treatment and reprocessing of recyclable materials was 3–9.5%, 1–18% and 1–8% respectively, relative to total energy savings. Mass combustion WtE achieved the highest savings in scenarios with CHP production, nonetheless, MBT-based systems had similarly high performance if SRF streams were co-combusted with coal. When RDF and SRF was only used in dedicated WtE plants, MBT-based systems totalled lower savings due to inherent system losses and additional energy costs. In scenarios without

Photodynamic Therapy for Actinic Keratoses: A Randomized Prospective Non-sponsored Cost-effectiveness Study of Daylight-mediated Treatment Compared with Light-emitting Diode Treatment.

PubMed

Neittaanmäki-Perttu, Noora; Grönroos, Mari; Karppinen, Toni; Snellman, Erna; Rissanen, Pekka

2016-02-01

Daylight-mediated photodynamic therapy (DL-PDT) is considered as effective as conventional PDT using artificial light (light-emitting diode (LED)-PDT) for treatment of actinic keratoses (AK). This randomized prospective non-sponsored study assessed the cost-effectiveness of DL-PDT compared with LED-PDT. Seventy patients with 210 AKs were randomized to DL-PDT or LED-PDT groups. Effectiveness was assessed at 6 months. The costs included societal costs and private costs, including the time patients spent in treatment. Results are presented as incremental cost-effectiveness ratio (ICER). The total costs per patient were significantly lower for DL-PDT (€132) compared with LED-PDT (€170), giving a cost saving of €38 (p = 0.022). The estimated probabilities for patients' complete response were 0.429 for DL-PDT and 0.686 for LED-PDT; a difference in probability of being healed of 0.257. ICER showed a monetary gain of €147 per unit of effectiveness lost. DL-PDT is less costly and less effective than LED-PDT. In terms of cost-effectiveness analysis, DL-PDT provides lower value for money compared with LED-PDT.

Psychological and functional effect of different primary treatments for prostate cancer: A comparative prospective analysis.

PubMed

Sciarra, Alessandro; Gentilucci, Alessandro; Salciccia, Stefano; Von Heland, Magnus; Ricciuti, Giam Piero; Marzio, Vittorio; Pierella, Federico; Musio, Daniela; Tombolini, Vincenzo; Frantellizzi, Viviana; Pasquini, Massimo; Maraone, Annalisa; Guandalini, Alessio; Maggi, Martina

2018-04-26

The aim of the study was to comparatively evaluate the psychological and functional effect of different primary treatments in patients with prostate cancer. We conducted a single-center prospective non randomized study in a real-life setting using functional and psychological questionnaires in prostate cancer cases submitted to radical prostatectomy, external radiotherapy, or active surveillance. Totally, 220 cases were evaluated at baseline and during the follow-up at 1-, 3-, 6-, and 12-month interval after therapy. Patients self-completed questionnaires on urinary symptoms and incontinence, erectile and bowel function, psychological distress (PD), anxiety, and depression. Several significant differences among the three groups of treatment were found regarding the total score of the functional questionnaires. Regarding PD, cases submitted to radical prostatectomy showed stable scores during all the 12 months of follow-up whereas cases submitted to radiotherapy showed a rapid significant worsening of scores at 1-month interval and persistent also at 6- and 12-month interval. Cases submitted to active surveillance showed a slight and slow worsening of scores only at 12-month interval. PD and depression resulted to be more associated with urinary symptoms than sexual function worsening whereas anxiety resulted to be associated either with urinary symptoms or sexual function worsening. The results of our comparative and prospective analysis could be used to better inform treatment decision-making. Patients and their teams might wish to know how functional and psychological aspects may differently be influenced by treatment choice. Copyright © 2018 Elsevier Inc. All rights reserved.

Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis.

PubMed

Cotton, Cary C; Erim, Daniel; Eluri, Swathi; Palmer, Sarah H; Green, Daniel J; Wolf, W Asher; Runge, Thomas M; Wheeler, Stephanie; Shaheen, Nicholas J; Dellon, Evan S

2017-06-01

Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective. We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics. In the base-case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments; most simulations found SFED to be less expensive. In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.