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.

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.

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.

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.

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.

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.

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.

[Extracorporeal shockwave therapy (ESWT) as therapeutic option in supraspinatus tendon syndrome? One year results of a placebo controlled study].

PubMed

Schmitt, J; Tosch, A; Hünerkopf, M; Haake, M

2002-07-01

Extracorporeal shock wave therapy (ESWT) is seen as a therapeutic option in the treatment of chronic supraspinatus tendinitis by some authors. To test whether ESWT comprising 3 x 2000 pulses with the positive energy flux density ED+ of 0.33 mJ/mm2 is clinically superior to a sham ESWT treatment, a prospective, randomized, single-blinded, placebo-controlled study with an independent observer was performed. Forty patients were treated either by verum ESWT or sham ESWT under local anesthesia. Target criteria were the age-corrected Constant score, pain at rest and during activity on a visual analogue scale, and subjective improvement. Patients who reported no subjective improvement after 12 weeks were deblinded and received verum ESWT if they had belonged to the placebo group (partial crossover). The results of the verum group lie within the range of results for ESWT published by other authors. Patients in the placebo group with local anesthetic showed equally good results. At 12 weeks, and 1 year after intervention, no difference could be found between the verum and placebo groups regarding Constant score, pain, shoulder function, or subjective improvement. The nonresponders to the placebo ESWT continued to show no improvement after receiving verum ESWT. This contradicts a specific ESWT effect. Based on the results of this placebo-controlled study, ESWT appears to have no clinically relevant effect on supraspinatus tendinitis. The study underlines the importance of a control group in evaluating new treatment methods for diseases with unknown natural history.

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, Osther PJS. Effect of Linear Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction-12-Month Follow-Up of a Randomized, Double-Blinded, Sham-Controlled Study. Sex Med 2018;6:1-7. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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.

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.

Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis.

PubMed

Clavijo, Raul I; Kohn, Taylor P; Kohn, Jaden R; Ramasamy, Ranjith

2017-01-01

Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been proposed as an effective non-invasive treatment option for erectile dysfunction (ED). To use systematic review and meta-analysis to assess the efficacy of Li-ESWT by comparing change in erectile function as assessed by the erectile function domain of the International Index of Erectile Function (IIEF-EF) in men undergoing Li-ESWT vs sham therapy for the treatment of ED. Systematic search was conducted of MEDLINE, EMBASE, and ClinicalTrials.gov for randomized controlled trials that were published in peer-reviewed journals or presented in abstract form of Li-ESWT used for the treatment of ED from January 2010 through March 2016. Randomized controlled trials were eligible for inclusion if they were published in the peer-reviewed literature and assessed erectile function outcomes using the IIEF-EF score. Estimates were pooled using random-effects meta-analysis. Change in IIEF-EF score after treatment with Li-ESWT in patients treated with active treatment vs sham Li-ESWT probes. Data were extracted from seven trials involving 602 participants. The average age was 60.7 years and the average follow-up was 19.8 weeks. There was a statistically significant improvement in pooled change in IIEF-EF score from baseline to follow-up in men undergoing Li-ESWT vs those undergoing sham therapy (6.40 points; 95% CI = 1.78-11.02; I 2  = 98.7%; P < .0001 vs 1.65 points; 95% CI = 0.92-2.39; I 2  = 64.6%; P < .0001; between-group difference, P = .047). Significant between-group differences were found for total treatment shocks received by patients (P < .0001). In this meta-analysis of seven randomized controlled trials, treatment of ED with Li-ESWT resulted in a significant increase in IIEF-EF scores. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

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 reductions in plantar fascia thickness. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

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.

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 tendinitis. Further, the different outcome measures used and inadequate reporting details in the included studies did not permit a quantitative synthesis of the effectiveness of this treatment. A lack of follow up period beyond one year in the studies also precluded conclusion to be made on the longer term effectiveness of ESWT. Due to variable treatment parameters (eg dosage), this review was unable to provide clear guidance of the dose-effect of the midterm effectiveness of ESWT. Studies of better methodologic design using standardized treatment protocols and studies with longer follow-up are required. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, 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.

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.

Extra Corporeal Shock Wave Therapy Versus Local Corticosteroid Injection in the Treatment of Chronic Plantar Fasciitis, a Single Blinded Randomized Clinical Trial.

PubMed

Eslamian, Fariba; Shakouri, Seyed Kazem; Jahanjoo, Fatemeh; Hajialiloo, Mehrzad; Notghi, Faraz

2016-09-01

Plantar fasciitis is a self-limiting condition, but can be painful and disabling. Among the different treatments which exist, corticosteroid injections are effective and popular. Extracorporeal shock wave therapy (ESWT) is another treatment modality used for resistant conditions. In this study, the authors evaluated the efficacy of radial ESWT versus corticosteroid injections in the treatment of chronic plantar fasciitis. Randomized clinical trial. Physical medicine and rehabilitation research center in a university hospital. Forty patients with plantar fasciitis who did not respond to conservative treatment. Patients were allocated to radial ESWT with 2000 shock waves/session of 0.2 mJ/mm(2) (n = 20) or local methylprednisolone injections (n = 20). Pain in the morning and during the day based on a visual analog scale (VAS), functional abilities using the foot function index (FFI), and satisfaction were evaluated before treatment and at 4 and 8 weeks after treatment. Patients (average age: 42.1± 8.20) received five sessions of ESWT or single steroid injection. Changes in the VAS in morning and during the day and the FFI throughout the study period were significant in both groups (P < 0.001). ESWT group had a higher reduction in VAS in morning and better function in FFI, but these changes were insignificant statistically [FFI decreased to 19.65 ± 21.26 points (67.4% improvement) in ESWT vs 31.50 ± 20.53 points (47.7%) in injection group at week 8, P = 0.072)]. Good or excellent results in the opinions of patients were achieved in 55% of ESWT and 30% of corticosteroid injection groups (P = 0.11). Both interventions caused improvement in pain and functional ability 2 months after treatment. Although inter-group differences were not significant, the FFI was improved more with ESWT and patients were more satisfied with ESWT, thus shockwave therapy seems a safe alternative for management of chronic plantar fasciitis. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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 © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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.

Low-Intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: a Systematic Review and Meta-Analysis.

PubMed

Man, Libo; Li, Guizhong

2017-09-26

To use systematic review and meta-analysis to assess the efficacy of low-energy extracorporeal shockwave therapy (LI-ESWT) for erectile dysfunction (ED) was undertaken with a meta-analysis to identify the efficacy of the treatment modality. A comprehensive search of the PubMed, Cochrane Register and Embase databases to March 2017 was performed for randomized controlled trials reporting on patients with ED treated with LI- ESWT. The International Index of Erectile Function (IIEF) and the Erection Hardness Score (EHS) were the most commonly used tools to evaluate the therapeutic efficacy of LI-ESWT. There were 9 studies including 637 patients from 2005 to 2017. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference [MD]: 2.54; 95% CI, 0.83-4.25; p= 0. 004) and EHS (risk difference[RD]: 0.16; 95% CI, 0.03-0.28; p = 0.01)). Therapeutic efficacy could last at least 3 mo (MD: 4.15; 95% CI, 1.40-6.90; p =0.003). Lower energy density(0.09mj/mm 2 , MD: 4.14; 95% CI, 0.87-7.42; p = 0.01) increased number of pulses (3000 pulses per treatment, MD: 5.11; 95% CI, 3.18-7.05, p < 0.0001) and shorter total treatment courses( <6 weeks, MD: 3.73; 95% CI, 0.54-6.93; p = 0.02) resulted in better therapeutic efficacy. These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of ED patients. The publication of robust evidence from additional RCTs and longer-term follow-up would provide more confidence regarding use of LI-ESWT for ED patients. Copyright © 2017. Published by Elsevier Inc.

Effectiveness of Extracorporeal Shock Wave Therapy Without Local Anesthesia in Patients With Recalcitrant Plantar Fasciitis: A Meta-Analysis of Randomized Controlled Trials.

PubMed

Lou, Jing; Wang, Shuai; Liu, Shuitao; Xing, Gengyan

2017-08-01

The objective of this meta-analysis was to investigate the efficacy of extracorporeal shock wave therapy in the treatment of recalcitrant plantar fasciitis without local anesthesia. The Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched from inception to September 2015 for randomized controlled trials comparing ESWT without local anesthesia versus placebo for treatment of plantar fasciitis in adults. The primary outcome was the 12-week post-intervention success rate of reducing the visual analog scale score by 60% from baseline at the first step in the morning, reducing the VAS score by 60% from baseline during daily activities, reducing the Roles and Maudsley score, reducing overall heel pain, and reducing pain after applying a force meter. Nine studies were included in the meta-analysis. Compared with placebo, ESWT significantly improved the success rate of reducing overall heel pain, reducing the VAS score by 60% at the first step in the morning and during daily activities, improving the Roles and Maudsley score to excellent or good, and reducing heel pain after application of a pressure meter. ESWT seems to be particularly effective in relieving pain associated with RPF. ESWT should be considered when traditional treatments have failed. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to (1) understand the recovery rates for nonsurgical treatment of plantar fasciitis, (2) understand the role of extracorporeal shockwave therapy (ESWT) in the treatment of recalcitrant plantar fasciitis, and (3) understand the indications to incorporate ESWT in the treatment plan of recalcitrant plantar fasciitis. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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.

Stress fractures of the base of the metatarsal bones in young trainee ballet dancers

PubMed Central

Albisetti, Walter; De Bartolomeo, Omar; Tagliabue, Lorenzo; Camerucci, Emanuela; Calori, Giorgio Maria

2009-01-01

Classical ballet is an art form requiring extraordinary physical activity, characterised by rigorous training. These can lead to many overuse injuries arising from repetitive minor trauma. The purpose of this paper is to report our experience in the diagnosis and treatment of stress fractures at the base of the second and third metatarsal bones in young ballet dancers. We considered 150 trainee ballet dancers from the Ballet Schools of "Teatro Alla Scala" of Milan from 2005 to 2007. Nineteen of them presented with stress fractures of the base of the metatarsal bones. We treated 18 dancers with external shockwave therapy (ESWT) and one with pulsed electromagnetic fields (EMF) and low-intensity ultrasound (US); all patients were recommended rest. In all cases good results were obtained. The best approach to metatarsal stress fractures is to diagnose them early through clinical examination and then through X-ray and MRI. ESWT gave good results, with a relatively short time of rest from the patients’ activities and a return to dancing without pain. PMID:19415273

Extracorporeal shockwaves as regenerative therapy in orthopedic traumatology: a narrative review from basic research to clinical practice.

PubMed

D Agostino, M C; Frairia, R; Romeo, P; Amelio, E; Berta, L; Bosco, V; Gigliotti, S; Guerra, C; Messina, S; Messuri, L; Moretti, B; Notarnicola, A; Maccagnano, G; Russo, S; Saggini, R; Vulpiani, M C; Buselli, P

2016-01-01

Extracorporeal Shock Wave Therapy (ESWT), after its first medical application in the urological field for lithotripsy, nowadays represents a valid therapeutical tool also for many musculoskeletal diseases, as well as for regenerative medicine applications. This is possible thanks to its mechanisms of action, which in the non-urological field are not related to mechanical disruption (as for renal stones), but rather to the capacity, by mechanotransduction, to induce neoangiogenesis, osteogenesis and to improve local tissue trophism, regeneration and remodeling, through stem cell stimulation. On the basis of these biological assumptions, it becomes clear that ESWT can represent a valid therapeutic tool also for all those pathological conditions that derive from musculoskeletal trauma, and are characterized by tissue loss and/or delayed healing and regeneration (mainly bone and skin, but not only). As a safe, repeatable and non–invasive therapy, in many cases it can represent a first–line therapeutic option, as an alternative to surgery (for example, in bone and skin healing disorders), or in combination with some other treatment options. It is hoped that with its use in daily practice also the muscle–skeletal field will grow, not only for standard indications, but also in post–traumatic sequelae, in order to improve recovery and shorten healing time, with undoubted advantages for the patients and lower health service expenses.

Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat.

PubMed

Alizadeh, Zahra; Halabchi, Farzin; Mazaheri, Reza; Abolhasani, Maryam; Tabesh, Mastaneh

2016-10-01

Today, different kinds of non-invasive body contouring modalities, including cryolipolysis, radiofrequency (RF), low-level laser therapy (LLLT), and high-intensity focused ultrasound (HIFU) are available for reducing the volume of subcutaneous adipose tissue or cellulite. Each procedure has distinct mechanisms for stimulating apoptosis or necrosis adipose tissue. In addition to the mentioned techniques, some investigations are underway for analyzing the efficacy of other techniques such as whole body vibration (WBV) and extracorporeal shockwave therapy (ESWT). In the present review the mechanisms, effects and side effects of the mentioned methods have been discussed. The effect of these devices on cellulite or subcutaneous fat reduction has been assessed. We searched pubmed, google scholar and the cochrane databases for systemic reviews, review articles, meta-analysis and randomized clinical trials up to February 2015. The keywords were subcutaneous fat, cellulite, obesity, noninvasive body contouring, cryolipolysis, RF, LLLT, HIFU, ESWT and WBV with full names and abbreviations. We included seven reviews and 66 original articles in the present narrative review. Most of them were applied on normal weight or overweight participants (body mass index < 30 kg/m 2 ) in both genders with broad range of ages (18 to 50 years on average). In the original articles, the numbers of included methods were: 10 HIFU, 13 RF, 22 cryolipolysis, 11 LLLT, 5 ESWT and 4 WBV therapies. Six of the articles evaluated combination therapies and seven compared the effects of different devices. Some of the noninvasive body contouring devices in animal and human studies such as cryolipolysis, RF, LLLT and HIFU showed statistical significant effects on body contouring, removing unwanted fat and cellulite in some body areas. However, the clinical effects are mild to moderate, for example 2 - 4 cm circumference reduction as a sign of subcutaneous fat reduction during total treatment sessions. Overall, there is no definitive noninvasive treatment method for cellulite. Additionally, due to the methodological differences in the existing evidence, comparing the techniques is difficult.

Review of the Mechanisms and Effects of Noninvasive Body Contouring Devices on Cellulite and Subcutaneous Fat

PubMed Central

Alizadeh, Zahra; Halabchi, Farzin; Mazaheri, Reza; Abolhasani, Maryam; Tabesh, Mastaneh

2016-01-01

Context Today, different kinds of non-invasive body contouring modalities, including cryolipolysis, radiofrequency (RF), low-level laser therapy (LLLT), and high-intensity focused ultrasound (HIFU) are available for reducing the volume of subcutaneous adipose tissue or cellulite. Each procedure has distinct mechanisms for stimulating apoptosis or necrosis adipose tissue. In addition to the mentioned techniques, some investigations are underway for analyzing the efficacy of other techniques such as whole body vibration (WBV) and extracorporeal shockwave therapy (ESWT). In the present review the mechanisms, effects and side effects of the mentioned methods have been discussed. The effect of these devices on cellulite or subcutaneous fat reduction has been assessed. Evidence Acquisition We searched pubmed, google scholar and the cochrane databases for systemic reviews, review articles, meta-analysis and randomized clinical trials up to February 2015. The keywords were subcutaneous fat, cellulite, obesity, noninvasive body contouring, cryolipolysis, RF, LLLT, HIFU, ESWT and WBV with full names and abbreviations. Results We included seven reviews and 66 original articles in the present narrative review. Most of them were applied on normal weight or overweight participants (body mass index < 30 kg/m2) in both genders with broad range of ages (18 to 50 years on average). In the original articles, the numbers of included methods were: 10 HIFU, 13 RF, 22 cryolipolysis, 11 LLLT, 5 ESWT and 4 WBV therapies. Six of the articles evaluated combination therapies and seven compared the effects of different devices. Conclusions Some of the noninvasive body contouring devices in animal and human studies such as cryolipolysis, RF, LLLT and HIFU showed statistical significant effects on body contouring, removing unwanted fat and cellulite in some body areas. However, the clinical effects are mild to moderate, for example 2 - 4 cm circumference reduction as a sign of subcutaneous fat reduction during total treatment sessions. Overall, there is no definitive noninvasive treatment method for cellulite. Additionally, due to the methodological differences in the existing evidence, comparing the techniques is difficult. PMID:28123436

Effect of extracorporeal shock wave therapy on scar pain in burn patients: A prospective, randomized, single-blind, placebo-controlled study.

PubMed

Cho, Yoon Soo; Joo, So Young; Cui, Huisong; Cho, Sung-Rae; Yim, Haejun; Seo, Cheong Hoon

2016-08-01

Extracorporeal shock wave therapy (ESWT) has been used to reduce pain in patients with various musculoskeletal diseases and wounds. We investigated the effect of ESWT on scar pain after complete wound epithelialization in burn patients. A prospective, single-blind, placebo-controlled study was conducted from February 2014 to 2015. Forty patients with burn scar pain despite standard therapy (medication, physical therapy, and burn rehabilitation massage therapy) were randomized into ESWT or control (sham ESWT) groups. ESWT was administered at 100 impulses/cm (0.05-0.15 mJ/mm) once per week for 3 weeks. The treatment effects were assessed using the numerical rating scale (NRS), pain threshold, Nirschl pain phase system, and Roles and Maudsley scores. The characteristics of patients between the 2 study groups were balanced (P >0.05) for age, sex, and total burn surface area (%). In both groups, the NRS, pain threshold (Ib/cm), and Nirschl pain phase system values significantly improved (P <0.05) after 3 sessions of ESWT or sham therapy, and there were significant differences between the 2 groups in terms of these 3 variables (P <0.001, P <0.001, P = 0.013, respectively). The Roles and Maudsley scores significantly improved; among 20 patients, 17 reported a score of poor (85%) and 3 reported fair (15%) before ESWT, whereas 3 reported poor (15%), 8 reported fair (40%), 5 reported good (25%), and 4 reported excellent (20%) after ESWT (P = 0.004). The scores did not improve in the control group (P = 0.128). ESWT significantly reduced scar pain in burn patients after wound recovery.

Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy on Men With Chronic Pelvic Pain Syndrome Refractory to 3-As Therapy.

PubMed

Guu, Shiao-Jin; Geng, Jiun-Hung; Chao, I-Ting; Lin, Hui-Tzu; Lee, Yung-Chin; Juan, Yung-Shun; Liu, Chia-Chu; Wang, Chii-Jye; Tsai, Chia-Chun

2018-03-01

Managing patients with chronic pelvic pain syndrome (CPPS) refractory to the traditional 3-As therapy (antibiotics, alpha-blockers, and anti-inflammatories) is a challenging task. Low-intensity extracorporeal shock wave therapy (LI-ESWT) was recently reported to be able to improve pain, urinary symptoms, and even sexual function by inducing neovascularization and anti-inflammation, reducing muscle tone, and influencing nerve impulses. This study evaluates whether combined treatment with LI-ESWT can restore clinical ability and quality of life (QoL) in patients refractory to 3-As therapy. This was an open-label, single-arm prospective study. Patients with CPPS without more than a 6-point decrease in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score under the maximal dosage of 3-As therapy were enrolled. LI-ESWT treatment consisted of 3,000 shock waves administered once weekly for 4 weeks. The NIH-CPSI, visual analog scale (VAS) score, International Prostate Symptom Score (IPSS), and the five-item version of the International Index of Erectile Function (IIEF-5) were used to evaluate efficacy at 1, 4, and 12 weeks after LI-ESWT. Thirty-three patients were enrolled in this study. After LI-ESWT treatment, 27 of the 33 patients (81.82%) had a successful response to LI-ESWT, with a decrease of 3.29 and 5.97 in the VAS score and total IPSS at the 3-month follow-up. Waist circumference was the only significant predictor of a successful response to LI-ESWT. LI-ESWT can serve as a salvage therapy for patients with CPPS refractory to traditional 3-As therapy. Further studies are needed to determine an adequate therapeutic protocol and important predictors in patients with different CPPS etiologies.

Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials.

PubMed

Huisstede, Bionka M; Hoogvliet, Peter; Franke, Thierry P; Randsdorp, Manon S; Koes, Bart W

2017-09-20

To review scientific literature studying the effectiveness of physical therapy and electrophysical modalities for carpal tunnel syndrome (CTS). The Cochrane Library, PubMed, Embase, CINAHL, and Physiotherapy Evidence Database. Two reviewers independently applied the inclusion criteria to select potential eligible studies. Two reviewers independently extracted the data and assessed the methodologic quality using the Cochrane Risk of Bias Tool. A best-evidence synthesis was performed to summarize the results of the included studies (2 reviews and 22 randomized controlled trials [RCTs]). For physical therapy, moderate evidence was found for myofascial massage therapy versus ischemic compression on latent, or active, trigger points or low-level laser therapy in the short term. For several electrophysical modalities, moderate evidence was found in the short term (ultrasound vs placebo, ultrasound as single intervention vs other nonsurgical interventions, ultrasound vs corticosteroid injection plus a neutral wrist splint, local microwave hyperthermia vs placebo, iontophoresis vs phonophoresis, pulsed radiofrequency added to wrist splint, continuous vs pulsed vs placebo shortwave diathermy, and interferential current vs transcutaneous electrical nerve stimulation vs a night-only wrist splint). In the midterm, moderate evidence was found in favor of radial extracorporeal shockwave therapy (ESWT) added to a neutral wrist splint, in favor of ESWT versus ultrasound, or cryo-ultrasound, and in favor of ultrasound versus placebo. For all other interventions studied, only limited, conflicting, or no evidence was found. No RCTs investigating the long-term effects of physical therapy and electrophysical modalities were found. Because of heterogeneity in the treatment parameters used in the included RCTs, optimal treatment parameters could not be identified. Moderate evidence was found for several physical therapy and electrophysical modalities for CTS in the short term and midterm. Future studies should concentrate on long-term effects and which treatment parameters of physical therapy and electrophysical modalities are most effective for CTS. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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 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.

Effect of Extracorporeal Shock Wave Therapy on Hamstring Tightness in Healthy Subjects: A Pilot Study

PubMed Central

Kim, Yong Wook; Chang, Won Hyuk; Kim, Na Young; Kwon, Jun Beom

2017-01-01

Purpose To assess the effect of extracorporeal shock wave therapy (ESWT) for healthy participants with hamstring tightness. Materials and Methods This study was performed at a university rehabilitation hospital. Twenty nine healthy adults with hamstring tightness were enrolled and randomly allocated into four groups (ESWT, stretching exercise, ESWT with stretching exercise, and control). The effects of individual treatments were compared by the finger-to-floor test and popliteal angle. Results The ESWT group, stretching exercise group and ESWT with stretching exercise group had decreased finger-to-floor distances and right popliteal angles immediately after intervention, compared with the control group (p<0.05). At 4 weeks after completion of the interventions, finger-to-floor distances and the right popliteal angle in only the ESWT with stretching exercise group showed a significant improvement, compared with the control group (p=0.008 and 0.023). Conclusion While ESWT and stretching both reduced hamstring tightness immediately after interventions, only ESWT with stretching exercise maintained the significantly improved relief of hamstring tightness significantly after 4 weeks. PMID:28332373

Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database

PubMed Central

Schmitz, Christoph; Császár, Nikolaus B. M.; Milz, Stefan; Schieker, Matthias; Maffulli, Nicola; Rompe, Jan-Dirk; Furia, John P.

2015-01-01

Background Extracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system. Sources of data This systematic review used data derived from the Physiotherapy Evidence Database (PEDro; www.pedro.org.au, 23 October 2015, date last accessed). Areas of agreement ESWT is effective and safe. An optimum treatment protocol for ESWT appears to be three treatment sessions at 1-week intervals, with 2000 impulses per session and the highest energy flux density the patient can tolerate. Areas of controversy The distinction between radial ESWT as ‘low-energy ESWT’ and focused ESWT as ‘high-energy ESWT’ is not correct and should be abandoned. Growing points There is no scientific evidence in favour of either radial ESWT or focused ESWT with respect to treatment outcome. Areas timely for developing research Future randomized controlled trials should primarily address systematic tests of the aforementioned optimum treatment protocol and direct comparisons between radial and focused ESWT. PMID:26585999

Lower energy radial shock wave therapy improves characteristics of hypertrophic scar in a rabbit ear model.

PubMed

Zhao, Jing-Chun; Zhang, Bo-Ru; Shi, Kai; Wang, Jian; Yu, Qing-Hua; Yu, Jia-Ao

2018-01-01

The aim of the present study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on scar characteristics and transforming growth factor (TGF)-β1/Smad signaling in order to explore a potential modality for the treatment of hypertrophic scars (HS). The HS model was generated in rabbit ears, then rabbits were randomly divided into 3 groups: Lower (L)-ESWT [treated with rESWT with lower energy flux density (EFD) of 0.1 mJ/mm 2 ], higher (H)-ESWT (treated with a higher EFD of 0.18 mJ/mm 2 ) and the sham ESWT group (S-ESWT; no ESWT treatment). Scar characteristics (wrinkles, texture, diameter, area, volume of elevation, hemoglobin and melanin) were assessed using the Antera 3D ® system. The protein and mRNA expression of TGF-β1, Smad2, Smad3 and Smad7 was assessed by enzyme-linked immunosorbent assay and reverse transcription-quantitative polymerase chain reaction, respectively. The Antera 3D ® results indicated that wrinkles and hemoglobin of the HS were significantly improved in both of the rESWT groups when compared with the S-ESWT group. However, these changes appeared much earlier in the L-ESWT group than the H-ESWT. Scar texture was also improved in the L-ESWT group. However, rESWT did not influence HS diameter, area, volume of elevation or melanin levels. rESWT had no effect on TGF-β1 or Smad7 expression in either of rESWT groups. Although no difference was observed in Smad2 mRNA expression in the L-ESWT group, the Smad3 mRNA and protein expression significantly decreased when compared with the H-ESWT and S-ESWT groups. By contrast, Smad2 and Smad3 mRNA expression were upregulated in the H-ESWT group. These results demonstrated that rESWT with 0.1 mJ/mm 2 EFD improved some characteristics of the HS tissue. Downregulation of Smad3 expression may underlie this inhibitory effect. Inhibition of the TGF-β1/Smad signal transduction pathway may be a potential therapeutic target for the management of HS.

Lower energy radial shock wave therapy improves characteristics of hypertrophic scar in a rabbit ear model

PubMed Central

Zhao, Jing-Chun; Zhang, Bo-Ru; Shi, Kai; Wang, Jian; Yu, Qing-Hua; Yu, Jia-Ao

2018-01-01

The aim of the present study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on scar characteristics and transforming growth factor (TGF)-β1/Smad signaling in order to explore a potential modality for the treatment of hypertrophic scars (HS). The HS model was generated in rabbit ears, then rabbits were randomly divided into 3 groups: Lower (L)-ESWT [treated with rESWT with lower energy flux density (EFD) of 0.1 mJ/mm2], higher (H)-ESWT (treated with a higher EFD of 0.18 mJ/mm2) and the sham ESWT group (S-ESWT; no ESWT treatment). Scar characteristics (wrinkles, texture, diameter, area, volume of elevation, hemoglobin and melanin) were assessed using the Antera 3D® system. The protein and mRNA expression of TGF-β1, Smad2, Smad3 and Smad7 was assessed by enzyme-linked immunosorbent assay and reverse transcription-quantitative polymerase chain reaction, respectively. The Antera 3D® results indicated that wrinkles and hemoglobin of the HS were significantly improved in both of the rESWT groups when compared with the S-ESWT group. However, these changes appeared much earlier in the L-ESWT group than the H-ESWT. Scar texture was also improved in the L-ESWT group. However, rESWT did not influence HS diameter, area, volume of elevation or melanin levels. rESWT had no effect on TGF-β1 or Smad7 expression in either of rESWT groups. Although no difference was observed in Smad2 mRNA expression in the L-ESWT group, the Smad3 mRNA and protein expression significantly decreased when compared with the H-ESWT and S-ESWT groups. By contrast, Smad2 and Smad3 mRNA expression were upregulated in the H-ESWT group. These results demonstrated that rESWT with 0.1 mJ/mm2 EFD improved some characteristics of the HS tissue. Downregulation of Smad3 expression may underlie this inhibitory effect. Inhibition of the TGF-β1/Smad signal transduction pathway may be a potential therapeutic target for the management of HS. PMID:29434689

Extracorporeal shock wave therapy vs cryoultrasound therapy in the treatment of chronic lateral epicondylitis. One year follow up study

PubMed Central

Vulpiani, Maria Chiara; Nusca, Sveva Maria; Vetrano, Mario; Ovidi, Serena; Baldini, Rossella; Piermattei, Cristina; Ferretti, Andrea; Saraceni, Vincenzo Maria

2015-01-01

Summary Background the purpose of this study is to compare the therapeutic effects of extracorporeal shock wave therapy (ESWT) to those of cryoultrasound (Cryo-US) therapy in chronic lateral epicondylitis during a 12-month period. Methods single-blinded, randomized, controlled study of 80 participants treated for chronic LE with 3 ESWT sessions at 48/72-hours intervals (n=40) or 12 Cryo-US therapy sessions (4 sessions per week) (n=40). VAS and satisfactory results, considered as the sum of excellent and good scores in the Roles and Maudsley score, were used as outcome measures at baseline and 3, 6 and 12 months post-treatment. Results the results show statistically significant differences in VAS between the two groups at 6 (p<0.001) and 12 months (p<0.001) in favour of the ESWT Group. At 12 months, a difference of more than 2 points in the VAS between the two groups is demonstrated in favour of the ESWT Group. Considering satisfactory results, significant differences between the two groups are observed at 6 (p=0.003) and 12 months (p <0.001) in favour of the ESWT Group where patients achieve a satisfactory rate over 50%. Conclusions ESWT has better clinical therapeutic results at 6- and 12-month follow-up as compared to Cryo-US therapy. Level of Evidence 1B. PMID:26605190

Extracorporeal shock wave therapy with low-energy flux density inhibits hypertrophic scar formation in an animal model.

PubMed

Zhao, Jing-Chun; Zhang, Bo-Ru; Hong, Lei; Shi, Kai; Wu, Wei-Wei; Yu, Jia-Ao

2018-04-01

Hypertrophic scar is characterized by excessive deposits of collagen during skin wound healing, which could become a challenge to clinicians. This study assessed the effects of the extracorporeal shock wave therapy (ESWT) on hypertrophic scar formation and the underlying gene regu-lation. A rabbit ear hypertrophic scar model was generated and randomly divided into three groups: L-ESWT group to receive L-ESWT (energy flux density of 0.1 mJ/mm2), H-ESWT (energy flux density of 0.2 mJ/mm2) and sham ESWT group (S-ESWT). Hypertrophic scar tissues were then collected and stained with hematoxylin and eosin (H&E) and Masson's trichrome staining, respectively, to assess scar elevation index (SEI), fibroblast density and collagen fiber arrangement. Expression of cell proliferation marker proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) were assessed using RT-PCR and immunohistochemistry in hypertrophic scar tissues. H&E staining sections showed significant reduction of SEI and fibroblast density in both ESWT treatment groups compared to S-ESWT, but there was no dramatic difference between L-ESWT and H-ESWT groups. Masson's trichrome staining showed that collagen fibers were more slender and broader and oriented in parallel to skin surface after administration of ESWT compared to control tissues. At the gene level, PCNA‑positive fibroblasts and α-SMA-positive myofibroblasts were significantly decreased after L-ESWT or H-ESWT compared to the controls. Furthermore, there was no significant difference in expression of PCNA mRNA between L-ESWT or H-ESWT and S-ESWT, whereas expression of α-SMA mRNA significantly decreased in L-ESWT compared to that of H-ESWT and S-ESWT (P=0.002 and P=0.030, respectively). In conclusion, L-ESWT could be effective on suppression of hypertrophic scar formation by inhibition of scar elevation index and fibroblast density as well as α-SMA expression in hypertrophic scar tissues of the rabbit model.

Role of extracorporeal shock wave therapy in management of Peyronie's disease: A preliminary report

PubMed Central

Shimpi, Rajendra Kashinath; Jain, Ravi Jineshkumar

2016-01-01

Introduction: Peyronie's Disease (PD) is a disease causing psycho social trauma to the patient. Multiple treatment options are available with variable results. Extra Corporeal Shock Wave Therapy (ESWT) is a new insight into the non invasive modality of management. It focuses on the mechanism of inducing angiogenesis in the penile cavernous tissue. Materials and Methods: The aim of the study is to determine the role of ESWT in the management of PD. The objectives include demonstrating the improvement in mean International Index of Erectile Function Score (IIEFS), improvement in pain score by Visual Analogue Scale (VAS), change in cavernosal artery flow on colour penile Doppler, reduction in plaque size, and improvement in penile curvature degree after the therapy. 30 patients, between 25-65 years, who were non responders to conservative line of management, were treated with ESWT. The results were evaluated at baseline and 18-24 weeks after the therapy. Results: ESWT significantly improves the cavernosal artery velocity, thereby supporting the theory of angiogenesis. ESWT improves all the domains of IIEF including Erectile Function, Sexual Desire, Sexual Satisfaction, Orgasm and Overall Satisfaction. There is a significant improvement in the pain and penile curvature, and reduction in the plaque size. No adverse effects have been recorded. Conclusion: ESWT offers a safe, minimally invasive, OPD based option to the management of the patients of PD in the stable phase of the disease. Patients who do not respond to the conservative line of management can be really benefited by ESWT. PMID:28057983

Low-Intensity Extracorporeal Shock Wave Therapy in Vascular Disease and Erectile Dysfunction: Theory and Outcomes.

PubMed

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

2013-07-01

Low-intensity extracorporeal shock wave therapy (LI-ESWT) to the penis has recently emerged as a new and promising modality in the treatment of erectile dysfunction (ED). To review the published literature on the mechanism of action of LI-ESWT; and to report our clinical data on its efficacy in men with vasculogenic ED. A Medline search using the relevant keywords on this topic has been done. From the results of numerous preclinical and animal studies that have been done to date, sufficient evidence shows that the underlying mechanism of action of LI-ESWT is probably neovascularization. Therefore, local application of LI-ESWT to the corpora cavernosa may potentially act in the same mechanism and increase corporal blood flow. We found that the application of LI-ESWT to patients who responded to oral therapy (PDE5i) eliminated their dependence on PDE5i and they were able to successfully achieve erections and vaginal penetration (60-75%). Furthermore, PDE5i non-responders became responders and capable of vaginal penetration (72%). Additionally, LI-ESWT resulted in long-term improvement of the erectile mechanism. LI-ESWT has the potential to improve and permanently restore erectile function by reinstating the penile blood flow. Although these results on LI-ESWT are promising, further multi- centered studies with longer follow-up are needed to confirm these findings. Gruenwald I, Kitrey ND, Appel B, and Vardi Y. Stem low-intensity extracorporeal shock wave therapy in vascular disease and erectile dysfunction: Theory and outcomes. Sex Med Rev 2013;1:83-90. Copyright © 2013 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Extracorporeal shock wave therapy combined with vascular endothelial growth factor-C hydrogel for lymphangiogenesis.

PubMed

Kim, In Gul; Lee, Ji Youl; Lee, David S; Kwon, Jeong Yi; Hwang, Ji Hye

2013-01-01

Lymphedema is a clinically incurable disease that occurs commonly after lymph node dissection and/or irradiation. Several studies have recently demonstrated that extracorporeal shock wave therapy (ESWT) could promote lymphangiogenesis associated with expression of vascular endothelial growth factor (VEGF)-C. This research concerned primarily the synergistic effect of ESWT combined with VEGF-C incorporated hydrogel (VEGF-C hydrogel) combination therapy for promoting lymphangiogenesis and ultimately alleviating lymphedema. The VEGF-C hydrogel was applied to the injury site in a mouse model of lymphedema and then regularly underwent ESWT (0.05 mJ/mm(2), 500 shots) every 3 days for 4 weeks. Four weeks after the treatment, mice treated with VEGF-C hydrogel and ESWT showed signs of the greatest decrease in edema/collagenous deposits when compared with the other experimental group. LYVE-1-positive vessels also revealed that the VEGF-C/ESWT group had significantly induced the growth of new lymphatic vessels compared to the other groups. Western blot analysis showed that expression of VEGF-C (1.24-fold) and VEGF receptor-3 (1.41-fold) was significantly increased in the VEGF-C/ESWT group compared to the normal group. These results suggested that VEGF-C and ESWT had a synergistic effect and were very effective in alleviating the symptoms of lymphedema and promoting lymphangiogenesis. Copyright © 2012 S. Karger AG, Basel.

High-energy versus low-energy extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: which is superior? A meta-analysis.

PubMed

Verstraelen, F U; In den Kleef, N J H M; Jansen, L; Morrenhof, J W

2014-09-01

There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment intensity remains unknown. High-energy ESWT is much more painful, more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist. A systematic review and meta-analysis of randomized trials was performed to answer two clear research questions: (1) Is there a greater increase in the Constant-Murley score in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? (2) Is there a greater chance of complete resorption of the calcifications in patients treated with high-energy ESWT compared with those treated with low-energy ESWT by 3 months and by 6 months? Five relevant electronic online databases, Medline (through PubMed), EMBASE (through OVID), Cinahl (through EBSCO), Web of Science, and the Cochrane Central Register of Controlled Trials, were systematically searched. We also crosschecked the reference lists of articles and reviews for possible relevant studies. Eligible for inclusion were all randomized controlled trials (RCTs) that compared high-energy ESWT (> 0.28 mJ/mm(2)) with low-energy ESWT (< 0.08 mJ/mm(2)). One author examined titles and abstracts of each identified study to assess study eligibility. Two reviewers independently extracted data and assessed the risk of bias and study quality. The primary outcome measure, the Constant-Murley score, was assessed by comparing mean functional outcome scores between the groups. Secondary outcomes were assessed using odds ratios, when appropriate data were pooled. Based on this process, five RCTs (359 participants) were included. All five RCTs showed greater improvement in functional outcome (Constant-Murley score) in patients treated with high-energy ESWT compared with patients treated with low-energy ESWT at 3 and 6 months. The 3-month mean difference was 9.88 (95% CI, 9.04-10.72, p < 0.001; 6-month data could not be pooled). Furthermore, high-energy ESWT more often resulted in complete resorption of the deposits at 3 months. The corresponding odds ratio was 3.40 (95% CI, 1.35-8.58) and p = 0.009 (6-month data could not be pooled). When shock wave therapy is chosen, high-energy shock wave therapy is more likely to result in improved Constant-Murley score and resorption of the deposits compared with low-energy therapy. Level I, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Comparison of the effects of extracorporeal shock wave therapy and a vacuum erectile device on penile erectile dysfunction: a randomized clinical trial.

PubMed

Qi, Tao; Ye, Lei; Wang, Bo; Zhang, Bin; Chen, Jun

2017-11-01

This randomized clinical trial (October 2012-December 2013) compared extracorporeal shock wave therapy (ESWT) and a vacuum erectile device (VED) for management of erectile dysfunction (ED). Consecutive Chinese patients (20-55 years) with ED, abnormal nocturnal penile tumescence and rigidity (NPTR), and international index of erectile function-5 items (IIEF-5) score <22 were randomized to receive ESWT or VED (twice weekly, 4 weeks). Primary outcomes were treatment efficacy and success rate 4 weeks after completion of therapy. Secondary outcomes included changes in IIEF-5 score, sex encounter profile (SEP) score, erection hardness score (EHS) and NPTR assessments 4 weeks post-therapy. All enrolled patients (n = 30 per group) completed the study. At baseline, age, IIEF-5 score, SEP score, EHS, and NPTR assessments were similar between groups. Four weeks post-therapy, IIEF-5 score increased in the ESWT (15.03 ± 3.00 vs. 11.60 ± 2.28) and VED (15.10 ± 3.06 vs. 11.53 ± 2.27) groups, as did SEP score, EHS, and NPTR measures (all P < .05). Efficacy in the ESWT and VED groups was excellent in 10% and 13.3%, respectively, and moderate in 63.3% and 53.3%, respectively. Treatment success rate in the ESWT and VED groups was 73.3% and 67.7%, respectively. VED use and ESWT have comparable efficacies in the treatment of ED in Chinese patients.

Extracorporeal shock wave therapy is not useful after arthroscopic rotator cuff repair.

PubMed

Kim, Jae Yoon; Lee, Jae Sung; Park, Chi Woo

2012-12-01

Extracorporeal shock wave therapy (ESWT) is known to accelerate the healing of musculoskeletal tissue. The purpose of this study was to test the hypothesis that ESWT stimulates rotator cuff healing after arthroscopic repair. Seventy-one consecutive patients with a small- to large-sized rotator cuff tear underwent arthroscopic rotator cuff repair. The patients were randomized into two groups: 35 patients underwent ESWT at 6 weeks after surgery (ESWT group) and 36 patients did not (control group). Cuff integrity was evaluated with computed tomographic arthrography at 6 months after surgery. Constant and UCLA scores were measurable outcomes. All patients were available for a minimum one-year follow-up. The mean age of the ESWT and control groups was 59.4 (SD: 7.7) and 58.6 years (SD: 7.8) (n.s.). There were no significant differences in tear size and repair method between the two groups (n.s.). The mean Constant and UCLA scores, respectively, increased from 54.6 to 90.6 (P < 0.001) and from 18.5 to 27.4 (P < 0.001) in the ESWT group, and from 58.9 to 89.3 (P < 0.001) and 18.5 to 27.4 in the control group. Computed tomographic arthrography was performed in 26 patients from the ESWT group and 24 from the control group, and cuff integrity was maintained in 46 out of 50 patients. Definite re-tear was observed in two patients of the ESWT group and four of the controls. There were no complications associated with ESWT. This study failed to prove that ESWT stimulates rotator cuff healing after arthroscopic rotator cuff repair. Additional ESWT after rotator cuff repair could theoretically be advantageous, and it was proven to be safe in this study. II.

Comparison of the effects of extracorporeal shock wave therapy and a vacuum erectile device on penile erectile dysfunction: a randomized clinical trial

PubMed Central

Qi, Tao; Ye, Lei; Wang, Bo; Zhang, Bin; Chen, Jun

2017-01-01

Abstract Background: This randomized clinical trial (October 2012–December 2013) compared extracorporeal shock wave therapy (ESWT) and a vacuum erectile device (VED) for management of erectile dysfunction (ED). Methods: Consecutive Chinese patients (20–55 years) with ED, abnormal nocturnal penile tumescence and rigidity (NPTR), and international index of erectile function-5 items (IIEF-5) score <22 were randomized to receive ESWT or VED (twice weekly, 4 weeks). Primary outcomes were treatment efficacy and success rate 4 weeks after completion of therapy. Secondary outcomes included changes in IIEF-5 score, sex encounter profile (SEP) score, erection hardness score (EHS) and NPTR assessments 4 weeks post-therapy. All enrolled patients (n = 30 per group) completed the study. At baseline, age, IIEF-5 score, SEP score, EHS, and NPTR assessments were similar between groups. Results: Four weeks post-therapy, IIEF-5 score increased in the ESWT (15.03 ± 3.00 vs. 11.60 ± 2.28) and VED (15.10 ± 3.06 vs. 11.53 ± 2.27) groups, as did SEP score, EHS, and NPTR measures (all P < .05). Efficacy in the ESWT and VED groups was excellent in 10% and 13.3%, respectively, and moderate in 63.3% and 53.3%, respectively. Treatment success rate in the ESWT and VED groups was 73.3% and 67.7%, respectively. Conclusion: VED use and ESWT have comparable efficacies in the treatment of ED in Chinese patients. PMID:29095274

Immediate Dose-Response Effect of High-Energy Versus Low-Energy Extracorporeal Shock Wave Therapy on Cutaneous Microcirculation.

PubMed

Kraemer, Robert; Sorg, Heiko; Forstmeier, Vinzent; Knobloch, Karsten; Liodaki, Eirini; Stang, Felix Hagen; Mailaender, Peter; Kisch, Tobias

2016-12-01

Elucidation of the precise mechanisms and therapeutic options of extracorporeal shock wave therapy (ESWT) is only at the beginning. Although immediate real-time effects of ESWT on cutaneous hemodynamics have recently been described, the dose response to different ESWT energies in cutaneous microcirculation has never been examined. Thirty-nine Sprague-Dawley rats were randomly assigned to three groups that received either focused high-energy shock waves (group A: total of 1000 impulses, 10 J) to the lower leg of the hind limb, focused low-energy shock waves (group B: total of 300 impulses, 1 J) or placebo shock wave treatment (group C: 0 impulses, 0 J) using a multimodality shock wave delivery system (Duolith SD-1 T-Top, Storz Medical, Tägerwilen, Switzerland). Immediate microcirculatory effects were assessed with the O2C (oxygen to see) system (LEA Medizintechnik, Giessen, Germany) before and for 20 min after application of ESWT. Cutaneous tissue oxygen saturation increased significantly higher after high-energy ESWT than after low-energy and placebo ESWT (A: 29.4% vs. B: 17.3% vs. C: 3.3%; p = 0.003). Capillary blood velocity was significantly higher after high-energy ESWT and lower after low-energy ESWT versus placebo ESWT (group A: 17.8% vs. group B: -22.1% vs. group C: -5.0%, p = 0.045). Post-capillary venous filling pressure was significantly enhanced in the high-energy ESWT group in contrast to the low-energy ESWT and placebo groups (group A: 25% vs. group B: 2% vs. group C: -4%, p = 0.001). Both high-energy and low-energy ESWT affect cutaneous hemodynamics in a standard rat model. High-energy ESWT significantly increases parameters of cutaneous microcirculation immediately after application, resulting in higher tissue oxygen saturation, venous filling pressure and blood velocity, which suggests higher tissue perfusion with enhanced oxygen saturation, in contrast to low-energy as well as placebo ESWT. Low-energy ESWT also increased tissue oxygen saturation, albeit to a lower extent, and decreases both blood velocity and venous filling pressure. Low-energy ESWT reduced tissue perfusion, but improved oxygen saturation immediately after the application. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum

PubMed Central

2017-01-01

Objective To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. Methods In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. Results Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. Conclusion Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum. PMID:28971042

New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis.

PubMed

Yin, Mengchen; Chen, Ni; Huang, Quan; Marla, Anastasia Sulindro; Ma, Junming; Ye, Jie; Mo, Wen

2017-12-01

To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. Randomized, controlled, prospective study. Outpatient of local medical center settings. Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm 2 , respectively (a rate of 8 impulses per second), were applied. The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e [.011+42.807×heel spur+.109×edema+5.395×VAS score] ) -1 .The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The Youden index was .4243, .3003, and .7189, respectively. The Hosmer-Lemeshow test showed a good fitting of the predictive model, with an overall accuracy of 89.6%. This study establishes a new and accurate predictive model for the efficacy of ESWT in managing patients with chronic plantar fasciitis. The use of these parameters, in the form of a predictive model for ESWT efficacy, has the potential to improve decision-making in the application of ESWT. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Magnetic Resonance Imaging and Clinical Outcomes of Laser Therapy, Ultrasound Therapy, and Extracorporeal Shock Wave Therapy for Treatment of Plantar Fasciitis: A Randomized Controlled Trial.

PubMed

Ulusoy, Aslihan; Cerrahoglu, Lale; Orguc, Sebnem

We determined and compared the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (US) therapy, and extracorporeal shock wave therapy (ESWT) using magnetic resonance imaging (MRI). We performed a randomized, prospective, comparative clinical study. A total of 60 patients with a diagnosis of chronic plantar fasciitis were divided randomly into 3 treatment groups: group 1 underwent 15 sessions of LLLT (8 J/cm 2 ; 830 nm); group 2 underwent 15 sessions of continuous US (1 mHz; 2 W/cm 2 ); and group 3 underwent 3 sessions of ESWT (2000 shocks). All patients were assessed using the visual analog scale (VAS), heel tenderness index (HTI), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, Roles-Maudsley score, and MRI before and 1 month after treatment. The primary efficacy success criterion was the percentage of decrease in heel pain of >60% from baseline at 1 month after treatment for ≥2 of the 3 heel pain (VAS) measurements. Significant improvement was measured using the mean VAS, AOFAS scale, and HTI scores for all 3 groups. The thickness of the plantar fascia had decreased significantly on MRI in all 3 groups. The treatment success rate was 70.6% in the LLLT group, 65% in the ESWT group, and 23.5% in the US group. LLLT and ESWT proved significantly superior to US therapy using the primary efficacy criterion (p = .006 and p = .012, respectively), with no significant difference between the LLLT and ESWT groups (p > .05). The treatment of chronic plantar fasciitis with LLLT and ESWT resulted in similar outcomes and both were more successful than US therapy in pain improvement and functional outcomes. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Can cellulite be treated with low-energy extracorporeal shock wave therapy?

PubMed Central

Angehrn, Fiorenzo; Kuhn, Christoph; Voss, Axel

2007-01-01

The present study investigates the effects of low-energy defocused extracorporeal generated shock waves on collagen structure of cellulite afflicted skin. Cellulite measurement using high-resolution ultrasound technology was performed before and after low-energy defocused extracorporeal shock wave therapy (ESWT) in 21 female subjects. ESWT was applied onto the skin at the lateral thigh twice a week for a period of six weeks. Results provide evidence that low-energy defocused ESWT caused remodeling of the collagen within the dermis of the tested region. Improving device-parameters and therapy regimes will be essential for future development of a scientific based approach to cellulite treatment. PMID:18225463

Spasticity and Electrophysiologic Changes after Extracorporeal Shock Wave Therapy on Gastrocnemius

PubMed Central

Sohn, Min Kyun; Cho, Kang Hee; Hwang, Seon Lyul

2011-01-01

Objective To evaluate the spasticity and electrophysiologic effects of applying extracorporeal shock wave therapy (ESWT) to the gastrocnemius by studying F wave and H-reflex. Method Ten healthy adults and 10 hemiplegic stroke patients with ankle plantarflexor spasticity received one session of ESWT on the medial head of the gastrocnemius. The modified Ashworth scale (MAS), tibial nerve conduction, F wave, and H-reflex results were measured before and immediately after the treatment. The Visual Analogue Scale (VAS) was used during ESWT to measure the side effects, such as pain. Results There were no significant effects of ESWT on the conduction velocity, distal latency and amplitude of tibial nerve conduction, minimal latency of tibial nerve F wave, latency, or H-M ratio of H-reflex in either the healthy or stroke group. However, the MAS of plantarflexor was significantly reduced from 2.67±1.15 to 1.22±1.03 (p<0.05) after applying ESWT in the stroke group. Conclusion After applying ESWT on the gastrocnemius in stroke patients, the spasticity of the ankle plantarflexor was significantly improved, with no changes of F wave or H-reflex parameters. Further studies are needed to evaluate the mechanisms of the antispastic effect of ESWT. PMID:22506181

Radial extracorporeal shock wave therapy improves cerebral blood flow and neurological function in a rat model of cerebral ischemia.

PubMed

Kang, Nan; Zhang, Jing; Yu, Xiaotong; Ma, Yuewen

2017-01-01

We performed middle cerebral artery occlusion (MCAO) in rats to investigate the effect and some of the underlying mechanisms of radial extracorporeal shock wave therapy (rESWT) in cerebral ischemia rats. We measured neurological function and cerebral blood flow (CBF) using a full-field laser perfusion imager and brain infarct volume on days 3, 12, and 30. Immunofluorescence, western blot, and real-time polymerase chain reaction (PCR) techniques were used to detect the expression of vascular endothelial growth factor (VEGF), neuron-specific enolase (NSE), nestin, Wnt3a, and β-catenin in the ischemic hemisphere. The dose of rESWT used on the head revealed remarkable advantages over sham rESWT, as demonstrated by improved neurological function scores, increased CBF, and reduced brain infarct volume. Furthermore, applying rESWT to the head and limbs enhanced short-term neurological function. Our results confirmed that rESWT can induce VEGF expression over an extended period with a profound effect, which may be the primary reason for CBF recovery. High NSE and nestin expression levels suggest that rESWT enhanced the number of neurons and neural stem cells (NSCs). Wnt3a and β-catenin expression were up-regulated in the ischemic hemisphere, indicating that rESWT promoted NSC proliferation and differentiation via the Wnt/β-catenin pathway. Overall, our findings suggest that an appropriate rESWT dose delivered to the head of rats helps restore neurological function and CBF, and additional application of rESWT to the limbs is more effective than treating the head alone.

Improvement of adipose tissue-derived cells by low-energy extracorporeal shock wave therapy.

PubMed

Priglinger, Eleni; Schuh, Christina M A P; Steffenhagen, Carolin; Wurzer, Christoph; Maier, Julia; Nuernberger, Sylvia; Holnthoner, Wolfgang; Fuchs, Christiane; Suessner, Susanne; Rünzler, Dominik; Redl, Heinz; Wolbank, Susanne

2017-09-01

Cell-based therapies with autologous adipose tissue-derived cells have shown great potential in several clinical studies in the last decades. The majority of these studies have been using the stromal vascular fraction (SVF), a heterogeneous mixture of fibroblasts, lymphocytes, monocytes/macrophages, endothelial cells, endothelial progenitor cells, pericytes and adipose-derived stromal/stem cells (ASC) among others. Although possible clinical applications of autologous adipose tissue-derived cells are manifold, they are limited by insufficient uniformity in cell identity and regenerative potency. In our experimental set-up, low-energy extracorporeal shock wave therapy (ESWT) was performed on freshly obtained human adipose tissue and isolated adipose tissue SVF cells aiming to equalize and enhance stem cell properties and functionality. After ESWT on adipose tissue we could achieve higher cellular adenosine triphosphate (ATP) levels compared with ESWT on the isolated SVF as well as the control. ESWT on adipose tissue resulted in a significantly higher expression of single mesenchymal and vascular marker compared with untreated control. Analysis of SVF protein secretome revealed a significant enhancement in insulin-like growth factor (IGF)-1 and placental growth factor (PLGF) after ESWT on adipose tissue. Summarizing we could show that ESWT on adipose tissue enhanced the cellular ATP content and modified the expression of single mesenchymal and vascular marker, and thus potentially provides a more regenerative cell population. Because the effectiveness of autologous cell therapy is dependent on the therapeutic potency of the patient's cells, this technology might raise the number of patients eligible for autologous cell transplantation. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

The TOPSHOCK study: Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - design of a randomised controlled trial

PubMed Central

2011-01-01

Background Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: radial shockwave therapy. Studies that investigate the effectiveness of radial shockwave therapy as treatment for patellar tendinopathy are scarce. Therefore the aim of this study is to compare the effectiveness of focussed shockwave therapy and radial shockwave therapy as treatments for patellar tendinopathy. Methods/design The TOPSHOCK study (Tendinopathy Of Patella SHOCKwave) is a two-armed randomised controlled trial in which the effectiveness of focussed shockwave therapy and radial shockwave therapy are directly compared. Outcome assessors and patients are blinded as to which treatment is given. Patients undergo three sessions of either focused shockwave therapy or radial shockwave therapy at 1-week intervals, both in combination with eccentric decline squat training. Follow-up measurements are scheduled just before treatments 2 and 3, and 1, 4, 7 and 12 weeks after the final treatment. The main outcome measure is the Dutch VISA-P questionnaire, which asks for pain, function and sports participation in subjects with patellar tendinopathy. Secondary outcome measures are pain determined with a VAS during ADL, sports and decline squats, rating of subjective improvement and overall satisfaction with the treatment. Patients will also record their sports activities, pain during and after these activities, and concurrent medical treatment on a weekly basis in a web-based diary. Results will be analysed according to the intention-to-treat principle. Discussion The TOPSHOCK study is the first randomised controlled trial that directly compares the effectiveness of focused shockwave therapy and radial shockwave therapy, both in combination with eccentric decline squat training, for treating patellar tendinopathy. Trial registration Trial registration number NTR2774. PMID:21989041

Extracorporeal shock wave therapy for injection site panniculitis in multiple sclerosis patients.

PubMed

Stieger, Marco; Schmid, Jean-Paul; Yawalkar, Nikhil; Hunziker, Thomas

2015-01-01

Painful cutaneous injection site reactions may hamper treatment with interferon β (IFN-β) and glatiramer acetate (GA) in multiple sclerosis (MS) patients. To maintain therapy adherence, efficient therapeutic modalities for these subcutaneous inflammatory lesions are urgently needed. We tested the application of local extracorporeal shock wave therapy (ESWT). We applied 5 sessions of ESWT to 8 patients suffering from MS who had developed painful panniculitis at the injection sites of either IFN-β or GA. Clinical outcomes, i.e. pain reduction and regression of induration, were assessed 3 and 6 months after completion of the ESWT using a visual analogue score. All patients showed both significant pain reduction and reduction of the skin induration in the treated lesions, while in untreated control lesions there was no improvement. ESWT proved to be a non-invasive, safe and efficient physical treatment modality for injection-induced painful cutaneous side effects of disease-modifying drugs in MS. © 2014 S. Karger AG, Basel.

Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis

PubMed Central

Sun, Jiale; Gao, Fuqiang; Wang, Yanhua; Sun, Wei; Jiang, Baoguo; Li, Zirong

2017-01-01

Abstract Background: Plantar fasciitis (PF) is the most common reason for heel pain. The efficacy of extracorporeal shock wave therapy (ESWT) as an ideal alternative to conservative treatments and surgery is controversial, and almost all previous articles compared general ESWT with placebo without indicating the kind of shock wave. We undertook a meta-analysis to compare the efficacy of general ESWT, focused shock wave (FSW), and radial shock wave (RSW) with placebo, to assess their effectiveness in chronic PF. Methods: The PubMed, Medline, EmBase, Web of Science, and Cochrane library databases were searched for studies comparing FSW or RSW therapy with placebo in chronic PF. Clinical outcomes included the odds ratios (ORs) of pain relief, pain reduction, and complications. Relevant data were analyzed using RevMan v5.3. Results: Nine studies involving 935 patients were included. ESWT had higher improvement rates than the placebo group (OR 2.58, 95% confidence interval [CI] 1.97–3.39, P < .00001). ESWT had markedly lower standardized mean difference than placebo, with heterogeneity observed (standardized mean difference 1.01, 95% CI −0.01 to 2.03, P = .05, I2 = 96%, P < .00001). FSW and RSW therapies had greater therapeutic success in pain relief than the placebo group (OR 2.17, 95% CI 1.49–3.16, P < .0001; OR 4.63, 95% CI 1.30–16.46, P = .02), but significant heterogeneity was observed in RSW therapy versus placebo (I2 = 81%, P = .005). Conclusion: This meta-analysis suggested that FSW therapy can relieve pain in chronic PF as an ideal alternative option; meanwhile, no firm conclusions of general ESWT and RSW effectiveness can be drawn. Due to variations in the included studies, additional trials are needed to validate these conclusions. PMID:28403111

The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review.

PubMed

Mani-Babu, Sethu; Morrissey, Dylan; Waugh, Charlotte; Screen, Hazel; Barton, Christian

2015-03-01

There is accumulating evidence for the effectiveness of extracorporeal shock wave therapy (ESWT) when treating lower limb tendinopathies including greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT), and Achilles tendinopathy (AT). To evaluate the effectiveness of ESWT for lower limb tendinopathies. Systematic review and meta-analysis. PubMed (Medline), Embase, Web of Knowledge, Cochrane, and CINAHL were searched from inception to February 2013 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non-English language studies were excluded. A quality assessment was performed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided. A total of 20 studies were identified, with 13 providing sufficient data to compute effect size calculations. The energy level, number of impulses, number of sessions, and use of a local anesthetic varied between studies. Additionally, current evidence is limited by low participant numbers and a number of methodological weaknesses including inadequate randomization. Moderate evidence indicates that ESWT is more effective than home training and corticosteroid injection in the short (<12 months) and long (>12 months) term for GTPS. Limited evidence indicates that ESWT is more effective than alternative nonoperative treatments including nonsteroidal anti-inflammatory drugs, physical therapy, and an exercise program and equal to patellar tenotomy surgery in the long term for PT. Moderate evidence indicates that ESWT is more effective than eccentric loading for insertional AT and equal to eccentric loading for midportion AT in the short term. Additionally, there is moderate evidence that combining ESWT and eccentric loading in midportion AT may produce superior outcomes to eccentric loading alone. Extracorporeal shock wave therapy is an effective intervention and should be considered for GTPS, PT, and AT particularly when other nonoperative treatments have failed. © 2014 The Author(s).

A comparison of the effectiveness of extracorporeal shock wave and ultrasound therapy in the management of heel pain

NASA Astrophysics Data System (ADS)

Cheing, G. L. Y.; Chang, H.; Lo, S. K.

2007-11-01

The aim of this study was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and ultrasound therapy (US) for managing heel pain. Thirty-seven subjects received either: ESWT (once a week), US (three times a week), or CONTROL (no treatment) for 3 consecutive weeks and were followed-up for 3 more weeks. A visual analogue scale (VAS), the maximum tolerable duration for prolonged walking or standing, and the Mayo clinical scoring system (MCSS) were evaluated. Mixed models treating baseline measures as covariates were adopted for statistical analysis. By week 3, intensity of heel pain on palpation was reduced by 37% (VAS score from 7.5 to 4.6) in the ESWT group, 24% (from 5.3 to 4.2) in the US group, and increased by 3% (5.6-5.7) in the control group; this difference was significant after adjusting for baseline VAS scores ( p = 0.022). The improvements in the maximum tolerable duration of prolonged walking or standing was only significant in the ESWT group (157% increase, p = 0.043) but not the other two groups. Both active treatment groups maintained the treatment effect at the three-week follow-up. We conclude that ESWT is potentially more effective in reducing heel pain than ultrasound therapy but additional evidence is needed due to the various limitations of the study.

Extracorporeal shock wave therapy as an adjunct wound treatment: a systematic review of the literature.

PubMed

Dymarek, Robert; Halski, Tomasz; Ptaszkowski, Kuba; Slupska, Lucyna; Rosinczuk, Joanna; Taradaj, Jakub

2014-07-01

Standard care procedures for complex wounds are sometimes supported and reinforced by physical treatment modalities such as extracorporeal shock wave therapy (ESWT). To evaluate available evidence of ESWT effectiveness in humans, a systematic review of the literature was conducted using MEDLINE, PubMed, Scopus, EBSCOhost, and PEDro databases. Of the 393 articles found, 13 met the publication date (year 2000-2013), study type (clinical study), language (English only), and abstract availability (yes) criteria. The 13 studies (n = 919 patients with wounds of varying etiologies) included seven randomized controlled trials that were evaluated using Cochrane Collaboration Group standards. Only studies with randomization, well prepared inclusion/exclusion criteria protocol, written in English, and full version available were analyzed. An additional six publications reporting results of other clinical studies including a total of 523patients were identified and summarized. ESWT was most commonly applied once or twice a week using used low or medium energy, focused or defocused generator heads (energy range 0.03 to 0.25 mJ/mm2; usually 0.1 mJ/mm2), and electrohydraulic or electromagnetic sources. Few safety concerns were reported, and in the controlled clinical studies statistically significant differences in rates of wound closure were reported compared to a variety of standard topical treatment modalities, sham ESWT treatment, and hyperbaric oxygen therapy. Based on this analysis, ESWT can be characterized as noninvasive, mostly painless, and safe. Controlled, randomized, multicenter, blind clinical trials still are required to evaluate the efficacy and cost-effectiveness of ESWT compared to sham control, other adjunctive treatments, and commonly used moisture-retentive dressings. In the future, ESWT may play an important role in wound care once evidence-based practice guidelines are developed.

Effects of extracorporeal shock wave therapy and polysulfated glycosaminoglycan treatment on subchondral bone, serum biomarkers, and synovial fluid biomarkers in horses with induced osteoarthritis.

PubMed

Kawcak, Chris E; Frisbie, David D; McIlwraith, C Wayne

2011-06-01

To evaluate effects of extracorporeal shock wave therapy (ESWT) and polysulfated glycosaminoglycan treatment (PSGAGT) on subchondral bone (SCB), serum biomarkers, and synovial fluid biomarkers in horses with induced osteoarthritis. 24 healthy 2- to 3-year-old horses. An osteochondral fragment was created on the distal aspect of the radial carpal bone in 1 middle carpal joint of each horse. Horses were randomly allocated to receive local application of ESWT (days 14 and 28; n = 8), PSGAGT (IM, q 4 d for 28 days; 8), or a sham ESWT probe (placebo; days 14 and 28; 8). Serum biomarkers were measured every 7 days, and synovial fluid biomarkers were measured every 14 days. Bone density was measured by use of computed tomography on days 0 and 70, and microdamage and bone formation variables were compared among groups at the end of the study (day 70). There was no significant effect of ESWT or PSGAGT on any bone variable. Serum osteocalcin concentration was significantly greater in horses that received ESWT, compared with placebo-treated horses, and serum concentration of the C-terminal telopeptide of type I collagen was significantly higher in horses that received ESWT, compared with placebo- and PSGAG-treated horses. Concentrations of the synovial fluid epitope CS846 were significantly higher in joints with osteoarthritis treated with ESWT CONCLUSIONS AND CLINICAL RELEVANCE: Treatment of osteoarthritis with ESWT had no effect on SCB but did induce increases in serum biomarkers indicative of bone remodeling. Treatment of osteoarthritis with PSGAG had no effect on SCB or biomarkers.

Low-Intensity Extracorporeal Shock Wave Therapy Enhances Brain-Derived Neurotrophic Factor Expression through PERK/ATF4 Signaling Pathway.

PubMed

Wang, Bohan; Ning, Hongxiu; Reed-Maldonado, Amanda B; Zhou, Jun; Ruan, Yajun; Zhou, Tie; Wang, Hsun Shuan; Oh, Byung Seok; Banie, Lia; Lin, Guiting; Lue, Tom F

2017-02-16

Low-intensity extracorporeal shock wave therapy (Li-ESWT) is used in the treatment of erectile dysfunction, but its mechanisms are not well understood. Previously, we found that Li-ESWT increased the expression of brain-derived neurotrophic factor (BDNF). Here we assessed the underlying signaling pathways in Schwann cells in vitro and in penis tissue in vivo after nerve injury. The result indicated that BDNF were significantly increased by the Li-ESWT after nerve injury, as well as the expression of BDNF in Schwann cells (SCs, RT4-D6P2T) in vitro. Li-ESWT activated the protein kinase RNA-like endoplasmic reticulum (ER) kinase (PERK) pathway by increasing the phosphorylation levels of PERK and eukaryotic initiation factor 2a (eIF2α), and enhanced activating transcription factor 4 (ATF4) in an energy-dependent manner. In addition, GSK2656157-an inhibitor of PERK-effectively inhibited the effect of Li-ESWT on the phosphorylation of PERK, eIF2α, and the expression of ATF4. Furthermore, silencing ATF4 dramatically attenuated the effect of Li-ESWT on the expression of BDNF, but had no effect on hypoxia-inducible factor (HIF)1α or glial cell-derived neurotrophic factor (GDNF) in Schwann cells. In conclusion, our findings shed new light on the underlying mechanisms by which Li-ESWT may stimulate the expression of BDNF through activation of PERK/ATF4 signaling pathway. This information may help to refine the use of Li-ESWT to further improve its clinical efficacy.

Low-Intensity Extracorporeal Shock Wave Therapy Enhances Brain-Derived Neurotrophic Factor Expression through PERK/ATF4 Signaling Pathway

PubMed Central

Wang, Bohan; Ning, Hongxiu; Reed-Maldonado, Amanda B.; Zhou, Jun; Ruan, Yajun; Zhou, Tie; Wang, Hsun Shuan; Oh, Byung Seok; Banie, Lia; Lin, Guiting; Lue, Tom F.

2017-01-01

Low-intensity extracorporeal shock wave therapy (Li-ESWT) is used in the treatment of erectile dysfunction, but its mechanisms are not well understood. Previously, we found that Li-ESWT increased the expression of brain-derived neurotrophic factor (BDNF). Here we assessed the underlying signaling pathways in Schwann cells in vitro and in penis tissue in vivo after nerve injury. The result indicated that BDNF were significantly increased by the Li-ESWT after nerve injury, as well as the expression of BDNF in Schwann cells (SCs, RT4-D6P2T) in vitro. Li-ESWT activated the protein kinase RNA-like endoplasmic reticulum (ER) kinase (PERK) pathway by increasing the phosphorylation levels of PERK and eukaryotic initiation factor 2a (eIF2α), and enhanced activating transcription factor 4 (ATF4) in an energy-dependent manner. In addition, GSK2656157—an inhibitor of PERK—effectively inhibited the effect of Li-ESWT on the phosphorylation of PERK, eIF2α, and the expression of ATF4. Furthermore, silencing ATF4 dramatically attenuated the effect of Li-ESWT on the expression of BDNF, but had no effect on hypoxia-inducible factor (HIF)1α or glial cell-derived neurotrophic factor (GDNF) in Schwann cells. In conclusion, our findings shed new light on the underlying mechanisms by which Li-ESWT may stimulate the expression of BDNF through activation of PERK/ATF4 signaling pathway. This information may help to refine the use of Li-ESWT to further improve its clinical efficacy. PMID:28212323

Extracorporeal Shock Wave Treatment (ESWT) enhances the in vitro-induced differentiation of human tendon-derived stem/progenitor cells (hTSPCs)

PubMed Central

Leone, Laura; Raffa, Salvatore; Vetrano, Mario; Ranieri, Danilo; Malisan, Florence; Scrofani, Cristina; Vulpiani, Maria Chiara; Ferretti, Andrea; Torrisi, Maria Rosaria; Visco, Vincenzo

2016-01-01

Extracorporeal shock wave therapy (ESWT) is a non-invasive and innovative technology for the management of specific tendinopathies. In order to elucidate the ESWT-mediated clinical benefits, human Tendon-derived Stem/Progenitor cells (hTSPCs) explanted from 5 healthy semitendinosus (ST) and 5 ruptured Achilles (AT) tendons were established. While hTSPCs from the two groups showed similar proliferation rates and stem cell surface marker profiles, we found that the clonogenic potential was maintained only in cells derived from healthy donors. Interestingly, ESWT significantly accelerated hTSPCs differentiation, suggesting that the clinical benefits of ESWT may be ascribed to increased efficiency of tendon repair after injury. PMID:26843618

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.

Treatment of chronic plantar fasciopathy with extracorporeal shock waves (review)

PubMed Central

2013-01-01

There is an increasing interest by doctors and patients in extracorporeal shock wave therapy (ESWT) for chronic plantar fasciopathy (PF), particularly in second generation radial extracorporeal shock wave therapy (RSWT). The present review aims at serving this interest by providing a comprehensive overview on physical and medical definitions of shock waves and a detailed assessment of the quality and significance of the randomized clinical trials published on ESWT and RSWT as it is used to treat chronic PF. Both ESWT and RSWT are safe, effective, and technically easy treatments for chronic PF. The main advantages of RSWT over ESWT are the lack of need for any anesthesia during the treatment and the demonstrated long-term treatment success (demonstrated at both 6 and 12 months after the first treatment using RSWT, compared to follow-up intervals of no more than 12 weeks after the first treatment using ESWT). In recent years, a greater understanding of the clinical outcomes in ESWT and RSWT for chronic PF has arisen in relationship not only in the design of studies, but also in procedure, energy level, and shock wave propagation. Either procedure should be considered for patients 18 years of age or older with chronic PF prior to surgical intervention. PMID:24004715

Histomorphologic evaluation of extracorporeal shock wave therapy of the fourth metatarsal bone and the origin of the suspensory ligament in horses without lameness.

PubMed

Bischofberger, Andrea S; Ringer, Simone K; Geyer, Hans; Imboden, Isabel; Ueltschi, Gottlieb; Lischer, Christoph J

2006-04-01

To determine via histologic examination and scintigraphy the effect of focused extracorporeal shock wave therapy (ESWT) on normal bone and the bone-ligament interface in horses. 6 horses without lameness. Origins of the suspensory ligament at the metacarpus (35-mm probe depth) and fourth metatarsal bone (5-mm probe depth) were treated twice (days 0 and 16) with 2,000 shocks (energy flux density, 0.15 mJ/mm2). One forelimb and 1 hind limb were randomly treated, and the contralateral limbs served as nontreated controls. Bone scans were performed on days -1 (before ESWT), 3, 16, and 19. Histomorphologic studies of control and treated tissues were performed on day 30. ESWT significantly increased the number of osteoblasts but caused no damage to associated soft tissue structures and did not induce cortical microfractures. A significant correlation between osteoblast numbers and radiopharmaceutical uptake was noticed on lateral views of the hind limb on days 3 and 16 and on caudal views of the forelimb on day 3. Results suggested that ESWT has the potential to increase osteoblast numbers in horses. The correlation between increased osteoblast numbers and radio-pharmaceutical uptake 3 days and 16 days after the first ESWT suggested that stimulation of osteogenesis occurred soon after ESWT. No damage to bone or the bone-ligament interface should occur at the settings used in this study, and ESWT can therefore be administered safely in horses.

Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes.

PubMed

Yalcin, E; Keskin Akca, A; Selcuk, B; Kurtaran, A; Akyuz, M

2012-02-01

Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave therapy (ESWT) offers a nonsurgical option in addition to stretching exercises, heel cups, NSAI, and corticosteroid injections. This study aimed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes. The study involved 108 patients with heel pain and radiologically diagnosed heel spurs. All patients underwent ESWT once a week for 5 weeks at the clinic. Each patient received 2,000 impulses of shock waves, starting with 0.05 mJ/mm2 (1.8 bar) and increasing to 0.4 mJ/mm2 (4.0 bar). Standard radiographies of the affected heels were obtained before and after the therapy. Clinical results demonstrated excellent (no pain) in 66.7% of the cases, good (50% of pain reduced) in 15.7% of the cases, and unsatisfactory (no reduction in pain) in 17.6%. After five ESWT treatments, no patients who received shock wave applications had significant spur reductions, but 19 patients (17.6%) had a decrease in the angle of the spur, 23 patients (21.3%) had a decrease in the dimensions of the spur, and one patient had a broken spur. Therefore, results showed no correlation between clinical outcome and radiologic changes. The present study supports the finding that even with no radiologic change after ESWT therapy, the therapy produces significant effects in reducing patients' complaints about heel spurs.

ESWT and alendronate sodium demonstrate equal protective effects in osteoarthritis of the knee

NASA Astrophysics Data System (ADS)

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

2016-01-01

This study compared the effects of extracorporeal shock wave therapy (ESWT) and alendronate sodium (alendronate) in osteoarthritis (OA) of rat knees. The control group was subjected to a sham surgery and did not receive either ESWT or alendronate treatment. The OA group underwent anterior cruciate ligament transection (ACLT) and medial meniscectomy (MM) surgery and did not receive either ESWT or alendronate. The ESWT group underwent ACLT and MM surgery and received ESWT after the surgery. The alendronate group received alendronate after ACLT and MM surgery. The evaluations included radiograph, bone mineral density (BMD), serum C-telopeptide collagen II (CTX-II), cartilage oligomeric protein (COMP), alkaline phosphatase and osteocalcin, histopathological examination and immunohistochemical analysis. Radiographs at 12 weeks showed pronounced OA changes in the OA group. The BMD values, CTX-II, COMP, alkaline phosphatase and osteocalcin showed no significant difference between ESWT and alendronate groups. In histopathology, the Mankin and Safranin O scores significantly increased in the OA, ESWT and alendronate groups, but without any significant difference between the ESWT and alendronate groups. In immunohistochemical analysis, the von Willebrand factor (vWF), vascular endothelial factor (VEGF), soluble vascular cell adhesion molecule (sVCAM), proliferating cell nuclear antigen (PCNA), bone morphogenetic protein 2 (BMP-2), and osteocalcin expressions in articular cartilage and subchondral bone showed a significant decrease in the OA group, but no difference was noted between the ESWT and alendronate groups. In conclusion, ESWT and alendronate sodium demonstrate equal protective effects from developing osteoarthritis of the knee in rats.

Long-Term Outcome of Low-Energy Extracorporeal Shock Wave Therapy for Plantar Fasciitis: Comparative Analysis According to Ultrasonographic Findings

PubMed Central

Park, Jong-Wan; Yoon, Kyungjae; Chun, Kwang-Soo; Lee, Joon-Youn; Park, Hee-Jin; Lee, So-Yeon

2014-01-01

Objective To investigate the long-term effect of low-energy extracorporeal shock wave therapy (ESWT) for plantar fasciitis (PF) according to ultrasonography (US) findings. Methods Thirty feet of 25 patients with clinical diagnosis of PF were enrolled and divided into two groups (Apparent-US and Uncertain-US) according to US findings, such as plantar fascia thickening or hypoechogenicity. Inclusion criteria were symptom duration >6 months and a fair or poor grade in Roles-Maudsley score (RMS). ESWT (0.10 mJ/mm2, 600 shocks) was given once a week for 6 weeks. Numeric rating scale (NRS) and RMS were evaluated prior to each ESWT session, at short-term follow-up (one week after all ESWT sessions) and long-term follow-up telephone interview (mean 24 months after ESWT). Good and excellent grade in RMS were considered as treatment success. Results Repeated measure ANOVA demonstrated that NRS significantly decreased with time after ESWT up to the long-term follow-up (time effect, p<0.001) without group-time interaction (p=0.641), indicating that ESWT equally decreased pain in both groups. Overall success rate was 63.3% (short-term follow-up) and 80.0% (long-term follow-up). In comparative analysis between groups, success rate of Apparent-US and Uncertain-US at short-term follow-up was 61.9% and 66.7%, respectively, and 85.7% and 66.7%, respectively, at long-term follow-up. Conclusion If other causes of heel pain are ruled out through meticulous physical examination and ultrasonography, low-energy ESWT in PF seems to be beneficial regardless of US findings. In terms of success rate, however, long-term outcome of Apparent-US appears to be superior to Uncertain-US. PMID:25229032

Repetitive shock wave therapy improves muscular microcirculation.

PubMed

Kisch, Tobias; Wuerfel, Waldemar; Forstmeier, Vinzent; Liodaki, Eirini; Stang, Felix H; Knobloch, Karsten; Mailaender, Peter; Kraemer, Robert

2016-04-01

Extracorporeal shock wave therapy (ESWT) is mainly applied in tendon as well as bone problems based on stem-cell activation and healing acceleration. The effect of ESWT on muscle tissue is much less understood to date. However, from a clinical perspective, muscle injuries are of distinct interest especially in elite athletes such as soccer players. A total of 26 rats were randomized into two groups. Group A received a single application of high-energetic focused ESWT (0.3 mJ/mm(2), 4 Hz, 1000 impulses, 10 J), whereas group B underwent the same procedure every 10 min for three sessions (3 × 0.3 mJ/mm(2), 4 Hz, 3 × 1000 impulses, totaling 30 J). Blood flow at a depth of 8 mm was measured continuously and noninvasively by a combined Laser-Doppler-Imaging and photospectrometric technique (Oxygen-to-see, O2C, LEA Medizintechnik, Germany). One minute after the application of high-energy ESWT blood flow in group A increased by 16.5% (P = 0.007). Thereafter, it decreased from minute 2 after application and remained significantly unchanged to baseline value until the end of the measuring period at 50 min (P = 0.550). Group B showed a similar significant increase in blood flow of 16.4% (P = 0.049) and a decrease afterward, too. After the second focused ESWT blood flow was boosted to 26.6% (P = 0.004), remaining significantly elevated until the third application was initiated. Muscular blood flow was increased to 29.8% after the third focused ESWT (P < 0.001), remaining significantly increased for another 10 min. Focused ESWT enhances blood flow in the muscle of rats. Moreover, repetitive ESWT extended this beneficial effect. Copyright © 2016 Elsevier Inc. All rights reserved.

Extracorporeal shock wave therapy in Peyronie's disease: results of a placebo-controlled, prospective, randomized, single-blind study.

PubMed

Hatzichristodoulou, Georgios; Meisner, Christoph; Gschwend, Jürgen E; Stenzl, Arnulf; Lahme, Sven

2013-11-01

Extracorporeal shock wave therapy (ESWT) for treatment of Peyronie's disease (PD) is controversial. To study the efficacy of ESWT by a placebo-controlled, randomized trial. Patients with PD (n=102) were randomly assigned (n=51) to each group (ESWT or placebo). All patients were given 6 weekly treatments. Patients in the ESWT-group received 2,000 shock waves per session, using the Piezoson 100 lithotripter (Richard Wolf, Knittlingen, Germany). Patients in the placebo-group were treated with interposition of a plastic membrane, which prevented any transmission of shock waves. Primary end point was decrease of pain between baseline and after 4 weeks follow-up. Secondary end points were changes in deviation, plaque size, and sexual function. Pain was assessed by a visual analog scale. Deviation was measured by a goniometer after artificial erection using Alprostadil (Viridal®, Schwarz Pharma, Monheim, Germany). Plaque size was measured with a ruler and sexual function assessed by a scale regarding the ability to perform sexual intercourse. Overall, only 45 patients experienced pain at baseline. In the subgroup analysis of these patients, pain decreased in 17/20 (85.0%) patients in the ESWT group and 12/25 (48.0%) patients in the placebo group (P=0.013, relative risk [RR]=0.29, 95% confidence interval: 0.09-0.87). Penile deviation was not reduced by ESWT (P=0.66) but worsened in 20/50 (40%) and 12/49 (24.5%) patients of the ESWT and placebo-group, respectively (P=0.133). Plaque size reduction was not different between the two groups (P=0.33). Additional, plaque size increased in five patients (10.9%) of the ESWT group only. An improvement in sexual function could not be verified (P=0.126, RR=0.46). Despite some potential benefit of ESWT in regard to pain reduction, it should be emphasized that pain usually resolves spontaneously with time. Given this and the fact that deviation may worsen with ESWT, this treatment cannot be recommended. © 2013 International Society for Sexual Medicine.

Low-intensity extracorporeal shock wave therapy for erectile dysfunction after radical prostatectomy: a review of preclinical studies.

PubMed

Zou, Zi-Jun; Liang, Jia-Yu; Liu, Zhi-Hong; Gao, Rui; Lu, Yi-Ping

2018-02-01

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel treatment for erectile dysfunction (ED). Its ability to improve erectile function has been shown in patients with vasculogenic ED by many randomized-controlled trials against sham procedures. However, the role of LI-ESWT in ED caused by radical prostatectomy (RP) is still questionable because this type of ED was excluded from nearly all clinical studies; it has been investigated in only a few small single-arm trials. This review summarizes preclinical studies on mechanisms of action of LI-ESWT for ED and neurological diseases to explore the potential of this treatment for nerve-impaired ED after RP.

Positive Effects of Extracorporeal Shock Wave Therapy on Spasticity in Poststroke Patients: A Meta-Analysis.

PubMed

Guo, Peipei; Gao, Fuqiang; Zhao, Tingting; Sun, Wei; Wang, Bailiang; Li, Zirong

2017-11-01

Spasticity is a common and serious complication following a stroke, and many clinical research have been conducted to evaluate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity in poststroke patients. This meta-analysis aimed to evaluate the therapeutic effect on decreasing spasticity caused by a stroke immediately and 4 weeks after the application of shock wave therapy. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for relevant studies through November 2016 using the following item: (Hypertonia OR Spasticity) and (Shock Wave or ESWT) and (Stroke). The outcomes were evaluated by Modified Ashworth Scale (MAS) grades and pooled by Stata 12.0 (Stata Corp, College Station, TX, USA). Six studies consisting of 9 groups were included in this meta-analysis. The MAS grades immediately after ESWT were significantly improved compared with the baseline values (standardized mean difference [SMD], -1.57; 95% confidence intervals [CIs], -2.20, -.94). Similarly, the MAS grades judged at 4 weeks after ESWT were also showed to be significantly lower than the baseline values (SMD, -1.93; 95% CIs, -2.71, -1.15). ESWT for the spasticity of patients after a stroke is effective, as measured by MAS grades. Moreover, no serious side effects were observed in any patients after shock wave therapy. Nevertheless, our current study with some limitations such as the limited sample size only provided limited quality of evidence; confirmation from a further systematic review or meta-analysis with large-scale, well-designed randomized control trials is required. Copyright © 2017. Published by Elsevier Inc.

Low-energy extracorporeal shock wave therapy for promotion of vascular endothelial growth factor expression and angiogenesis and improvement of locomotor and sensory functions after spinal cord injury.

PubMed

Yahata, Kenichiro; Kanno, Haruo; Ozawa, Hiroshi; Yamaya, Seiji; Tateda, Satoshi; Ito, Kenta; Shimokawa, Hiroaki; Itoi, Eiji

2016-12-01

OBJECTIVE Extracorporeal shock wave therapy (ESWT) is widely used to treat various human diseases. Low-energy ESWT increases expression of vascular endothelial growth factor (VEGF) in cultured endothelial cells. The VEGF stimulates not only endothelial cells to promote angiogenesis but also neural cells to induce neuroprotective effects. A previous study by these authors demonstrated that low-energy ESWT promoted expression of VEGF in damaged neural tissue and improved locomotor function after spinal cord injury (SCI). However, the neuroprotective mechanisms in the injured spinal cord produced by low-energy ESWT are still unknown. In the present study, the authors investigated the cell specificity of VEGF expression in injured spinal cords and angiogenesis induced by low-energy ESWT. They also examined the neuroprotective effects of low-energy ESWT on cell death, axonal damage, and white matter sparing as well as the therapeutic effect for improvement of sensory function following SCI. METHODS Adult female Sprague-Dawley rats were divided into the SCI group (SCI only) and SCI-SW group (low-energy ESWT applied after SCI). Thoracic SCI was produced using a New York University Impactor. Low-energy ESWT was applied to the injured spinal cord 3 times a week for 3 weeks after SCI. Locomotor function was evaluated using the Basso, Beattie, and Bresnahan open-field locomotor score for 42 days after SCI. Mechanical and thermal allodynia in the hindpaw were evaluated for 42 days. Double staining for VEGF and various cell-type markers (NeuN, GFAP, and Olig2) was performed at Day 7; TUNEL staining was also performed at Day 7. Immunohistochemical staining for CD31, α-SMA, and 5-HT was performed on spinal cord sections taken 42 days after SCI. Luxol fast blue staining was performed at Day 42. RESULTS Low-energy ESWT significantly improved not only locomotion but also mechanical and thermal allodynia following SCI. In the double staining, expression of VEGF was observed in NeuN-, GFAP-, and Olig2-labeled cells. Low-energy ESWT significantly promoted CD31 and α-SMA expressions in the injured spinal cords. In addition, low-energy ESWT significantly reduced the TUNEL-positive cells in the injured spinal cords. Furthermore, the immunodensity of 5-HT-positive axons was significantly higher in the animals treated by low-energy ESWT. The areas of spared white matter were obviously larger in the SCI-SW group than in the SCI group, as indicated by Luxol fast blue staining. CONCLUSIONS The results of this study suggested that low-energy ESWT promotes VEGF expression in various neural cells and enhances angiogenesis in damaged neural tissue after SCI. Furthermore, the neuroprotective effect of VEGF induced by low-energy ESWT can suppress cell death and axonal damage and consequently improve locomotor and sensory functions after SCI. Thus, low-energy ESWT can be a novel therapeutic strategy for treatment of SCI.

A comparison of the effectiveness of radial extracorporeal shock wave therapy and ultrasound therapy in the treatment of chronic plantar fasciitis: a randomized controlled trial.

PubMed

Konjen, Nipaporn; Napnark, Tapakorn; Janchai, Siriporn

2015-01-01

To compare the effectiveness ofradial extracorporeal shock wave therapy (rSWET) and ultrasound therapy (US) in the treatment of chronic plantar fasciitis. Randomized controlled trial. Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. Thirty patients who were diagnosed with plantar fasciitis for at least 3 months and who had not responded to other forms of conservative treatment were recruited for this study. They were randomly divided into two groups of 15 patients. The rESWT group was treated with 1 session per week and the US group with 3 sessions per week, with both groups undergoing a total of 6 consecutive weeks of treatment. Visual analog scale (VAS) assessments were performed before and after treatment at 1, 3, 6, 12, and 24 weeks. The mobility subscale of the plantar fasciitis pain and disability scale (PFPS) was measured before and after treatment. Patient satisfaction was evaluated at the conclusion of the 6-week treatment protocol. VAS pain intensity scores were significantly decreased in both groups (p < 0.001), when measured after treatment at 1, 3, 6, 12, and 24 weeks. The VAS pain scores for the rESWT group dropped significantly more than those of the US group (p < 0.001). At the end of treatment, the PFPS mobility subscale scores in both groups were significantly decreased (p < 0.001). Similar to the VAS pain score outcome, the PFPS mobility subscale score for the rESWT group decreased significantly more than that of the US group (p < 0.001). Patient satisfaction was significantly higher in the rESWT group, relative to the US group (p = 0.025). In chronic plantar fasciitis treatment, both rESWT and US were found to be effective in reducing pain and increasing mobility; however, statistical analysis showed that rESWT is significantly more effective than US.

Assessment of the treatment costs of extracorporeal shock wave therapy versus surgical treatment for shoulder diseases.

PubMed

Haake, M; Rautmann, M; Wirth, T

2001-01-01

To determine the actual costs of extracorporeal shock wave therapy (ESWT) in patients with tendinitis of the supraspinatus muscle. A comparison of the costs of surgical treatment versus the costs for ESWT was made. The total accrued costs were determined 12 weeks after intervention, using a sample group of 60 patients with calcifying or noncalcifying tendinitis of the supraspinatus muscle. The costs per case ranged from EUR 2,700 to EUR 4,300 per patient for ESWT and from EUR 13,400 to EUR 23,450 for surgical treatment, dependent on the method of calculation. Approximately 65% of the per-patient cost is attributable to productivity losses in the workplace. In comparable short-term results, costs for operative treatment are 5-7 times higher than for ESWT. The greater trauma caused by an operative procedure leads to patients being off work for a longer period and thus a correspondingly higher social economic burden.

Extracorporeal shock wave therapy in periodontics: A new paradigm.

PubMed

Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K

2014-05-01

The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome.

Study protocol: a double blind randomised control trial of high volume image guided injections in Achilles and patellar tendinopathy in a young active population.

PubMed

Barker-Davies, Robert M; Nicol, Alastair; McCurdie, I; Watson, James; Baker, Polly; Wheeler, Patrick; Fong, Daniel; Lewis, Mark; Bennett, Alexander N

2017-05-22

Chronic tendinopathy is a significant problem particularly in active populations limiting sporting and occupational performance. The prevalence of patellar tendinopathy in some sports is near 50% and the incidence of lower limb tendinopathy is 1.4% p.a. in the UK Military. Management includes isometric, eccentric, heavy slow resistance exercises and extracorporeal shockwave therapy (ESWT). Often these treatments are inadequate yet there is no good evidence for injection therapies and success rates from surgery can be as low as 50%. High Volume Image Guided Injection (HVIGI) proposes to strip away the neovascularity and disrupt the nerve ingrowth seen in chronic cases and has shown promising results in case series. This study aims to investigate the efficacy of HVIGI in a randomised controlled trial (RCT). RCT comparing 40ml HVIGI, with or without corticosteroid, with a 3ml local anaesthetic sham-control injection. Ninety-six participants will be recruited. male, 18-55 years old, chronic Achilles or patellar tendinopathy of at least 6 months, failed conservative management including ESWT, and Ultrasound (US) evidence of neovascularisation, tendon thickening and echogenic changes. Outcome measures will be recorded at baseline, 6 weeks, 3, 6 and 12 months. Primary outcome measures include The Victoria Institute of Sport Assessments for Achilles and patellar tendinopathy (VISA-A and VISA-P) and VAS pain. Secondary outcome measures include Modified Ohberg score, maximum tendon diameter and assessment of hypoechoic appearance on US, and Functional Activity Assessment. Despite previous interventional trials and reviews there is still insufficient evidence to guide injectable therapy for chronic tendinopathy that has failed conservative treatment. The scant evidence available suggests HVIGI has the greatest potential however there is no level one RCT evidence to support this. Investigating the efficacy of HVIGI against control in a RCT and separating the effect of HVIGI and corticosteroid will add high level evidence to the management of chronic tendinopathy resistant to conservative treatment. EudraCT: 2015-003587-36 3 Dec 2015.

Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial

PubMed Central

2012-01-01

Background There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in calcific tendinopathy of the rotator cuff, but the best current evidence does not support its use in non-calcifying tendinopathy. We conducted a randomized placebo-controlled trial to investigate the efficacy and safety of low energy ESWT for non-calcifying tendinopathy of the rotator cuff. Methods 20 patients with non-calcifying supraspinatus tendinopathy (NCST) were randomized to an active or a sham treatment group. Physical, blood, roentgenographic, and MRI examinations of the shoulder were conducted to verify that patients met the inclusion and exclusion criteria. These examinations were repeated six and twelve weeks after treatments. Effectiveness was determined by comparison of the mean improvement in the Constant and Murley score (CMS) between the treatment and the placebo groups at three months. Safety was assessed by analyzing the number and severity of adverse events. Results All the patients completed the investigation protocol. At the final follow-up, significant improvement in the total CMS score and most of the CMS subscales was observed in the ESWT group when compared to the baseline values. Significantly higher total CMS, and significantly higher scores for CMS pain and ROM were observed in the ESWT group when compared to the placebo. No serious adverse events were noted after ESWT. Conclusions Patients suffering from NCST may benefit from low energy ESWT, at least in short-term. The application protocol of ESWT is likely to play a key-role in a successful treatment. Future investigations should be undertaken on the long-term effects of this technique for the treatment of NCST. Trial registration Current Controlled Trials ISRCTN41236511 PMID:22672772

Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial.

PubMed

Moghtaderi, Alireza; Khosrawi, Saeid; Dehghan, Farnaz

2014-01-01

Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone. The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session. Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P < 0.001) and control (P = 0.01) groups, eight weeks after treatment, but there were significantly better results in the case group. The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.

Treatment Outcomes of Corticosteroid Injection and Extracorporeal Shock Wave Therapy as Two Primary Therapeutic Methods for Acute Plantar Fasciitis: A Prospective Randomized Clinical Trial.

PubMed

Mardani-Kivi, Mohsen; Karimi Mobarakeh, Mahmoud; Hassanzadeh, Zabihallah; Mirbolook, Ahmadreza; Asadi, Kamran; Ettehad, Hossein; Hashemi-Motlagh, Keyvan; Saheb-Ekhtiari, Khashayar; Fallah-Alipour, Keyvan

2015-01-01

The outcome of corticosteroid injection (CSI) and extracorporeal shock wave therapy (ESWT) as primary treatment of acute plantar fasciitis has been debated. The purpose of the present study was to evaluate and compare the therapeutic effects of CSI and ESWT in patients with acute (<6-week duration) symptomatic plantar fasciitis. Of the 116 eligible patients, 68 were randomized to 2 equal groups of 34 patients, each undergoing either ESWT or CSI. The ESWT method included 2000 impulses with energy of 0.15 mJ/mm(2) and a total energy flux density of 900 mJ/mm(2) for 3 consecutive sessions at 1-week intervals. In the CSI group, 40 mg of methyl prednisolone acetate plus 1 mL of lidocaine 2% was injected into the maximal tenderness point at the inframedial calcaneal tuberosity. The success and recurrence rates and pain intensity measured using the visual analog scale, were recorded and compared at the 3-month follow-up visit. The pain intensity had reduced significantly in all patients undergoing either technique. However, the value and trend of pain reduction in the CSI group was significantly greater than those in the ESWT group (p < .0001). In the ESWT and CSI groups, 19 (55.9%) and 5 (14.7%) patients experienced treatment failure, respectively. Age, gender, body mass index, and recurrence rate were similar between the 2 groups (p > .05). Both ESWT and CSI can be used as the primary and/or initial treatment option for treating patients with acute plantar fasciitis; however, the CSI technique had better therapeutic outcomes. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A meta-analysis of extracorporeal shock wave therapy for Peyronie's disease.

PubMed

Gao, L; Qian, S; Tang, Z; Li, J; Yuan, J

2016-09-01

The efficiency of extracorporeal shock wave therapy (ESWT) for Peyronie's disease (PD) has been controversial for a very long time. We aimed to evaluate the efficiency of ESWT for PD and provide possible evidence on the basis of a meta-analysis of existing comparative studies. All controlled studies, including randomized controlled trials (RCTs), cohort studies and case-control studies, that focused on the efficiency of ESWT for PD, were prospectively identified through comprehensive searches of PubMed, the Cochrane Library and Embase databases. We conducted a meta-analysis of these studies. Six studies including 443 patients were selected for the meta-analysis. Pooling data of these studies showed that ESWT could significantly increase the percentage of men with lessening of penile plaques (odds ratio (OR) 2.07, 95% confidence interval (CI) 1.11-3.85, P=0.02), relief of pain (OR 4.46, 95% CI 2.29-8.68, P<0.0001) and complete remission of pain (OR 5.86, 95% CI 2.66-12.92, P<0.0001). However, insignificant differences were found in improvement of penile curvature (OR 1.88, 95% CI 0.97-3.65, P=0.06) and sexual function (OR 2.22, 95% CI 0.69-7.11, P=0.18) between ESWT and placebo groups. Further, similar results were shown for sensitivity and publication bias analysis when only RCTs were included. However, sporadic complications caused by ESWT were reported, but no patient needed additional treatment aside from conservative observation. ESWT may be an effective and safe treatment for lessening of penile plaques and relieving pain for men with PD, but not for improving of penile curvature and sexual function.

Extracorporeal shock wave therapy (ESWT) in urology: a systematic review of outcome in Peyronie's disease, erectile dysfunction and chronic pelvic pain.

PubMed

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

2017-01-01

The objective was to evaluate high-level evidence studies of extracorporeal shock wave therapy (ESWT) for urological disorders. We included randomized controlled trials reporting outcomes of ESWT in urology. Literature search on trials published in English using EMBASE, Medline and PubMed was carried out. The systematic review was performed according to PRISMA guidelines. We identified 10 trials on 3 urological indications. Two of 3 trials on Peyronie's disease (PD) involving 238 patients reported improvement in pain; however, no clinical significant changes in penile deviation and plaque size were observed. Four studies on erectile dysfunction (ED) including 337 participants were included. Using International Index of Erectile Function (IIEF-EF) and erectile hardness scale (EHS) data suggested a significant positive effect of ESWT in phosphodiesterase-5 inhibitor (PDE-5i) responders in 2 of 4 trials and 3 of 4 trials, respectively. Three studies on chronic pelvic pain (CPP) engaging 200 men reported positive changes in National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). There was considerable heterogeneity between trials both with regard to treatment techniques and outcome measures, making it difficult to compare results. ESWT may resolve pain in PD patients, while evidence for reducing curvature and plaques size is poor. Effects of ESWT on IIEF in ED patients are inconsistent; however, data on EHS does imply that the treatment potentially may recover natural erection in PDE-5i responders. ESWT seems to be able to resolve pain in CPP patients in the short term. In all three disease entities, long-term outcome data are still warranted.

Short-term outcomes of extracorporeal shock wave therapy for the treatment of chronic non-calcific tendinopathy of the supraspinatus: a double-blind, randomized, placebo-controlled trial.

PubMed

Galasso, Olimpio; Amelio, Ernesto; Riccelli, Daria Anna; Gasparini, Giorgio

2012-06-06

There is evidence supporting the use of extracorporeal shock wave therapy (ESWT) in calcific tendinopathy of the rotator cuff, but the best current evidence does not support its use in non-calcifying tendinopathy. We conducted a randomized placebo-controlled trial to investigate the efficacy and safety of low energy ESWT for non-calcifying tendinopathy of the rotator cuff. 20 patients with non-calcifying supraspinatus tendinopathy (NCST) were randomized to an active or a sham treatment group. Physical, blood, roentgenographic, and MRI examinations of the shoulder were conducted to verify that patients met the inclusion and exclusion criteria. These examinations were repeated six and twelve weeks after treatments. Effectiveness was determined by comparison of the mean improvement in the Constant and Murley score (CMS) between the treatment and the placebo groups at three months. Safety was assessed by analyzing the number and severity of adverse events. All the patients completed the investigation protocol. At the final follow-up, significant improvement in the total CMS score and most of the CMS subscales was observed in the ESWT group when compared to the baseline values. Significantly higher total CMS, and significantly higher scores for CMS pain and ROM were observed in the ESWT group when compared to the placebo. No serious adverse events were noted after ESWT. Patients suffering from NCST may benefit from low energy ESWT, at least in short-term. The application protocol of ESWT is likely to play a key-role in a successful treatment. Future investigations should be undertaken on the long-term effects of this technique for the treatment of NCST. Current Controlled Trials ISRCTN41236511.

Investigating the Effect of Extracorporeal Shock Wave Therapy on Reducing Chronic Pain in Patients with Pes Anserine Bursitis: A Randomized, Clinical- Controlled Trial

PubMed Central

Khosrawi, Saeid; Taheri, Parisa; Ketabi, Marziyeh

2017-01-01

Background: Knee pain, is one of the most common causes of patients’ referring to physiatric clinics, and several factors, are involved in its creation. One of these factors is pes anserine bursitis (PAB) for which various treatment methods are used. This study aims to investigate the effect of this method on reducing chronic pain in these patients. Materials and Methods: This clinical trial was conducted in 2013- 2014 on patients with PAB referring to academic, physical medicine clinics. The patients with chronic PAB (pain duration more than 3 months), who were refractory to conservative treatments, were randomly divided into two 20-member experimental groups (extracorporeal shock wave therapy [ESWT] and sham ESWT). Pain scores of all patients were measured using the Visual Analog Scale (VAS) and McGill Pain Questionnaire (MPQ) (total and present pain indexes [TPIs and PPIs]) before intervention, immediately after intervention (3rd week), and after 8 weeks. The pain scores were then compared and statistically analyzed. Results: In the ESWT group, the mean patient pain score of the VAS and TPI in MPQ were significantly lower than in the sham ESWT group immediately after intervention (3rd week): P =0.02, P = 0.04 respectively; and 8 weeks after the end of treatment: P =0.01, P = 0.000. Moreover, the PPI in both groups had significantly decreased over time, although in ESWT group this decrement was significantly more than sham ESWT group (P < 0.001). Conclusion: The results showed that ESWT could be effective in reducing the pain and treating PAB. PMID:28626745

Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis.

PubMed

Lee, Sang Seok; Kang, Sangkuk; Park, Noh Kyoung; Lee, Chan Woo; Song, Ho Sup; Sohn, Min Kyun; Cho, Kang Hee; Kim, Jung Hwan

2012-10-01

To evaluate the effectiveness of initial extracorporeal shock wave therapy (ESWT) for patients newly diagnosed with lateral or medial epicondylitis, compared to local steroid injection. An analysis was conducted of twenty-two patients who were newly confirmed as lateral or medial epicondylitis through medical history and physical examination. The ESWT group (n=12) was treated once a week for 3 weeks using low energy (0.06-0.12 mJ/mm(2), 2,000 shocks), while the local steroid injection group (n=10) was treated once with triamcinolone 10 mg mixed with 1% lidocaine solution. Nirschl score and 100 point score were assessed before and after the treatments of 1st, 2nd, 4th and 8th week. And Roles and Maudsley score was assessed one and eight weeks after the treatments. Both groups showed significant improvement in Nirschl score and 100 point score during the entire period. The local steroid injection group improved more in Nirschl score at the first week and in 100 point score at the first 2 weeks, compared to those of the ESWT group. But the proportion of excellent and good grades of Roles and Maudsley score in the ESWT group increased more than that of local steroid injection group by the final 8th week. The ESWT group improved as much as the local steroid injection group as treatment for medial and lateral epicondylitis. Therefore, ESWT can be a useful treatment option in patients for whom local steroid injection is difficult.

Extracorporeal shockwave therapy in calcifying tendinitis of the shoulder.

PubMed

Farr, Sebastian; Sevelda, Florian; Mader, Patrick; Graf, Alexandra; Petje, Gert; Sabeti-Aschraf, Manuel

2011-12-01

Strategies for extracorporeal shockwave therapy in calcifying tendinitis of the rotator cuff vary concerning quantity of sessions and doses. The purpose of this prospective pilot study was to determine the difference between the outcome of a single high-dosage extracorporeal shockwave therapy and two sessions of low-dosage extracorporeal shockwave therapy. This study compared a single high-level middle-energetic extracorporeal shockwave therapy (0.3 mJ/mm(2)) with a low-level middle-energetic extracorporeal shockwave therapy applied twice in a weekly interval (0.2 mJ/mm(2)). Thirty patients that suffered from calcifying tendinitis for at least 6 months received navigated, fluoroscopy-guided extracorporeal shockwave therapy. The gain of Constant Murley Score, Visual Analogue Scale during state of rest and weight-bearing situations ("stress") and radiographic progress was documented 6 and 12 weeks after therapy. In both groups, a significant reduction in pain during stress and improvement of function was observed. In contrast, no significant reduction in pain during rest was observed. No significant difference between both groups concerning reduction in the calcific deposit after 6 weeks was detected. Group B showed minor advantages in radiographical improvement after 12 weeks. In 36% of the patients, the calcific deposit completely dissoluted after 12 weeks. This pilot study indicates that a single high-level extracorporeal shockwave therapy may be as effective as two applications of a lower-dosed extracorporeal shockwave therapy for calcifying tendinitis. An effective single-session strategy could reduce treatment time, material costs and healthcare expenses and ionizing radiation in case of fluoroscopy guidance.

Extracorporeal shock wave therapy in periodontics: A new paradigm

PubMed Central

Venkatesh Prabhuji, Munivenkatappa Lakshmaiah; Khaleelahmed, Shaeesta; Vasudevalu, Sujatha; Vinodhini, K.

2014-01-01

The quest for exploring new frontiers in the field of medical science for efficient and improved treatment modalities has always been on a rise. Extracorporeal shock wave therapy (ESWT) has been enormously used in medical practice, principally, for the management of urolithiasis, cholelithiasis and also in various orthopedic and musculoskeletal disorders. The efficacy of ESWT in the stimulation of osteoblasts, fibroblasts, induction of neovascularization and increased expression of bone morphogenic proteins has been well documented in the literature. However, dentistry is no exception to this trend. The present article enlightens the various applications of ESWT in the field of dentistry and explores its prospective applications in the field of periodontics, and the possibility of incorporating the beneficial properties of shock waves in improving the treatment outcome. PMID:25024562

The dose-effect relationship in extracorporeal shock wave therapy: the optimal parameter for extracorporeal shock wave therapy.

PubMed

Zhang, Xiongliang; Yan, Xiaoyu; Wang, Chunyang; Tang, Tingting; Chai, Yimin

2014-01-01

Extracorporeal shock wave therapy (ESWT) has been demonstrated to have the angiogenic effect on ischemic tissue. We hypothesize that ESWT exerts the proangiogenesis effect with an energy density-dependent mode on the target cells. Endothelial progenitor cells (EPCs) of rats were obtained by cultivation of bone marrow-derived mononuclear cells. EPCs were divided into five groups of different energy densities, and each group was furthermore subdivided into four groups of different shock numbers. Thus, there were 20 subgroups in total. The expressions of angiogenic factors, apoptotic factors, inflammation mediators, and chemotactic factors were examined, and the proliferation activity was measured after ESWT. When EPCs were treated with low-energy (0.04-0.13 mJ/mm(2)) shock wave, the expressions of endothelial nitric oxide synthase, angiopoietin (Ang) 1, Ang-2, and B-cell lymphoma 2 increased and those of interleukin 6, fibroblast growth factor 2, C-X-C chemokine receptor type 4, vascular endothelial growth factor a, Bcl-2-associated X protein, and caspase 3 decreased. stromal cell-derived factor 1 changed without statistical significance. When cells were treated with high-energy (0.16 mJ/mm(2)) shock wave, most of the expressions of cytokines declined except the apoptotic factors and fibroblast growth factor 2, and cells lead to apoptosis. The proliferation activity and the ratio of Ang-1/Ang-2 reached their peak values, when cells were treated with ESWT with the intensity ranging from 0.10-0.13 mJ/mm(2) and shock number ranging from 200-300 impulses. Meanwhile, a minimal value of the ratio of Bax/Bcl-2 was observed. There is a dose-effect relationship in ESWT. The shock intensity ranging from 0.10-0.13 mJ/mm(2) and shock number ranging from 200-300 impulses were the optimal parameters for ESWT to treat cells in vitro. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

The effect of extracorporeal shock wave therapy for the treatment of plantar fasciitis in regard to middle-aged patients' activity level and pain localization

NASA Astrophysics Data System (ADS)

Hanada, M.; Takahashi, M.; Matsuyama, Y.

2017-12-01

In this retrospective cohort study, we compared the efficacy of extracorporeal shock wave therapy (ESWT) for plantar fasciitis in patients with different activity levels and different pain locations. In total, 92 patients (99 feet) who were over 40 years old with chronic plantar fasciitis were treated with ESWT after being categorized as participating in recreational sports(group R) or only activities of daily living (group D). On the other hand, patients were categorized as having pain in the plantar fascia enthesis (group E) or the entire plantar fascia (group W). Pain during activity and general tenderness were evaluated by using the visual analog scale (VAS) before and after ESWT. Although the VAS for pain score during activity significantly improved in both groups R and D after ESWT (P<0.001 in both groups), the degree of improvement in the VAS for pain score in group R was not significantly different from that in group D (P=0.061 ). The VAS for tenderness score also significantly improved in both groups R and D (P<0.001 in both groups), but there was also no significant difference between the degree of improvement in the VAS for tenderness in group R and that in group D (P=0.41 ). However, the degree of improvement in the VAS for pain and VAS for tenderness scores was significantly greater in group E than that in group W (P<0.001, =0.042 , respectively). We concluded that ESWT was effective for treating plantar fasciitis in middle-aged patients and ESWT was effective in patients not only playing recreational sports but also having activities of daily living. ESWT was more effective in patients with pain in the plantar fascia enthesis than in patients with pain in the entire plantar fascia.

Comparison of extracorporeal shock wave therapy with botulinum toxin type A in the treatment of plantar fasciitis.

PubMed

Roca, Bernardino; Mendoza, María A; Roca, Manuel

2016-10-01

To compare the efficacy of extracorporeal shock wave therapy (ESWT) with botulinum toxin type A (BoNT-A) in the treatment of plantar fasciitis (PF). Open label, prospective, randomized study. A total of 72 patients were included. In all participants the median (and interquartile range) of the visual analog scale (VAS) of pain result, when taking the first steps, was 8 (6-9) points before treatment and 6 (4-8) points after treatment (p < 0.001). In the group of patients that received ESWT, the median (and interquartile range) of improvement in the VAS of pain result, when taking the first steps, was 2 (1-4) points, and in the group of patients that received BoNT-A the same result was 1 (0-2) points (p = 0.009). In the group of patients that received ESWT, the median (and interquartile range) of improvement in the Roles and Maudsley scale of pain result was 1 (0-1) points, and in the group of patients that received BoNT-A the same result was 0 (0-1) points (p = 0.006). In a multivariate analysis use of ESWT and lower weight were associated with improvement of pain with treatment in at least one of the three VAS of pain scales used in the study. ESWT was superior to BoNT-A in the control of pain in patients with PF. Implications for Rehabilitation Plantar fasciitis is characterized by pain at the calcaneal origin of the plantar fascia, exacerbated by weight bearing after prolonged periods of rest. Although studies comparing extracorporeal shock wave therapy or botulinum toxin type A to placebo suggest a superiority of the first one, no reliable data exist about it. Extracorporeal shock wave therapy was superior to botulinum toxin type A in the control of pain in patients with PF.

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

PubMed

Han, Yong; Lee, June-Kyung; Lee, Bong-Yeon; Kee, Hoi-Sung; Jung, Kwang-Ik; Yoon, Seo-Ra

2016-10-01

To evaluate the effectiveness of lower energy flux density (EFD) extracorporeal shock wave therapy (ESWT) in the early stage of avascular necrosis (AVN) of the femoral head. Nineteen patients and 30 hips were enrolled. All subjects received 4 weekly sessions of ESWT, at different energy levels; group A (n=15; 1,000 shocks/session, EFD per shock 0.12 mJ/mm 2 ) and group B (n=15; 1,000 shocks/session, EFD per shock 0.32 mJ/mm 2 ). We measured pain by using the visual analog scale (VAS), and disability by using the Harris hip score, Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). To determine the effect of the lower EFD ESWT, we assessed the VAS, Harris hip score, HOOS, WOMAC of the subjects before and at 1, 3, and 6 months. In both groups, the VAS, Harris hip score, HOOS, and WOMAC scores improved over time (p<0.05). Lower EFD ESWT may be an effective method to improve the function and to relieve pain in the early stage of AVN.

Remote effects of extracorporeal shock wave therapy on cutaneous microcirculation.

PubMed

Kisch, Tobias; Sorg, Heiko; Forstmeier, Vinzent; Knobloch, Karsten; Liodaki, Eirini; Stang, Felix; Mailänder, Peter; Krämer, Robert

2015-11-01

Extracorporeal shock wave treatment (ESWT) has proven its clinical benefits in different fields of medicine. Tissue regeneration and healing is improved after shock wave treatment. Even in the case of burn wounds angiogenesis and re-epithelialization is accelerated, but ESWT in extensive burn wounds is impracticable. High energy ESWT influences cutaneous microcirculation at body regions remote from application site. Eighteen Sprague Dawley rats were randomly assigned to two groups and received either high energy ESWT (Group A: total 1000 impulses, 10 J) or placebo shock wave treatment (Group B: 0 impulses, 0 J), applied to the dorsal lower leg of the hind limb. Ten minutes later microcirculatory effects were assessed at the contralateral lower leg of the hind limb (remote body region) by combined Laser-Doppler-Imaging and Photospectrometry. In Group A cutaneous capillary blood velocity was significantly increased by 152.8% vs. placebo ESWT at the remote body location (p = 0.01). Postcapillary venous filling pressure remained statistically unchanged (p > 0.05), while cutaneous tissue oxygen saturation increased by 12.7% in Group A (p = 0.220). High energy ESWT affects cutaneous hemodynamics in body regions remote from application site in a standard rat model. The results of this preliminary study indicate that ESWT might be beneficial even in disseminated and extensive burn wounds by remote shock wave effects and should therefore be subject to further scientific evaluation. Copyright © 2015 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

Radial Shock Wave Devices Generate Cavitation

PubMed Central

Császár, Nikolaus B. M.; Angstman, Nicholas B.; Milz, Stefan; Sprecher, Christoph M.; Kobel, Philippe; Farhat, Mohamed; Furia, John P.; Schmitz, Christoph

2015-01-01

Background Conflicting reports in the literature have raised the question whether radial extracorporeal shock wave therapy (rESWT) devices and vibrating massage devices have similar energy signatures and, hence, cause similar bioeffects in treated tissues. Methods and Findings We used laser fiber optic probe hydrophone (FOPH) measurements, high-speed imaging and x-ray film analysis to compare fundamental elements of the energy signatures of two rESWT devices (Swiss DolorClast; Electro Medical Systems, Nyon, Switzerland; D-Actor 200; Storz Medical, Tägerwillen, Switzerland) and a vibrating massage device (Vibracare; G5/General Physiotherapy, Inc., Earth City, MO, USA). To assert potential bioeffects of these treatment modalities we investigated the influence of rESWT and vibrating massage devices on locomotion ability of Caenorhabditis elegans (C. elegans) worms. Results FOPH measurements demonstrated that both rESWT devices generated acoustic waves with comparable pressure and energy flux density. Furthermore, both rESWT devices generated cavitation as evidenced by high-speed imaging and caused mechanical damage on the surface of x-ray film. The vibrating massage device did not show any of these characteristics. Moreover, locomotion ability of C. elegans was statistically significantly impaired after exposure to radial extracorporeal shock waves but was unaffected after exposure of worms to the vibrating massage device. Conclusions The results of the present study indicate that both energy signature and bioeffects of rESWT devices are fundamentally different from those of vibrating massage devices. Clinical Relevance Prior ESWT studies have shown that tissues treated with sufficient quantities of acoustic sound waves undergo cavitation build-up, mechanotransduction, and ultimately, a biological alteration that “kick-starts” the healing response. Due to their different treatment indications and contra-indications rESWT devices cannot be equated to vibrating massage devices and should be used with due caution in clinical practice. PMID:26509573

Radial Shock Wave Devices Generate Cavitation.

PubMed

Császár, Nikolaus B M; Angstman, Nicholas B; Milz, Stefan; Sprecher, Christoph M; Kobel, Philippe; Farhat, Mohamed; Furia, John P; Schmitz, Christoph

2015-01-01

Conflicting reports in the literature have raised the question whether radial extracorporeal shock wave therapy (rESWT) devices and vibrating massage devices have similar energy signatures and, hence, cause similar bioeffects in treated tissues. We used laser fiber optic probe hydrophone (FOPH) measurements, high-speed imaging and x-ray film analysis to compare fundamental elements of the energy signatures of two rESWT devices (Swiss DolorClast; Electro Medical Systems, Nyon, Switzerland; D-Actor 200; Storz Medical, Tägerwillen, Switzerland) and a vibrating massage device (Vibracare; G5/General Physiotherapy, Inc., Earth City, MO, USA). To assert potential bioeffects of these treatment modalities we investigated the influence of rESWT and vibrating massage devices on locomotion ability of Caenorhabditis elegans (C. elegans) worms. FOPH measurements demonstrated that both rESWT devices generated acoustic waves with comparable pressure and energy flux density. Furthermore, both rESWT devices generated cavitation as evidenced by high-speed imaging and caused mechanical damage on the surface of x-ray film. The vibrating massage device did not show any of these characteristics. Moreover, locomotion ability of C. elegans was statistically significantly impaired after exposure to radial extracorporeal shock waves but was unaffected after exposure of worms to the vibrating massage device. The results of the present study indicate that both energy signature and bioeffects of rESWT devices are fundamentally different from those of vibrating massage devices. Prior ESWT studies have shown that tissues treated with sufficient quantities of acoustic sound waves undergo cavitation build-up, mechanotransduction, and ultimately, a biological alteration that "kick-starts" the healing response. Due to their different treatment indications and contra-indications rESWT devices cannot be equated to vibrating massage devices and should be used with due caution in clinical practice.

High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head.

PubMed

Xie, Kai; Mao, Yuanqing; Qu, Xinhua; Dai, Kerong; Jia, Qingwei; Zhu, Zhenan; Yan, Mengning

2018-02-02

Nontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH. Fifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I-III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study. The visual analog pain scale (VAS), Harris hip score, radiography, and magnetic resonance imaging were used to estimate treatment results. The progression of ONFH was evaluated by imaging examination and clinical outcomes. The results were classified as clinical success (no progression of hip symptoms) and imaging success (no progression of stage or substage on radiography and MRI). The mean follow-up duration was 130.6 months (range, 121 to 138 months). The mean VAS decreased from 3.8 before ESWT to 2.2 points at the 10-year follow-up (p < 0.001). The mean Harris hip score improved from 77.4 before ESWT to 86.9 points at the 10-year follow-up. The clinical success rates were 87.5% in ARCO stage I patients, 71.4% in ARCO stage II patients, and 75.0% in ARCO stage III patients. Imaging success was observed in all stage I hips, 64.3% of stage II hips, and 12.5% of stage III hips. Seventeen hips showed progression of the ARCO stage/substage on imaging examination. Eight hips showed femoral head collapse at the 10-year follow-up. Four hips in ARCO stage III and one hip in ARCO stage II were treated with total hip arthroplasty during the follow-up. Three were performed 1 year after ESWT, one at 2 years, and one at 5 years. The results of the current study indicated that ESWT is an effective treatment method for nontraumatic ONFH, resulting in pain relief and function restoration, especially for patients with ARCO stage I-II ONFH.

Effect of low-energy extracorporeal shock wave on vascular regeneration after spinal cord injury and the recovery of motor function.

PubMed

Wang, Lei; Jiang, Yuquan; Jiang, Zheng; Han, Lizhang

2016-01-01

Latest studies show that low-energy extracorporeal shock wave therapy (ESWT) can upregulate levels of vascular endothelial growth factor (VEGF). VEGF can ease nervous tissue harm after spinal cord injury (SCI). This study aims to explore whether low-energy ESWT can promote expression of VEGF, protect nervous tissue after SCI, and improve motor function. Ninety adult female rats were divided into the following groups: Group A (simple laminectomy), Group B (laminectomy and low-energy ESWT), Group C (spinal cord injury), and Group D (spinal cord injury and low-energy ESWT). Impinger was used to cause thoracic spinal cord injury. Low-energy ESWT was applied as treatment after injury three times a week, for 3 weeks. After SCI, the Basso, Beattie, and Bresnahan (BBB) scale was used to evaluate motor function over a period of 42 days at different time points. Hematoxylin and eosin (HE) staining was used to evaluate nerve tissue injury. Neuronal nuclear antigen (NeuN) staining was also used to evaluate loss of neurons. Polymerase chain reaction was used to detect messenger RNA (mRNA) expression of VEGF and its receptor fms-like tyrosine kinase 1 (Flt-1). Immunostaining was used to evaluate VEGF protein expression level in myeloid tissue. BBB scores of Groups A and B showed no significant result related to dyskinesia. HE and NeuN staining indicated that only using low-energy ESWT could not cause damage of nervous tissue in Group B. Recovery of motor function at 7, 35, and 42 days after SCI in Group D was better than that in Group C (P<0.05). Compared with Group C, number of NeuN-positive cells at 42 days after SCI increased significantly (P<0.05). The mRNA levels of VEGF and Flt-1 and VEGF expression at 7 days after SCI in Group D were significantly higher than those in Group C (P<0.05). Low-energy ESWT promotes expression of VEGF, decreases secondary damage of nerve tissue, and improves recovery of motor function. It can be regarded as one mode of clinical routine adjunctive therapy for spinal injury.

Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

PubMed Central

Lee, Su-Jin; Kang, Jung-Ho; Kim, Ja-Young; Kim, Jin-Hong; Jung, Kwang-Ik

2013-01-01

Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p<0.01). After 3 sessions of ESWT, group M showed significant improvement in the VAS and RM score than group L, whereas after 3 additional sessions applied in group L, the main outcomes were no longer significantly different in both groups (p>0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT. PMID:23869336

Mechanical Stimulation (Pulsed Electromagnetic Fields “PEMF” and Extracorporeal Shock Wave Therapy “ESWT”) and Tendon Regeneration: A Possible Alternative

PubMed Central

Rosso, Federica; Bonasia, Davide E.; Marmotti, Antonio; Cottino, Umberto; Rossi, Roberto

2015-01-01

The pathogenesis of tendon degeneration and tendinopathy is still partially unclear. However, an active role of metalloproteinases (MMP), growth factors, such as vascular endothelial growth factor (VEGF) and a crucial role of inflammatory elements and cytokines was demonstrated. Mechanical stimulation may play a role in regulation of inflammation. In vitro studies demonstrated that both pulsed electromagnetic fields (PEMF) and extracorporeal shock wave therapy (ESWT) increased the expression of pro-inflammatory cytokine such as interleukin (IL-6 and IL-10). Moreover, ESWT increases the expression of growth factors, such as transforming growth factor β(TGF-β), (VEGF), and insulin-like growth factor 1 (IGF1), as well as the synthesis of collagen I fibers. These pre-clinical results, in association with several clinical studies, suggest a potential effectiveness of ESWT for tendinopathy treatment. Recently PEMF gained popularity as adjuvant for fracture healing and bone regeneration. Similarly to ESWT, the mechanical stimulation obtained using PEMFs may play a role for treatment of tendinopathy and for tendon regeneration, increasing in vitro TGF-β production, as well as scleraxis and collagen I gene expression. In this manuscript the rational of mechanical stimulations and the clinical studies on the efficacy of extracorporeal shock wave (ESW) and PEMF will be discussed. However, no clear evidence of a clinical value of ESW and PEMF has been found in literature with regards to the treatment of tendinopathy in human, so further clinical trials are needed to confirm the promising hypotheses concerning the effectiveness of ESWT and PEMF mechanical stimulation. PMID:26617513

Comparative analysis of angiogenic gene expression in normal and impaired wound healing in diabetic mice: effects of extracorporeal shock wave therapy.

PubMed

Zins, Stephen R; Amare, Mihret F; Tadaki, Douglas K; Elster, Eric A; Davis, Thomas A

2010-12-01

Impaired wound healing is a persistent clinical problem which has been treated with mixed results. Studies aimed at elucidating the mechanism of impaired wound healing have focused on small cohorts of genes which leave an incomplete picture of the wound healing process. We aimed to investigate impaired wound healing via a comprehensive panel of angiogenic/inflammation-related genes and wound closure kinetics with and without the application of extracorporeal shock wave therapy (ESWT), which has been demonstrated to improve wound healing. Full-thickness skin from the dorsal surface of "normal" (BALB/c) and "impaired" (db (+)/db (+)) mice was excised, and wound margin tissue was harvested 2, 7, and 10 days post injury. A separate, but identical wound model was established over 40 days in order to measure wound closure kinetics. Over time, the normal non-ESWT treated wounds exhibited varying patterns of elevated expression of 25-30 genes, whereas wounds with impaired healing displayed prolonged elevated expression of only a few genes (CXCL2, CXCL5, CSF3, MMP9, TGF-α). In response to ESWT, gene expression was augmented in both types of wounds, especially in the expression of PECAM-1; however, ESWT had no effect on wound closure in either model. In addition, multiple doses of ESWT exacerbated the delayed wound healing, and actually caused the wounds to initially increase in size. These data provide a more complete picture of impaired wound healing, and a way to evaluate various promising treatments.

Evaluation of the effect of extracorporeal shock wave treatment on experimentally induced osteoarthritis in middle carpal joints of horses.

PubMed

Frisbie, David D; Kawcak, Christopher E; McIlwraith, C Wayne

2009-04-01

OBJECTIVE-To assess the clinical, biochemical, and histologic effects of extracorporeal shock wave therapy (ESWT) in the treatment of horses with experimentally induced osteoarthritis (OA). ANIMALS-Twenty-four 2- to 3-year-old horses without evidence of lameness. PROCEDURES-OA was induced arthroscopically in 1 middle carpal joint of each horse. Fourteen days after induction of OA, horses were treated with a sham ESWT probe (placebo; n = 8), polysulfated glycosaminoglycan (PSGAG) administered IM every 4 days for 28 days as a positive control treatment (8), or ESWT administered on days 14 and 28 with a focused shock wave unit (8). Evaluations included clinical assessments of degree of lameness every 2 weeks and weekly synovial fluid analyses. Horses were euthanized 70 days after induction of OA, and gross pathologic and histologic examinations of cartilage and synovial membrane specimens were performed at necropsy. A generalized linear mixed model was used to compare outcomes among treatment groups. RESULTS-No adverse treatment-related events were detected in any horse. The degree of lameness in horses treated with ESWT improved significantly, compared with the degree of lameness in placebo- or PSGAG-treated horses. No disease-modifying effects were evident in results for synovial fluid, synovial membranes, or cartilage from the ESWT- or PSGAG-treated horses. CONCLUSIONS AND CLINICAL RELEVANCE-Although a disease-modifying effect of ESWT was not detected, the significant clinical effect of ESWT suggested that this modality should be considered for treatment of horses with OA in combination with another modality that does affect the disease process.

The effect of high-energy extracorporeal shock waves on hyaline cartilage of adult rats in vivo.

PubMed

Mayer-Wagner, Susanne; Ernst, Judith; Maier, Markus; Chiquet, Matthias; Joos, Helga; Müller, Peter E; Jansson, Volkmar; Sievers, Birte; Hausdorf, Jörg

2010-08-01

The aim of this study was to determine if extracorporeal shock wave therapy (ESWT) in vivo affects the structural integrity of articular cartilage. A single bout of ESWT (1500 shock waves of 0.5 mJ/mm(2)) was applied to femoral heads of 18 adult Sprague-Dawley rats. Two sham-treated animals served as controls. Cartilage of each femoral head was harvested at 1, 4, or 10 weeks after ESWT (n = 6 per treatment group) and scored on safranin-O-stained sections. Expression of tenascin-C and chitinase 3-like protein 1 (Chi3L1) was analyzed by immunohistochemistry. Quantitative real-time polymerase chain reaction (PCR) was used to examine collagen (II)alpha(1) (COL2A1) expression and chondrocyte morphology was investigated by transmission electron microscopy no changes in Mankin scores were observed after ESWT. Positive immunostaining for tenascin-C and Chi3L1 was found up to 10 weeks after ESWT in experimental but not in control cartilage. COL2A1 mRNA was increased in samples 1 and 4 weeks after ESWT. Alterations found on the ultrastructural level showed expansion of the rough-surfaced endoplasmatic reticulum, detachment of the cell membrane and necrotic chondrocytes. Extracorporeal shock waves caused alterations of hyaline cartilage on a molecular and ultrastructural level that were distinctly different from control. Similar changes were described before in the very early phase of osteoarthritis (OA). High-energy ESWT might therefore cause degenerative changes in hyaline cartilage as they are found in initial OA. Copyright 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis

PubMed Central

Zou, Zi-jun; Tang, Liang-you; Liu, Zhi-hong; Liang, Jia-yu; Zhang, Ruo-chen; Wang, Yu-jie; Tang, Yong-quan; Gao, Rui; Lu, Yi-ping

2017-01-01

ABSTRACT Aim: The role of low-intensity extracorporeal shock wave therapy (LI-ESWT) in erectile dysfunction (ED) is not clearly determined. The purpose of this study is to investigate the short-term efficacy and safety of LI-ESWT for ED patients. Materials and Methods: Relevant studies were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG and VIP databases. Effective rate in terms of International Index of Erectile Function-Erectile Function Domain (IIEF-EF) and Erectile Hardness Score (EHS) at about 1XSmonth after LI-ESWT was extracted from eligible studies for meta-analysis to calculate risk ratio (RR) of effective treatment in ED patients treated by LI-ESWT compared to those receiving sham-treatment. Results: Overall fifteen studies were included in the review, of which four randomized controlled trials (RCTs) were for meta-analysis. Effective treatment was 8.31 [95°/o confidence interval (CI): 3.88-17.78] times more effective in the LI-ESWT group (n=176) than in the sham-treatment group (n= 101) at about 1 month after the intervention in terms of EHS, while it was 2.50 (95% CI: 0.74–8.45) times more in the treatment group (n= 121) than in the control group (n=89) in terms of IIEF-EF. Nine-week protocol with energy density of 0.09mJ/mm2 and 1500 pluses seemed to have better therapeutic effect than five-week protocol. No significant adverse event was reported. Conclusion: LI-ESWT, as a noninvasive treatment, has potential short-term therapeutic effect on patients with organic ED irrespective of sensitivity to PDE5is. Owing to the limited number and quality of the studies, more large-scale, well-designed and longterm follow-up time studies are needed to confirm our analysis. PMID:28379665

Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis.

PubMed

Zou, Zi-Jun; Tang, Liang-You; Liu, Zhi-Hong; Liang, Jia-Yu; Zhang, Ruo-Chen; Wang, Yu-Jie; Tang, Yong-Quan; Gao, Rui; Lu, Yi-Ping

2017-01-01

The role of low-intensity extracorporeal shock wave therapy (LI-ESWT) in erectile dysfunction (ED) is not clearly determined. The purpose of this study is to investigate the short-term efficacy and safety of LI-ESWT for ED patients. Relevant studies were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG and VIP databases. Effective rate in terms of International Index of Erectile Function-Erectile Function Domain (IIEF-EF) and Erectile Hardness Score (EHS) at about 1month after LI-ESWT was extracted from eligible studies for meta-analysis to calculate risk ratio (RR) of effective treatment in ED patients treated by LI-ESWT compared to those receiving sham-treatment. Overall fifteen studies were included in the review, of which four randomized controlled trials (RCTs) were for meta-analysis. Effective treatment was 8.31 [95% confidence interval (CI): 3.88-17.78] times more effective in the LI-ESWT group (n=176) than in the sham-treatment group (n=101) at about 1 month after the intervention in terms of EHS, while it was 2.50 (95% CI: 0.74-8.45) times more in the treatment group (n=121) than in the control group (n=89) in terms of IIEF-EF. Nine-week protocol with energy density of 0.09mJ/mm2 and 1500 pluses seemed to have better therapeutic effect than five-week protocol. No significant adverse event was reported. LI-ESWT, as a noninvasive treatment, has potential short-term therapeutic effect on patients with organic ED irrespective of sensitivity to PDE5is. Owing to the limited number and quality of the studies, more large-scale, well-designed and long-term follow-up time studies are needed to confirm our analysis. Copyright® by the International Brazilian Journal of Urology.

Effect of unfocused extracorporeal shock wave therapy on growth factor gene expression in wounds and intact skin of horses.

PubMed

Link, Kaitlyn A; Koenig, Judith B; Silveira, Andressa; Plattner, Brandon L; Lillie, Brandon N

2013-02-01

To compare the effect of extracorporeal shock wave therapy (ESWT) on expression of fibroblast growth factor-7 (FGF-7), transforming growth factor-β1 (TGF-β1), insulin-like growth factor-1 (IGF-1), platelet-derived growth factor-A (PDGF), and vascular endothelial growth factor-A (VEGF) in skin with surgically created skin wounds and intact skin in horses. 14 healthy horses. 8 horses were treated with ESWT at 6 locations along the neck at 36, 24, 12, 6, 2, or 1 hour prior to collection of full-thickness biopsy specimens from each location; a control specimen was collected from a sham-treated location. In 6 horses, 5 full-thickness wounds were created in each forelimb. Wounds in 1 forelimb/horse received ESWT immediately after creation and subsequently on days 7, 14, and 21; wounds in the contralateral forelimb remained untreated. Biopsy specimens were collected from 1 wound on each forelimb on days 7, 14, 21, 28, and 35. Expression levels of FGF-7, TGF-β1, IGF-1, PDGF, and VEGF were assessed in tissue samples from the horses' necks and forelimbs. In surgically created wounds, ESWT treatment was associated with reduced TGF-β1 expression, compared with expression in control wounds, during the entire study period. At 28 days following wound creation, IGF-1 expression was significantly increased for treated and untreated wounds, compared with findings on days 7, 14, 21, and 35. There was no significant effect of treatment on FGF-7, TGF-β1, IGF-1, PDGF, or VEGF expression in intact skin. Intervention with ESWT to suppress TGF-β1 may decrease granulation tissue production, resulting in improved wound healing on the distal portion of horses' limbs.

Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience.

PubMed

Husain, J; Lynn, N N; Jones, D K; Collins, G N; O'Reilly, P H

2000-09-01

To evaluate prospectively the efficacy of extracorporeal shock wave therapy (ESWT) as a conservative treatment for Peyronie's disease. After obtaining ethical committee approval, 37 patients with Peyronie's disease were treated using ESWT. Before treatment the degree of angulation was assessed by artificially inducing an erection with a vacuum device. The severity of pain on erection was assessed using a visual analogue scale (0-5). Each patient was treated with a minimum of three sessions of ESWT (3000 shock waves at an energy density of 0.11-0.17 mJ/mm2) at 3-week intervals. The results were analysed using the Wilcoxon signed-rank test. Of the 37 patients, 34 completed the protocol; the mean (range) duration of the disease was 19.43 (4-60) months and the mean follow-up 7.5 (5-11) months. Almost half (47%) of the patients reported an improvement in angulation, with a mean reduction of 29.3 degrees (10 degrees -60 degrees ) (P < 0.001); 12 of the 20 (60%) patients with pain on erection reported immediate relief, the mean reduction being 2.3 (1-4) on the visual analogue scale (P < 0.001). There was only minimal bruising at the site of treatment and no major side-effects were reported. ESWT is an effective and safe treatment for Peyronie's disease; the long-term follow-up and results are awaited.

A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part II: Effects on function.

PubMed

Reznik, J E; Biros, E; Sacher, Y; Kibrik, O; Milanese, S; Gordon, S; Galea, M P

2017-01-01

Neurogenic heterotopic ossification (NHO) occurs as a complication of traumatic brain injury (TBI). Management of clinically significant NHO remains variable. Complications of mature NHO include limitation of mobility. The effect of the extracorporeal shock wave therapy (ESWT) on range of motion at hip and knee, and function in patients with TBI with chronic NHO was investigated. A series of single-case studies applying ESWT to chronic NHO at the hip or knee of 11 patients with TBI were undertaken at a rehabilitation hospital. Participants received four applications of high-energy EWST delivered to the affected hip or knee over a period of 8 weeks. Two-weekly follow- up assessments were carried out; final assessments were made 3 and 6 months post-intervention. Range of motion (ROM) and Functional Reach (FR) or Modified Functional Reach (MFR) were measured. Application of high-energy ESWT was associated with significant improvement in ROM (flexion) of the NHO-affected knee (Tau = 0.833, 95% CI 0.391-1.276, p = 0.002) and significant improvement of FR (Overall Tau 0.486, 95% CI 0.141-0.832, p = 0.006); no significant improvement in hip ROM or MFR. ESWT may improve mobility and balance of patients with TBI who have chronic NHO.

Epicardial shock-wave therapy improves ventricular function in a porcine model of ischaemic heart disease.

PubMed

Holfeld, Johannes; Zimpfer, Daniel; Albrecht-Schgoer, Karin; Stojadinovic, Alexander; Paulus, Patrick; Dumfarth, Julia; Thomas, Anita; Lobenwein, Daniela; Tepeköylü, Can; Rosenhek, Raphael; Schaden, Wolfgang; Kirchmair, Rudolf; Aharinejad, Seyedhossein; Grimm, Michael

2016-12-01

Previously we have shown that epicardial shock-wave therapy improves left ventricular ejection fraction (LVEF) in a rat model of myocardial infarction. In the present experiments we aimed to address the safety and efficacy of epicardial shock-wave therapy in a preclinical large animal model and to further evaluate mechanisms of action of this novel therapy. Four weeks after left anterior descending (LAD) artery ligation in pigs, the animals underwent re-thoracotomy with (shock-wave group, n = 6) or without (control group, n = 5) epicardial shock waves (300 impulses at 0.38 mJ/mm 2 ) applied to the infarcted anterior wall. Efficacy endpoints were improvement of LVEF and induction of angiogenesis 6 weeks after shock-wave therapy. Safety endpoints were haemodynamic stability during treatment and myocardial damage. Four weeks after LAD ligation, LVEF decreased in both the shock-wave (43 ± 3%, p < 0.001) and control (41 ± 4%, p = 0.012) groups. LVEF markedly improved in shock-wave animals 6 weeks after treatment (62 ± 9%, p = 0.006); no improvement was observed in controls (41 ± 4%, p = 0.36), yielding a significant difference. Quantitative histology revealed significant angiogenesis 6 weeks after treatment (controls 2 ± 0.4 arterioles/high-power field vs treatment group 9 ± 3; p = 0.004). No acute or chronic adverse effects were observed. As a potential mechanism of action in vitro experiments showed stimulation of VEGF receptors after shock-wave treatment in human coronary artery endothelial cells. Epicardial shock-wave treatment in a large animal model of ischaemic heart failure exerted a positive effect on LVEF improvement and did not show any adverse effects. Angiogenesis was induced by stimulation of VEGF receptors. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

Extracorporeal shock wave treatment for chronic lateral epicondylitis (tennis elbow).

PubMed

Ho, C

2007-01-01

(1) Electrohydraulic, electromagnetic, or piezoelectric devices are used to translate energy into acoustic waves during extracorporeal shock wave treatment (ESWT) for chronic lateral epicondylitis (CLE) of the elbow (elbow tendonitis or tennis elbow). These waves may help to accelerate the healing process via an unknown mechanism. (2) Results from randomized controlled trials have been conflicting. Half of the studies showed statistically significant improvement in pain in the treatment group, and half of the studies had data showing no benefit over placebo for any measured outcomes. (3) Limited evidence shows that ESWT is cheaper than arthroscopic surgery, open surgery, and other conservative therapies, such as steroid infiltrations and physiotherapy, that continue for more than six weeks. (4) The lack of convincing evidence regarding its effectiveness does not support the use of ESWT for CLE.

Low-energy extracorporeal shock wave therapy promotes vascular endothelial growth factor expression and improves locomotor recovery after spinal cord injury.

PubMed

Yamaya, Seiji; Ozawa, Hiroshi; Kanno, Haruo; Kishimoto, Koshi N; Sekiguchi, Akira; Tateda, Satoshi; Yahata, Kenichiro; Ito, Kenta; Shimokawa, Hiroaki; Itoi, Eiji

2014-12-01

Extracorporeal shock wave therapy (ESWT) is widely used for the clinical treatment of various human diseases. Recent studies have demonstrated that low-energy ESWT upregulates the expression of vascular endothelial growth factor (VEGF) and promotes angiogenesis and functional recovery in myocardial infarction and peripheral artery disease. Many previous reports suggested that VEGF produces a neuroprotective effect to reduce secondary neural tissue damage after spinal cord injury (SCI). The purpose of the present study was to investigate whether low-energy ESWT promotes VEGF expression and neuroprotection and improves locomotor recovery after SCI. Sixty adult female Sprague-Dawley rats were randomly divided into 4 groups: sham group (laminectomy only), sham-SW group (low-energy ESWT applied after laminectomy), SCI group (SCI only), and SCI-SW group (low-energy ESWT applied after SCI). Thoracic spinal cord contusion injury was inflicted using an impactor. Low-energy ESWT was applied to the injured spinal cord 3 times a week for 3 weeks. Locomotor function was evaluated using the Basso, Beattie, and Bresnahan (BBB) Scale (open field locomotor score) at different time points over 42 days after SCI. Hematoxylin and eosin staining was performed to assess neural tissue damage in the spinal cord. Neuronal loss was investigated by immunostaining for NeuN. The mRNA expressions of VEGF and its receptor, Flt-1, in the spinal cord were assessed using real-time polymerase chain reaction. Immunostaining for VEGF was performed to evaluate VEGF protein expression in the spinal cord. In both the sham and sham-SW groups, no animals showed locomotor impairment on BBB scoring. Histological analysis of H & E and NeuN stainings in the sham-SW group confirmed that no neural tissue damage was induced by the low-energy ESWT. Importantly, animals in the SCI-SW group demonstrated significantly better locomotor improvement than those in the SCI group at 7, 35, and 42 days after injury (p < 0.05). The number of NeuN-positive cells in the SCI-SW group was significantly higher than that in the SCI group at 42 days after injury (p < 0.05). In addition, mRNA expressions of VEGF and Flt-1 were significantly increased in the SCI-SW group compared with the SCI group at 7 days after injury (p < 0.05). The expression of VEGF protein in the SCI-SW group was significantly higher than that in the SCI group at 7 days (p < 0.01). The present study showed that low-energy ESWT significantly increased expressions of VEGF and Flt-1 in the spinal cord without any detrimental effect. Furthermore, it significantly reduced neuronal loss in damaged neural tissue and improved locomotor function after SCI. These results suggested that low-energy ESWT enhances the neuroprotective effect of VEGF in reducing secondary injury and leads to better locomotor recovery following SCI. This study provides the first evidence that low-energy ESWT can be a safe and promising therapeutic strategy for SCI.

Low-intensity extracorporeal shock wave therapy--a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy.

PubMed

Gruenwald, Ilan; Appel, Boaz; Vardi, Yoram

2012-01-01

Low-intensity shock wave therapy (LI-ESWT) has been reported as an effective treatment in men with mild and moderate erectile dysfunction (ED). The aim of this study is to determine the efficacy of LI-ESWT in severe ED patients who were poor responders to phosphodiesterase type 5 inhibitor (PDE5i) therapy. This was an open-label single-arm prospective study on ED patients with an erection hardness score (EHS) ≤ 2 at baseline. The protocol comprised two treatment sessions per week for 3 weeks, which were repeated after a 3-week no-treatment interval. Patients were followed at 1 month (FU1), and only then an active PDE5i medication was provided for an additional month until final follow-up visit (FU2). At each treatment session, LI-ESWT was applied on the penile shaft and crus at five different anatomical sites (300 shocks, 0.09 mJ/mm(2) intensity at 120 shocks/min). Each subject underwent a full baseline assessment of erectile function using validated questionnaires and objective penile hemodynamic testing before and after LI-ESWT. Outcome measures used are changes in the International Index of Erectile Function-erectile function domain (IIEF-ED) scores, the EHS measurement, and the three parameters of penile hemodynamics and endothelial function. Twenty-nine men (mean age of 61.3) completed the study. Their mean IIEF-ED scores increased from 8.8 ± 1 (baseline) to 12.3 ± 1 at FU1 (P = 0.035). At FU2 (on active PDE5i treatment), their IIEF-ED further increased to 18.8 ± 1 (P < 0.0001), and 72.4% (P < 0.0001) reached an EHS of ≥ 3 (allowing full sexual intercourse). A significant improvement (P = 0.0001) in penile hemodynamics was detected after treatment and this improvement significantly correlated with increases in the IIEF-ED (P < 0.05). No noteworthy adverse events were reported. Penile LI-ESWT is a new modality that has the potential to treat a subgroup of severe ED patients. These preliminary data need to be reconfirmed by multicenter sham control studies in a larger group of ED patients. © 2011 International Society for Sexual Medicine.

Efficacy of Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome: A Randomized, Controlled Trial

PubMed Central

Vahdatpour, Babak; Moayednia, Amir; Emadi, Masoud; Khorami, Mohammad Hatef; Haghdani, Saeid

2013-01-01

Objectives. To investigate the effectiveness of extracorporeal shock wave therapy (ESWT) for symptoms alleviation in chronic pelvic pain syndrome (CPPS). Materials and Methods. 40 patients with CPPS were randomly allocated into either the treatment or sham group. In the first group, patients were treated by ESWT once a week for 4 weeks by a defined protocol. In the sham group, the same protocol was applied but with the probe being turned off. The follow-up assessments were done at 1, 2, 3, and 12 weeks by Visual Analogue Scale (VAS) for pain and NIH-developed Chronic Prostatitis Symptom Index (NIH-CPSI). Results. Pain domain scores at follow-up points in both treatment and sham groups were reduced, more so in the treatment group, which were significant at weeks 2, 3, and 12. Urinary scores became significantly different at weeks 3 and 12. Also, quality of life (QOL) and total NIH-CPSI scores at all four follow-up time points reduced more significantly in the treatment group as compared to the sham group. Noticeably, at week 12 a slight deterioration in all variables was observed compared to the first 3 weeks of the treatment period. Conclusions. our findings confirmed ESWT therapy as a safe and effective method in CPPS in short term. PMID:24000311

Efficacy of extracorporeal shock wave therapy for the treatment of chronic pelvic pain syndrome: a randomized, controlled trial.

PubMed

Vahdatpour, Babak; Alizadeh, Farshid; Moayednia, Amir; Emadi, Masoud; Khorami, Mohammad Hatef; Haghdani, Saeid

2013-01-01

Objectives. To investigate the effectiveness of extracorporeal shock wave therapy (ESWT) for symptoms alleviation in chronic pelvic pain syndrome (CPPS). Materials and Methods. 40 patients with CPPS were randomly allocated into either the treatment or sham group. In the first group, patients were treated by ESWT once a week for 4 weeks by a defined protocol. In the sham group, the same protocol was applied but with the probe being turned off. The follow-up assessments were done at 1, 2, 3, and 12 weeks by Visual Analogue Scale (VAS) for pain and NIH-developed Chronic Prostatitis Symptom Index (NIH-CPSI). Results. Pain domain scores at follow-up points in both treatment and sham groups were reduced, more so in the treatment group, which were significant at weeks 2, 3, and 12. Urinary scores became significantly different at weeks 3 and 12. Also, quality of life (QOL) and total NIH-CPSI scores at all four follow-up time points reduced more significantly in the treatment group as compared to the sham group. Noticeably, at week 12 a slight deterioration in all variables was observed compared to the first 3 weeks of the treatment period. Conclusions. our findings confirmed ESWT therapy as a safe and effective method in CPPS in short term.

[Extracorporeal shock wave therapy in chronic prostatitis].

PubMed

Kul'chavenya, E V; Shevchenko, S Yu; Brizhatyuk, E V

2016-04-01

Chronic prostatitis is a prevalent urologic disease, but treatment outcomes are not always satisfactory. As a rule, chronic prostatitis results in chronic pelvic pain syndrome, significantly reducing the patient's quality of life. Open pilot prospective non-comparative study was conducted to test the effectiveness of extracorporeal shock wave therapy (ESWT) using Aries (Dornier) machine in patients with chronic prostatitis (CP) of IIIb category. A total of 27 patients underwent ESWL as monotherapy, 2 times a week for a course of 6 sessions. Exposure settings: 5-6 energy level (by sensation), the frequency of 5 Hz, 2000 pulses per session; each patient received a total energy up to 12000 mJ. per procedure. Treatment results were evaluated using NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) upon completing the 3 week course of 6 treatments and at 1 month after ESWT. Immediately after the ESWT course positive trend was not significant: pain index decreased from 9.1 to 7.9, urinary symptom score remained almost unchanged (4.2 at baseline, 4.1 after treatment), quality of life index also showed a slight improvement, dropping from 7.2 points to 6.0. Total NIH-CPSI score decreased from 20.5 to 18.0. One month post-treatment pain significantly decreased to 3.2 points, the urinary symptom score fell to 2.7 points, the average quality of life score was 3.9 points. ESWT, performed on Aries (Dornier) machine, is highly effective as monotherapy in patients with category IIIb chronic prostatitis.

Exposure of zebra mussels to extracorporeal shock waves demonstrates formation of new mineralized tissue inside and outside the focus zone.

PubMed

Sternecker, Katharina; Geist, Juergen; Beggel, Sebastian; Dietz-Laursonn, Kristin; de la Fuente, Matias; Frank, Hans-Georg; Furia, John P; Milz, Stefan; Schmitz, Christoph

2018-04-03

The success rate of extracorporeal shock wave therapy (ESWT) for fracture nonunions in human medicine (i.e., radiographic union at six months after ESWT) is only approximately 75%. Detailed knowledge regarding the underlying mechanisms that induce bio-calcification after ESWT is limited. We analyzed the biological response within mineralized tissue of a new invertebrate model organism, the zebra mussel Dreissena polymorpha , after exposure with extracorporeal shock waves (ESWs). Mussels were exposed to ESWs with positive energy density of 0.4 mJ/mm 2 (A) or were sham exposed (B). Detection of newly calcified tissue was performed by exposing the mussels to fluorescent markers. Two weeks later, the A-mussels showed a higher mean fluorescence signal intensity within the shell zone than the B-mussels (p<0.05). Acoustic measurements revealed that the increased mean fluorescence signal intensity within the shell of the A-mussels was independent of the size and position of the focal point of the ESWs. These data demonstrate that induction of bio-calcification after ESWT may not be restricted to the region of direct energy transfer of ESWs into calcified tissue. The results of the present study are of relevance for better understanding of the molecular and cellular mechanisms that induce formation of new mineralized tissue after ESWT. © 2018. Published by The Company of Biologists Ltd.

Peyronie's disease and low intensity shock wave therapy: Clinical outcomes and patient satisfaction rate in an open-label single arm prospective study in Australian men

PubMed Central

2015-01-01

Purpose To evaluate the efficacy, safety and patient satisfaction outcomes following low intensity extracorporeal shock wave therapy (LiESWT) in men with Peyronie's disease (PD) using a standardised protocol. Materials and Methods In this open-label single arm prospective study, patients with PD were enrolled following informed consent. Patient demographics, change in penile curvature and plaque hardness, International Index of Erectile Function (IIEF)-5 score, and overall satisfaction score (on a 5-point scale) were recorded. Treatment template consists of 3000 shock waves to the Peyronie's plaque over 20 minutes, twice weekly for 6 weeks. Results The majority of patients have PD history longer than 6 months (mean, 12.8 months; range, 6-28 months). Two thirds of patients have received and failed oral medical therapy. There were improvements in penile curvature (more than 15 degrees in 33% of men), plaque hardness (60% of men) and penile pain (4 out of 6 men) following LiESWT. There was a moderate improvement in IIEF-5 score (>5 points reported in 20% of men). No complication was reported and the majority of patients were satisfied (rated 4 out of 5; 70% of men) and would recommend this therapy to others. Conclusions In a carefully selected group of men with PD, LiESWT appears to be safe, has moderate efficacy and is associated with high patient satisfaction rate in the short term. PMID:26568796

Effect of extracorporeal shock wave on proliferation and differentiation of equine adipose tissue-derived mesenchymal stem cells in vitro

PubMed Central

Raabe, O; Shell, K; Goessl, A; Crispens, C; Delhasse, Y; Eva, A; Scheiner-Bobis, G; Wenisch, S; Arnhold, S

2013-01-01

Mesenchymal stem cells are regarded as common cellular precursors of the musculoskeletal tissue and are responsible for tissue regeneration in the course of musculoskeletal disorders. In equine veterinary medicine extracorporeal shock wave therapy (ESWT) is used to optimize healing processes of bone, tendon and cartilage. Nevertheless, little is known about the effects of the shock waves on cells and tissues. Thus, the aim of this study was to investigate the influence of focused ESWT on the viability, proliferation, and differentiation capacity of adipose tissue-derived mesenchymal stem cells (ASCs) and to explore its effects on gap junctional communication and the activation of signalling cascades associated with cell proliferation and differentiation. ASCs were treated with different pulses of focused ESWT. Treated cells showed increased proliferation and expression of Cx43, as detected by means of qRT-PCR, histological staining, immunocytochemistry and western blot. At the same time, cells responded to ESWT by significant activation (phosphorylation) of Erk1/2, detected in western blots. No significant effects on the differentiation potential of the ASCs were evident. Taken together, the present results show significant effects of shock waves on stem cells in vitro. PMID:23671817

Historical ESWT Paradigms Are Overcome: A Narrative Review

PubMed Central

Nauck, Tanja; Korakakis, Vasileios; Malliaropoulos, Nikos

2016-01-01

Extracorporeal Shock Wave Therapy (ESWT) is a conservative treatment modality with still growing interest in musculoskeletal disorders. This narrative review aims to present an overview covering 20-year development in the field of musculoskeletal ESWT. Eight historical paradigms have been identified and put under question from a current perspective: energy intensity, focus size, anesthesia, imaging, growth plates, acuteness, calcifications, and number of sessions. All paradigms as set in a historical consensus meeting in 1995 are to be revised. First, modern musculoskeletal ESWT is divided into focused and radial technology and the physical differences are about 100-fold with respect to the applied energy. Most lesions to be treated are easy to reach and clinical focusing plays a major role today. Lesion size is no longer a matter of concern. With the exception of nonunion fractures full, regional, or even local anesthesia is not helpful in musculoskeletal indications. Juvenile patients can also effectively be treated without risk of epiphyseal damage. Further research is needed to answer the question about if and which acute injuries can be managed effectively. Treatment parameters like the number of sessions are still relying on empirical data and have to be further elucidated. PMID:27493955

Effect of extracorporeal shock wave therapy on the treatment of patients with carpal tunnel syndrome.

PubMed

Vahdatpour, Babak; Kiyani, Abolghasem; Dehghan, Farnaz

2016-01-01

The carpal tunnel syndrome (CTS) is the most common neuropathy. The aim of this study was to evaluate the effect of a new and noninvasive treatment including extracorporeal shock wave therapy (ESWT) in the treatment of CTS. This study is a clinical trial conducted on 60 patients with moderate CTS in selected health centers of Isfahan Medical University from November 2014 to April 2015. Patients with CTS were randomly divided into two groups. Conservative treatment including wrist splint at night for 3 months, consumption of nonsteroidal anti-inflammatory drugs for 2 weeks, and oral consumption of Vitamin B1 for a month was recommended for both groups. The first group was treated with ESWT, one session per week for 4 weeks. Focus probe with 0.05, 0.07, 0.1, and 0.15 energy and shock numbers 800, 900, 1000, and 1100 were used from the first session to the fourth, respectively. The evaluated parameters were assessed before treatment and after 3 and 6 months. Data were analyzed using SPSS version 19, Student's t-test, and Chi-square test. All parameters were significantly decreased in the ESWT group after 3 months. These results remained almost constant after 6 months compared with 3 months after treatment. However, only two parameters considerably improved after 3 months of treatment in the control group. The entire indexes in the control group implicated the regression of results in long-term period. It is recommended to use ESWT as a conservative treatment in patients with CTS.

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 effects were seen. Conclusion: Radial acoustic waves are effective and safe to treat cellulite. The effect of treatment begins delayed and is first seen after 5 treatments. The improvement of cellulite increases continual up to 3 months. Patients' satisfaction and acceptance is high

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.

Extracorporeal shock wave therapy in the treatment of Peyronie's disease: experience with standard lithotriptor (siemens-multiline).

PubMed

Lebret, Thierry; Loison, Guillaume; Hervé, Jean-Marie; Mc Eleny, Kevin R; Lugagne, Pierre-Marie; Yonneau, Laurent; Orsoni, Jean-Luc; Saporta, François; Butreau, Martine; Botto, Henry

2002-05-01

To assess in a prospective study whether extracorporeal shock wave therapy (ESWT) using a standard radioscopic location lithotriptor is effective in the treatment of Peyronie's disease. Fifty-four patients were included in this prospective study. Before and after treatment, the angulation was calculated by auto-photography. Pain severity was assessed by a visual analog pain scale. A self-evaluation questionnaire (International Index of Erectile Function) was used. All patients had symptoms (35 had pain during erection and 51 angulation greater than 20 degrees ). The mean disease duration was 16 months. The mean angulation before treatment was 48 degrees (range 10 degrees to 100 degrees ). Twenty-four patients had erectile dysfunction (questionnaire score less than 18). The Multiline Siemens lithotriptor was used. The plaque was located by palpation, and 1 mL of contrast agent was injected. Scopic visualization was used. Each patient received a minimum of one session of ESWT (3000 shock waves, 7 kJ) applied to a flaccid penis. All patients completed the protocol. The tolerance and safety were excellent. Of the 35 patients with pain on erection, 31 (91%) noticed relief immediately after ESWT (mean reduction 2.9 on the visual analog pain scale) (P <0.00001). For 29 patients (53.7%), an improvement in angulation (greater than 10 degrees ) was observed, with a mean reduction of 31 degrees (P <0.001). For patients with erectile dysfunction, only 6 (25%) had an increased questionnaire score (greater than 4). Twenty-five patients thought the plaque was smoother. ESWT with a standard lithotriptor (without the mobile arm) in Peyronie's disease is a feasible, safe, and effective treatment for pain on erection and significantly improves the penile angle.

Effects of Roughly Focused Extracorporeal Shock Waves Therapy on the Expressions of Bone Morphogenetic Protein-2 and Osteoprotegerin in Osteoporotic Fracture in Rats

PubMed Central

Huang, Hai-Ming; Li, Xiao-Lin; Tu, Shu-Qiang; Chen, Xiao-Feng; Lu, Chang-Chun; Jiang, Liang-Hua

2016-01-01

Background: Roughly focused extracorporeal shock waves therapy (ESWT) is characterized by a wide focal area, a large therapy zone, easy positioning, and less pain during treatment. The purpose of this study was to investigate the effects of roughly focused ESWT on the expression of osteoprotegerin (OPG) and bone morphogenetic protein-2 (BMP-2) in osteoporotic fractures in rats. Methods: Seventy-two female Sprague-Dawley (SD) rats, 3 months old, were divided into sham-operated group (n = 6) and an ovariectomized (OVX) group (n = 66). Sixty OVX SD rats were used as a model of double proximal tibial osteotomy and inner fixation. The osteotomy site in the left tibia was treated with roughly focused ESWT once at an energy density of 0.26 mJ/mm2, 60 doses/min, and 2000 pact quantities. The contralateral right tibia was left untreated and served as a control. Expression of OPG and BMP-2 in the callus of the osteoporotic fracture area was assessed using immunohistochemistry, real-time polymerase chain reaction (PCR), and Western blotting analysis. Results: Bone mineral density (BMD) at the proximal tibia, femur, and L5 spine was significantly reduced after ovariectomy. BMD of proximal tibia was 12.9% less in the OVX group than that in the sham-operated group. Meanwhile, bilateral oophorectomy resulted in a lower trabecular bone volume fraction (BV/TV) in the proximal tibia of the sham-OVX animals. Three months after bilateral oophorectomy, BV/TV was 14.29% of baseline BV/TV in OVX legs versus 45.91% in the sham-OVX legs (P < 0.001). These data showed that the SD rats became a suitable model of osteoporosis, 3 months after they were OVX. Immunohistochemical analysis showed higher levels of BMP-2 and OPG expression in the treatment group than those in the control group. Compared with the contralateral controls, decreased expression of OPG and BMP-2 at 3 days after roughly focused ESWT, followed by a later increase at 7 days, was indicated by real-time PCR and Western blotting analysis. The OPG messenger RNA (mRNA) expression levels peaked at 6 weeks after the shock wave treatment, paired with a much earlier (at 4 weeks) increase of BMP-2, and declined close to normal at 8 weeks. Conclusions: Roughly focused ESWT may promote the expression of OPG and BMP-2 in the osteoporotic fracture area in rats. BMP-2 and OPG may act synergistically and may lead to a significant enhancement of bone formation and remodeling. PMID:27779163

[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.

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.

Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis

PubMed Central

Ragab, Ehab Mohamed

2009-01-01

Background Planter fasciitis is a common cause of heel pain in adults. Many treatment options exist. Most of patients resolve with conservative management. Approximately 10% of patients develop persistent and often disabling symptoms. Patients and methods This prospective study includes 37 patients with an established diagnosis of chronic plantar fasciitis, aiming to compare two different techniques of treatment. First group includes 17 patients with a mean age of 42 years treated by endoscopic plantar fasciotomy (EPF); the mean follow-up was 11 months. Second group includes 20 patients with a mean age of 45 years treated by extracorporeal shock Wave Therapy (ESWT); the mean follow-up was 7.6 months. Results In the first group (EPF), using the visual analog scale the average post-operative pain was improved from 9.1 to 1.6. Post-operatively, 58.8% had no limitation of functional activities, 35.3% had minimal limitation of activities and 5.9% had moderate limitation of activities. Concerning patient satisfaction, 82.3% of patients were completely satisfied, 11.8% of patients were satisfied with reservation and 5.9% of patients were unsatisfied. For the second group (ESWT), using the visual analog scale the average post-operative pain was improved from 9 to 2.1. Post-operatively, 50% had no functional limitation of activities, 35% had minimal limitation of activities, 10% had moderate limitation of activities, and 5% had severe limitation of activities. Concerning patient satisfaction, 75% of patients were completely satisfied and 25% were satisfied with reservation or unsatisfied. Conclusion Because of better results with endoscopic release versus the benefits of no complications, no immobilization, and early resumption of full activities with ESWT, we conclude that ESWT is a reasonable earlier line of treatment of chronic plantar fasciitis before EPF. PMID:20033696

The Dose-Related Effects of Extracorporeal Shock Wave Therapy for Knee Osteoarthritis

PubMed Central

Kim, Jin-Hong; Kim, Ja-Young; Choi, Cheol-Min; Lee, June-Kyung; Kee, Hoi-Sung; Jung, Kwang-Ik

2015-01-01

Objective To investigate the dose-related effects of extracorporeal shock wave therapy (ESWT) for knee osteoarthritis. Methods Seventy-five subjects were recruited, 60 of which met the inclusion criteria. The patients were randomly classified into two groups: group L, which was a low-energy group (n=30; 1,000 shocks/session; energy flux density [EFD], 0.040 mJ/mm2) and group M, which was a medium-energy group (n=30; 1,000 shocks/session; EFD, 0.093 mJ/mm2). For each group, 1,000 shock waves were delivered to the medial tibial plateau area, once a week, for 3 weeks. The main outcome measures were the visual analogue scale (VAS), the Roles and Maudsley (RM) score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Lequesne index. Each assessment was performed at the baseline and at 1, 4, and 12 weeks after ESWT. Results In both groups, the VAS, the RM and WOMAC scores, and the Lequesne index were significantly improved over time (p<0.001), and group M showed greater improvement over group L at the 1, 4 and 12 weeks assessments. Conclusion In this study, medium-energy group (group M) showed greater improvement in regard to relieving pain and restoring functional outcome than the low-energy group (group L). Therefore, EFD can be considered to have significant influence when treating with ESWT for knee osteoarthritis. PMID:26361599

Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis.

PubMed

Lu, Zhihua; Lin, Guiting; Reed-Maldonado, Amanda; Wang, Chunxi; Lee, Yung-Chin; Lue, Tom F

2017-02-01

As a novel therapeutic method for erectile dysfunction (ED), low-intensity extracorporeal shock wave treatment (LI-ESWT) has been applied recently in the clinical setting. We feel that a summary of the current literature and a systematic review to evaluate the therapeutic efficacy of LI-ESWT for ED would be helpful for physicians who are interested in using this modality to treat patients with ED. A systematic review of the evidence regarding LI-ESWT for patients with ED was undertaken with a meta-analysis to identify the efficacy of the treatment modality. A comprehensive search of the PubMed and Embase databases to November 2015 was performed. Studies reporting on patients with ED treated with LI-ESWT were included. The International Index of Erectile Function (IIEF) and the Erection Hardness Score (EHS) were the most commonly used tools to evaluate the therapeutic efficacy of LI-ESWT. There were 14 studies including 833 patients from 2005 to 2015. Seven studies were randomized controlled trials (RCTs); however, in these studies, the setup parameters of LI-ESWT and the protocols of treatment were variable. The meta-analysis revealed that LI-ESWT could significantly improve IIEF (mean difference: 2.00; 95% confidence interval [CI], 0.99-3.00; p<0.0001) and EHS (risk difference: 0.16; 95% CI, 0.04-0.29; p=0.01). Therapeutic efficacy could last at least 3 mo. The patients with mild-moderate ED had better therapeutic efficacy after treatment than patients with more severe ED or comorbidities. Energy flux density, number of shock waves per treatment, and duration of LI-ESWT treatment were closely related to clinical outcome, especially regarding IIEF improvement. The number of studies of LI-ESWT for ED have increased dramatically in recent years. Most of these studies presented encouraging results, regardless of variation in LI-ESWT setup parameters or treatment protocols. These studies suggest that LI-ESWT could significantly improve the IIEF and EHS of ED patients. The publication of robust evidence from additional RCTs and longer-term follow-up would provide more confidence regarding use of LI-ESWT for ED patients. We reviewed 14 studies of men who received low-intensity extracorporeal shock wave treatment (LI-ESWT) for erectile dysfunction (ED). There was evidence that these men experienced improvements in their ED following LI-ESWT. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Catastrophic complication following injection and extracorporeal shock wave therapy of a medial femoral condyle subchondral cystic lesion in a 14 year old Arabian mare.

PubMed

Moser, Darla K; Schoonover, Mike J; Sippel, Kate M; Dieterly, Alix M; Ritchey, Jerry W; Wall, Corey R

2017-01-01

This report describes fibrous cyst lining injection and extracorporeal shock wave therapy (ESWT) of a medial femoral condyle (MFC) subchondral cystic lesion (SCL) resulting in catastrophic MFC fracture in an Arabian mare. The mare was presented for evaluation of a severe hind limb lameness of approximately 4 months duration. On presentation, a non-weight bearing lameness of the left hind limb with severe effusion and soft tissue swelling of the stifle region was noted. Radiographic evaluation of the stifle revealed a large SCL of the MFC with associated osteoarthritis. Arthroscopic guided intra-lesional injection of the SCL with corticosteroids and autologous bone marrow concentrate was performed followed by ESWT of the MFC. The mare was discharged walking comfortably 48-hours post-operatively. An acute increase in lameness was noted 14 days post-operatively. Imaging revealed catastrophic fracture of the left MFC. Possible mechanisms leading to failure of the MFC secondary to the described treatment are discussed.

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.

Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy.

PubMed

Rompe, Jan D; Cacchio, Angelo; Weil, Lowell; Furia, John P; Haist, Joachim; Reiners, Volker; Schmitz, Christoph; Maffulli, Nicola

2010-11-03

Whether plantar fascia-specific stretching or shock-wave therapy is effective as an initial treatment for proximal plantar fasciopathy remains unclear. The aim of this study was to test the null hypothesis of no difference in the effectiveness of these two forms of treatment for patients who had unilateral plantar fasciopathy for a maximum duration of six weeks and which had not been treated previously. One hundred and two patients with acute plantar fasciopathy were randomly assigned to perform an eight-week plantar fascia-specific stretching program (Group I, n = 54) or to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group II, n = 48). All patients completed the seven-item pain subscale of the validated Foot Function Index and a patient-relevant outcome questionnaire. Patients were evaluated at baseline and at two, four, and fifteen 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 few 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 plantar fascia-specific stretching than for those managed with shock-wave therapy (p < 0.001), as well as individually for item 2 (p = 0.002). Thirty-five patients (65%) in Group I versus fourteen patients (29%) in Group II were satisfied with the treatment (p < 0.001). These findings persisted at four months. At fifteen months after baseline, no significant between-group difference was measured. A program of manual stretching exercises specific to the plantar fascia is superior to repetitive low-energy radial shock-wave therapy for the treatment of acute symptoms of proximal plantar fasciopathy.

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 or wound area. As a result, LGS also showed no deleterious effects on the tissue which would hinder wound healing. With these results, LGS therapy shows promise as an alternative infected wound treatment, and a system capable of completing thorough animal trials is available for future researchers.

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 shock-wave therapy is more efficient than repetitive low-energy radial shock-wave therapy alone for the treatment of chronic symptoms of proximal plantar fasciopathy. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes.

PubMed

Cacchio, Angelo; Rompe, Jan D; Furia, John P; Susi, Piero; Santilli, Valter; De Paulis, Fosco

2011-01-01

Chronic proximal hamstring tendinopathy is an overuse syndrome that is usually managed by nonoperative methods. Shockwave therapy has proved to be effective in many tendinopathies. Shockwave therapy may be more effective than other nonoperative treatments for chronic proximal hamstring tendinopathy. Randomized controlled clinical study; Level of evidence, 1. Forty professional athletes with chronic proximal hamstring tendinopathy were enrolled between February 1, 2004, and September 30, 2006. Patients were randomly assigned to receive either shockwave therapy, consisting of 2500 impulses per session at a 0.18 mJ/mm² energy flux density without anesthesia, for 4 weeks (SWT group, n = 20), or traditional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, physiotherapy, and an exercise program for hamstring muscles (TCT group, n = 20). Patients were evaluated before treatment, and 1 week and 3, 6, and 12 months after the end of treatment. The visual analog scale (VAS) score for pain and Nirschl phase rating scale (NPRS) were used as primary outcome measures. The patients were observed for a mean of 10.7 months (range, 1-12 months). Six patients were lost to follow-up because they underwent a surgical intervention: 3 (all in TCT group) were lost at 3 months; 2 (1 in each group), at 6 months; and 1 (in the TCT group), at 12 months. Primary follow-up was at 3 months after the beginning of treatment. The VAS scores in the SWT and TCT groups were 7 points before treatment (P = .84), and 2 points and 5 points, respectively, 3 months after treatment (P < .001). The NPRS scores in the SWT and TCT groups were 5 points in either group before treatment (P = .48), and 2 points and 6 points, respectively, 3 months after treatment (P < .001). At 3 months after treatment, 17 of the 20 patients (85%) in the SWT group and 2 of the 20 patients (10%) in the TCT group achieved a reduction of at least 50% in pain (P < .001). There were no serious complications in the SWT group. Shockwave therapy is a safe and effective treatment for patients with chronic proximal hamstring tendinopathy.

Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review.

PubMed

Harniman, Elaine; Carette, Simon; Kennedy, Carol; Beaton, Dorcas

2004-01-01

The authors conducted a systematic review to assess the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of calcific and noncalcific tendonitis of the rotator cuff. Conservative treatment for rotator cuff tendonitis includes physiotherapy, nonsteroidal antiinflammatory drugs, and corticosteroid injections. If symptoms persist with conservative treatment, surgery is often considered. Extracorporeal shock wave therapy has been suggested as a treatment alternative for chronic rotator cuff tendonitis, which may decrease the need for surgery. Articles for this review were identified by electronically searching Medline, EMBASE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), and Evidence Based Medicine (EBM) and hand-screening references. Two reviewers selected the trials that met the inclusion criteria, extracted the data, and assessed the methodological quality of the selected trials. Finally, the strength of scientific evidence was appraised. Evidence was classified as strong, moderate, limited, or conflicting. Sixteen trials met the inclusion criteria. There were only five randomized, controlled trials and all involved chronic (>/=3 months) conditions, three for calcific tendonitis and two for noncalcific tendonitis. For randomized, controlled trials, two (40%) were of high quality, one (33%) for calcific tendonitis and one (50%) for noncalcific tendonitis. The 11 nonrandomized trials included nine that involved calcific tendonitis and two that involved both calcific and noncalcific tendonitis. Common problem areas were sample size, randomization, blinding, treatment provider bias, and outcome measures. There is moderate evidence that high-energy ESWT is effective in treating chronic calcific rotator cuff tendonitis when the shock waves are focused at the calcified deposit. There is moderate evidence that low-energy ESWT is not effective for treating chronic noncalcific rotator cuff tendonitis, although this conclusion is based on only one high-quality study, which was underpowered. High-quality randomized, controlled trials are needed with larger sample sizes, better randomization and blinding, and better outcome measures.

Comparative Analysis of Angiogenic Gene Expression in Normal and Impaired Wound Healing in Diabetic Mice: Effects of Extracorporeal Shock Wave Therapy

DTIC Science & Technology

2010-01-01

vivo. Circulation 110(19): 3055-3061 19. Stojadinovic A, Elster EA, Anam K et al (2008) Angiogenic response to extracorporeal shock wave treatment in...healing in diabetic mice: effects of extracorporeal shock wave therapy Stephen R. Zins • Mihret F. A mare • Douglas K. Tadaki • Eric. A. Elster... extracorporeal shock wave therapy (ESWT), which has been demonstrated to improve wound healing. Full-thick- ness skin from the dorsal surface of "nonnal" (BALB

Extracorporeal shock wave treatment for chronic plantar fasciitis (heel pain).

PubMed

Ho, C

2007-01-01

(1) Electrohydraulic, electromagnetic, or piezoelectric devices are used to translate energy into acoustic waves during extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis (or heel pain). These waves may help to accelerate the healing process via an unknown mechanism. (2) ESWT, which is performed as an outpatient procedure, is intended to alleviate the pain due to chronic plantar fasciitis. (3) Results from randomized controlled trials have been conflicting. Six trials reported data that favour ESWT over placebo or conservative treatment for efficacy outcomes, while three trials showed no significant difference between the ESWT group and the placebo group. (4) The lack of convergent findings from randomized trials of ESWT for chronic plantar fasciitis suggests uncertainty about its effectiveness. The evidence reviewed in this bulletin does not support the use of this technology for this condition.

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

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.

The use of shock waves in peripheral nerve regeneration: new perspectives?

PubMed

Hausner, Thomas; Nógrádi, Antal

2013-01-01

Low-energy extracorporeal shock wave treatment (ESWT) is a relatively new therapeutic tool that is widely used for the treatment of epicondylitis and plantar fasciitis and to foster bone and wound healing. Shock waves, sonic pulses with high energy impact, are thought to induce biochemical changes within the targeted tissues through mechanotransduction. The biological effects of ESWT are manifested in improved vascularization, the local release of growth factors, and local anti-inflammatory effects, but the target cells too are influenced. ESWT appears to have differential effects on peripheral nerves and has been proved to promote axonal regeneration after axotomy. This review discusses the effects of ESWT on intact and injured peripheral nerves and suggests a multiple mechanism of action. © 2013 Elsevier Inc. All rights reserved.

Acoustic field characterization of the Duolith: measurements and modeling of a clinical shock wave therapy device.

PubMed

Perez, Camilo; Chen, Hong; Matula, Thomas J; Karzova, Maria; Khokhlova, Vera A

2013-08-01

Extracorporeal shock wave therapy (ESWT) uses acoustic pulses to treat certain musculoskeletal disorders. In this paper the acoustic field of a clinical portable ESWT device (Duolith SD1) was characterized. Field mapping was performed in water for two different standoffs of the electromagnetic head (15 or 30 mm) using a fiber optic probe hydrophone. Peak positive pressures at the focus ranged from 2 to 45 MPa, while peak negative pressures ranged from -2 to -11 MPa. Pulse rise times ranged from 8 to 500 ns; shock formation did not occur for any machine settings. The maximum standard deviation in peak pressure at the focus was 1.2%, indicating that the Duolith SD1 generates stable pulses. The results compare qualitatively, but not quantitatively with manufacturer specifications. Simulations were carried out for the short standoff by matching a Khokhlov-Zabolotskaya-Kuznetzov equation to the measured field at a plane near the source, and then propagating the wave outward. The results of modeling agree well with experimental data. The model was used to analyze the spatial structure of the peak pressures. Predictions from the model suggest that a true shock wave could be obtained in water if the initial pressure output of the device were doubled.

Acoustic field characterization of the Duolith: Measurements and modeling of a clinical shock wave therapy device

PubMed Central

Perez, Camilo; Chen, Hong; Matula, Thomas J.; Karzova, Maria; Khokhlova, Vera A.

2013-01-01

Extracorporeal shock wave therapy (ESWT) uses acoustic pulses to treat certain musculoskeletal disorders. In this paper the acoustic field of a clinical portable ESWT device (Duolith SD1) was characterized. Field mapping was performed in water for two different standoffs of the electromagnetic head (15 or 30 mm) using a fiber optic probe hydrophone. Peak positive pressures at the focus ranged from 2 to 45 MPa, while peak negative pressures ranged from −2 to −11 MPa. Pulse rise times ranged from 8 to 500 ns; shock formation did not occur for any machine settings. The maximum standard deviation in peak pressure at the focus was 1.2%, indicating that the Duolith SD1 generates stable pulses. The results compare qualitatively, but not quantitatively with manufacturer specifications. Simulations were carried out for the short standoff by matching a Khokhlov-Zabolotskaya-Kuznetzov equation to the measured field at a plane near the source, and then propagating the wave outward. The results of modeling agree well with experimental data. The model was used to analyze the spatial structure of the peak pressures. Predictions from the model suggest that a true shock wave could be obtained in water if the initial pressure output of the device were doubled. PMID:23927207

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.

Radial extracorporeal shock wave treatment harms developing chicken embryos

PubMed Central

Kiessling, Maren C.; Milz, Stefan; Frank, Hans-Georg; Korbel, Rüdiger; Schmitz, Christoph

2015-01-01

Radial extracorporeal shock wave treatment (rESWT) has became one of the best investigated treatment modalities for cellulite, including the abdomen as a treatment site. Notably, pregnancy is considered a contraindication for rESWT, and concerns have been raised about possible harm to the embryo when a woman treated with rESWT for cellulite is not aware of her pregnancy. Here we tested the hypothesis that rESWT may cause serious physical harm to embryos. To this end, chicken embryos were exposed in ovo to various doses of radial shock waves on either day 3 or day 4 of development, resembling the developmental stage of four- to six-week-old human embryos. We found a dose-dependent increase in the number of embryos that died after radial shock wave exposure on either day 3 or day 4 of development. Among the embryos that survived the shock wave exposure a few showed severe congenital defects such as missing eyes. Evidently, our data cannot directly be used to draw conclusions about potential harm to the embryo of a pregnant woman treated for cellulite with rESWT. However, to avoid any risks we strongly recommend applying radial shock waves in the treatment of cellulite only if a pregnancy is ruled out. PMID:25655309

[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.

Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method.

PubMed

Altenburg, Wytske A; Duiverman, Marieke L; Ten Hacken, Nick H T; Kerstjens, Huib A M; de Greef, Mathieu H G; Wijkstra, Peter J; Wempe, Johan B

2015-02-19

Although the endurance shuttle walk test (ESWT) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation (PR) for COPD, the minimally important difference (MID) has not yet been established. We aimed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR. Data were derived from a randomized controlled trial, investigating the value of noninvasive positive pressure ventilation added to PR. Fifty-five patients with stable COPD, GOLD stage IV, with chronic respiratory failure were included (mean (SD) FEV1 31.1 (12.0) % pred, age 62 (9) y). MID estimates of the ESWT in seconds, percentage and meters change were calculated with anchor based and distribution based methods. Six minute walking distance (6MWD), peak work rate on bicycle ergometry (Wpeak) and Chronic Respiratory Questionnaire (CRQ) were used as anchors and Cohen's effect size was used as distribution based method. The estimated MID of the ESWT with the different anchors ranged from 186-199 s, 76-82% and 154-164 m. Using the distribution based method the MID was 144 s, 61% and 137 m. Estimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure. Therefore we recommend using a range of 186-199 s, 76-82% or 154-164 m as MID of the ESWT in COPD patients with chronic respiratory failure. Further research in larger populations should elucidate whether this cut-off value is also valid in other COPD populations and with other interventions. ClinicalTrials.Gov (ID NCT00135538).

Extracorporeal shock wave treatment for chronic rotator cuff tendonitis (shoulder pain).

PubMed

Ho, C

2007-01-01

(1) Electrohydraulic, electromagnetic, or piezoelectric devices are used to translate energy into acoustic waves during extracorporeal shock wave treatment (ESWT) for chronic rotator cuff tendonitis (shoulder pain). The acoustic waves may help to accelerate the healing process of chronic rotator cuff tendonitis via an unknown mechanism. (2) ESWT, which is performed as an outpatient procedure, is intended to alleviate the pain due to chronic rotator cuff tendonitis. (3) Limited evidence from a German study indicates that the cost of ESWT for rotator cuff tendonitis is one-fifth to one-seventh the cost of surgical treatment, with longer recovery time and time off work in the surgical treatment group accounting for about two-thirds of the overall cost. (4) The evidence reviewed for this bulletin supports the use of high-energy ESWT for chronic calcific rotator cuff tendonitis, but not for non-calcific rotator cuff tendonitis. High-quality RCTs with larger sample sizes are needed to provide stronger evidence.

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.

Does Kinesiotaping improve pain and functionality in patients with newly diagnosed lateral epicondylitis?

PubMed

Eraslan, Leyla; Yuce, Deniz; Erbilici, Arzu; Baltaci, Gul

2018-03-01

This study aimed to compare the short-term effects of kinesiotaping and extracorporeal shock wave therapy (ESWT) along with physiotherapy on pain, functionality, and grip strength in patients with newly diagnosed lateral epicondylitis undergoing rehabilitation. Forty-five voluntary patients (mean age 48 years) were randomly assigned to three groups. Patients in all groups received physiotherapy consisting of a cold pack and transcutaneous electrical nerve stimulation five times per week for a total of 15 sessions and a home exercise programme including stretching and eccentric strength exercises. In the second group, patients received kinesiotaping 5 days a week for 3 weeks. In the third group, ESWT was applied three times for 3 weeks. Patients were assessed by visual analogue scale for pain intensity, pain-free grip strength using a hand dynamometer, Cyriax Resisted Muscle Test, and Patient-Rated Tennis Elbow Evaluation Scale. All measurements were collected at baseline and after treatment. There were no significant differences in the demographic characteristics of the patients in all groups at baseline. Intra-group analysis revealed that pain intensity decreased, whereas maximum grip strength and functionality increased in all groups at the end of the treatment (p < 0.05). Inter-group analysis revealed that the kinesiotaping group yielded better results in decreasing pain intensity than the other groups (p < 0.05). The kinesiotaping group (p < 0.001) and ESWT group (p = 0.002) yielded better results in improving functionality than the physiotherapy group. There were significant differences in recovering pain-free grip strength in the kinesiotaping group (p < 0.05). Kinesiotaping was found to be effective for decreasing pain intensity, recovering grip strength, and improving functionality in patients with lateral epicondylitis undergoing rehabilitation. Therapeutic study, Level II.

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.

Extracorporeal shock wave treatment of non- or delayed union of proximal metatarsal fractures.

PubMed

Alvarez, Richard G; Cincere, Brandon; Channappa, Chandra; Langerman, Richard; Schulte, Robert; Jaakkola, Juha; Melancon, Keith; Shereff, Michael; Cross, G Lee

2011-08-01

Nonunion or delayed union of fractures in the proximal aspect of metatarsals 1 to 4 and Zone 2 of the fifth metatarsal were treated by high energy extracorporeal shock wave treatment (ESWT) to study the safety and efficacy of this method of treatment in a FDA study of the Ossatron device. In a prospective single-arm, multi-center study, 34 fractures were treated in 32 patients (two subjects had two independent fractures) with ESWT. All fractures were at least 10 (range, 10 to 833) weeks after injury, with a median of 23 weeks. ESWT application was conducted using a protocol totaling 2,000 shocks for a total energy application of approximately 0.22 to 0.51 mJ/mm2 per treatment. The mean ESWT application time for each of the treatments was 24.6 +/- 16.6 minutes, and anesthesia time averaged 27.1 +/- 10.4 minutes. All subjects were followed for 1 year after treatment at intervals of 12 weeks, 6, 9, and 12 months. The overall success rate at the 12-week visit was 71% with low complications, significant pain improvement as well as improvement on the SF-36. The success/fail criteria was evaluated again at the 6- and 12-month followup, showing treatment success rates of 89% (23/26) and 90% (18/20), respectively. The most common adverse event was swelling in the foot, reported by five subjects (15.6%). High-energy ESWT appears to be effective and safe in patients for treatment of nonunion or a delayed healing of a proximal metatarsal, and in fifth metatarsal fractures in Zone 2.

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.

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 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.

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 nNOS-positive nerves, endothelium, and smooth muscle in the penis. These beneficial effects appear to be mediated by recruitment of endogenous MSCs. Qiu X, Lin G, Xin Z, Ferretti L, Zhang H, Lue TF, and Lin C-S. Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model. J Sex Med 2013;10:738-746. © 2012 International Society for Sexual Medicine.

Acoustic and Cavitation Fields of Shock Wave Therapy Devices

NASA Astrophysics Data System (ADS)

Chitnis, Parag V.; Cleveland, Robin O.

2006-05-01

Extracorporeal shock wave therapy (ESWT) is considered a viable treatment modality for orthopedic ailments. Despite increasing clinical use, the mechanisms by which ESWT devices generate a therapeutic effect are not yet understood. The mechanistic differences in various devices and their efficacies might be dependent on their acoustic and cavitation outputs. We report acoustic and cavitation measurements of a number of different shock wave therapy devices. Two devices were electrohydraulic: one had a large reflector (HMT Ossatron) and the other was a hand-held source (HMT Evotron); the other device was a pneumatically driven device (EMS Swiss DolorClast Vet). Acoustic measurements were made using a fiber-optic probe hydrophone and a PVDF hydrophone. A dual passive cavitation detection system was used to monitor cavitation activity. Qualitative differences between these devices were also highlighted using a high-speed camera. We found that the Ossatron generated focused shock waves with a peak positive pressure around 40 MPa. The Evotron produced peak positive pressure around 20 MPa, however, its acoustic output appeared to be independent of the power setting of the device. The peak positive pressure from the DolorClast was about 5 MPa without a clear shock front. The DolorClast did not generate a focused acoustic field. Shadowgraph images show that the wave propagating from the DolorClast is planar and not focused in the vicinity of the hand-piece. All three devices produced measurable cavitation with a characteristic time (cavitation inception to bubble collapse) that varied between 95 and 209 μs for the Ossatron, between 59 and 283 μs for the Evotron, and between 195 and 431 μs for the DolorClast. The high-speed camera images show that the cavitation activity for the DolorClast is primarily restricted to the contact surface of the hand-piece. These data indicate that the devices studied here vary in acoustic and cavitation output, which may imply that the mechanisms by which they generate therapeutic effects are different.

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.

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

The Effectiveness of Physical Agents for Lower-Limb Soft Tissue Injuries: A Systematic Review.

PubMed

Yu, Hainan; Randhawa, Kristi; Côté, Pierre; Optima Collaboration

2016-07-01

Study Design Systematic review. Background Soft tissue injuries to the lower limb bring a substantial health and economic burden to society. Physical agents are commonly used to treat these injuries. However, the effectiveness of many such physical agents is not clearly established in the literature. Objective To evaluate the effectiveness and safety of physical agents for soft tissue injuries of the lower limb. Methods We searched 5 databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies. Paired reviewers independently screened the retrieved literature and appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a high risk of bias were excluded. We synthesized low-risk-of-bias studies according to principles of best-evidence synthesis. Results We screened 10261 articles. Of 43 RCTs identified, 20 had a high risk of bias and were excluded from the analysis, and 23 RCTs had a low risk of bias and were included in the analysis. The available higher-quality evidence suggests that patients with persistent plantar fasciitis may benefit from ultrasound or foot orthoses, while those with persistent midportion Achilles tendinopathy may benefit from shockwave therapy. However, the current evidence does not support the use of shockwave therapy for recent plantar fasciitis, low-Dye taping for persistent plantar fasciitis, low-level laser therapy for recent ankle sprains, or splints for persistent midportion Achilles tendinopathy. Finally, evidence on the effectiveness of the following interventions is not established in the current literature: (1) shockwave therapy for persistent plantar fasciitis, (2) cryotherapy or assistive devices for recent ankle sprains, (3) braces for persistent midportion Achilles tendinopathy, and (4) taping or electric muscle stimulation for patellofemoral pain syndrome. Conclusion Almost half the identified RCTs that evaluated the effectiveness of physical agents for the management of lower-limb soft tissue injuries had a high risk of bias. High-quality RCTs are still needed to assess the effectiveness of physical agents for managing the broad range of lower-limb soft tissue injuries. The effectiveness of most interventions remains unclear. Level of Evidence Therapy, 1a. Protocol registered July 10, 2014 with PROSPERO (CRD42014010621). J Orthop Sports Phys Ther 2016;46(7):523-554. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6521.

COMPARISON BETWEEN EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AT 120 AND 60 SHOCKWAVES PER MINUTE FOR TREATMENT OF URINARY STONES.

PubMed

Kashima, Soki; Horikawa, Yohei; Obara, Takashi; Muto, Yumina; Koizumi, Atsushi; Honma, Naoko; Akihama, Susumu; Shimoda, Naotake

2016-01-01

(Purpose) It has recently been suggested that a slow delivery rate of shockwaves by extracorporeal shock wave lithotripsy (SWL) improved treatment outcomes for urinary stones. We retrospectively analyzed the treatment outcomes of different shockwave delivery rates at 120 and 60 shockwaves per minute. (Patients and method) A total of 88 patients were treated at a fast delivery rate of 120 shockwaves per minute between July 2010 and April 2012, and 139 patients were treated at a slow delivery rate of 60 shockwaves per minute between May 2012 and May 2014 (n=227) using a Sonolith ® Praktis lithotripter. The treatment outcome of stone-free rate (SFR) after one SWL session was assessed at four weeks. (Result) SWL at 60 shockwaves per minute resulted in a significantly higher SFR compared with SWL at 120 shockwaves per minute (39.8% and 59.0%, respectively, p=0.0047), particularly for upper ureter (U1) stones (53.1% and 72.0%, respectively, p=0.028). Multivariate analysis showed that younger age, stone sizes of 10 mm or less, U1 stones, and slow delivery rate were significant predictors of a stone-free outcome. There were fewer adverse events after the delivery rate of 60 shockwaves per minute (p=0.058). (Conclusion) Our study suggests that SWL at 60 shockwaves per minute should be recommended to successfully treat urinary stones using the Sonolith ® Praktis lithotripter.

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

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.

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.

[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.

Ultrafast collisional ion heating by electrostatic shocks.

PubMed

Turrell, A E; Sherlock, M; Rose, S J

2015-11-13

High-intensity lasers can be used to generate shockwaves, which have found applications in nuclear fusion, proton imaging, cancer therapies and materials science. Collisionless electrostatic shocks are one type of shockwave widely studied for applications involving ion acceleration. Here we show a novel mechanism for collisionless electrostatic shocks to heat small amounts of solid density matter to temperatures of ∼keV in tens of femtoseconds. Unusually, electrons play no direct role in the heating and it is the ions that determine the heating rate. Ions are heated due to an interplay between the electric field of the shock, the local density increase during the passage of the shock and collisions between different species of ion. In simulations, these factors combine to produce rapid, localized heating of the lighter ion species. Although the heated volume is modest, this would be one of the fastest heating mechanisms discovered if demonstrated in the laboratory.

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.

Creatine supplementation and physical training in patients with COPD: A double blind, placebo-controlled study

PubMed Central

Faager, Gun; Söderlund, Karin; Sköld, Carl Magnus; Rundgren, Siw; Tollbäck, Anna; Jakobsson, Per

2006-01-01

Study objectives Patients with chronic obstructive pulmonary disease (COPD) have low exercise capacity and low content of high energetic phosphates in their skeletal muscles. The aim of the present study was to investigate whether creatine supplementation together with exercise training may increase physical performance compared with exercise training in patients with COPD. Design In a randomized, double-blind, placebo-controlled study, 23 patients with COPD (forced expiratory volume in one second [FEV1] < 70% of predicted) were randomized to oral creatine (n = 13) or placebo (n = 10) supplementation during an 8-week rehabilitation programme including exercise training. Physical performance was assessed by Endurance Shuttle Walking Test (ESWT), dyspnea and leg fatigue with Borg CR-10, quality of life with St George’s Respiratory Questionnaire (SGRQ). In addition, lung function test, artery blood gases, grip strength test, muscle strength and fatigue in knee extensors were measured. Results COPD patients receiving creatine supplementation increased their average walking time by 61% (ESWT) (p < 0.05) after the training period compared with 48% (p = 0.07) in the placebo group. Rated dyspnea directly after the ESWT decreased significantly from 7 to 5 (p < 0.05) in the creatine group. However, the difference between the groups was not statistically significant neither in walking time nor in rated dyspnea. Creatine supplementation did not increase the health related quality of life, lung function, artery blood gases, grip strength and knee extensor strength/fatigue. Conclusions Oral creatine supplementation in combination with exercise training showed no significant improvement in physical performance, measured as ESWT, in patients with COPD compared with exercise training alone. PMID:18044100

Thermoacoustic Imaging and Therapy Guidance based on Ultra-short Pulsed Microwave Pumped Thermoelastic Effect Induced with Superparamagnetic Iron Oxide Nanoparticles

PubMed Central

Wen, Liewei; Yang, Sihua; Zhong, Junping; Zhou, Quan; Xing, Da

2017-01-01

Multifunctional nanoparticle-mediated imaging and therapeutic techniques are promising modalities for accurate localization and targeted treatment of cancer in clinical settings. Thermoacoustic (TA) imaging is highly sensitive to detect the distribution of water, ions or specific nanoprobes and provides excellent resolution, good contrast and superior tissue penetrability. TA therapy is a potential non-invasive approach for the treatment of deep-seated tumors. In this study, human serum albumin (HSA)-functionalized superparamagnetic iron oxide nanoparticle (HSA-SPIO) is used as a multifunctional nanoprobe with clinical application potential for MRI, TA imaging and treatment of tumor. In addition to be a MRI contrast agent for tumor localization, HSA-SPIO can absorb pulsed microwave energy and transform it into shockwave via the thermoelastic effect. Thereby, the reconstructed TA image by detecting TA signal is expected to be a sensitive and accurate representation of the HSA-SPIO accumulation in tumor. More importantly, owing to the selective retention of HSA-SPIO in tumor tissues and strong TA shockwave at the cellular level, HSA-SPIO induced TA effect under microwave-pulse radiation can be used to highly-efficiently kill cancer cells and inhibit tumor growth. Furthermore, ultra-short pulsed microwave with high excitation efficiency and deep penetrability in biological tissues makes TA therapy a highly-efficient anti-tumor modality on the versatile platform. Overall, HSA-SPIO mediated MRI and TA imaging would offer more comprehensive diagnostic information and enable dynamic visualization of nanoagents in the tumorous tissue thereby tumor-targeted therapy. PMID:28638483

Thermoacoustic Imaging and Therapy Guidance based on Ultra-short Pulsed Microwave Pumped Thermoelastic Effect Induced with Superparamagnetic Iron Oxide Nanoparticles.

PubMed

Wen, Liewei; Yang, Sihua; Zhong, Junping; Zhou, Quan; Xing, Da

2017-01-01

Multifunctional nanoparticle-mediated imaging and therapeutic techniques are promising modalities for accurate localization and targeted treatment of cancer in clinical settings. Thermoacoustic (TA) imaging is highly sensitive to detect the distribution of water, ions or specific nanoprobes and provides excellent resolution, good contrast and superior tissue penetrability. TA therapy is a potential non-invasive approach for the treatment of deep-seated tumors. In this study, human serum albumin (HSA)-functionalized superparamagnetic iron oxide nanoparticle (HSA-SPIO) is used as a multifunctional nanoprobe with clinical application potential for MRI, TA imaging and treatment of tumor. In addition to be a MRI contrast agent for tumor localization, HSA-SPIO can absorb pulsed microwave energy and transform it into shockwave via the thermoelastic effect. Thereby, the reconstructed TA image by detecting TA signal is expected to be a sensitive and accurate representation of the HSA-SPIO accumulation in tumor. More importantly, owing to the selective retention of HSA-SPIO in tumor tissues and strong TA shockwave at the cellular level, HSA-SPIO induced TA effect under microwave-pulse radiation can be used to highly-efficiently kill cancer cells and inhibit tumor growth. Furthermore, ultra-short pulsed microwave with high excitation efficiency and deep penetrability in biological tissues makes TA therapy a highly-efficient anti-tumor modality on the versatile platform. Overall, HSA-SPIO mediated MRI and TA imaging would offer more comprehensive diagnostic information and enable dynamic visualization of nanoagents in the tumorous tissue thereby tumor-targeted therapy.

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.

Emerging Non-Cancer Applications of Therapeutic Ultrasound

PubMed Central

O’Reilly, Meaghan A.; Hynynen, Kullervo

2015-01-01

Ultrasound therapy has been investigated for over half a century. Ultrasound can act on tissue through a variety of mechanisms, including thermal, shockwave and cavitation mechanisms, and through these can elicit different responses. Ultrasound therapy can provide a non-invasive or minimally invasive treatment option, and ultrasound technology has advanced to the point where devices can be developed to investigate a wide range of applications. This review focuses on non-cancer, clinical applications of therapeutic ultrasound, with an emphasis on treatments that have recently reached clinical investigations, and preclinical research programs that have great potential to impact patient care. PMID:25792225

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.

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.

Management of cystinuric patients: an observational, retrospective, single-centre analysis.

PubMed

Ahmed, Kamran; Khan, Mohammad Shamim; Thomas, Kay; Challacombe, Ben; Bultitude, Matthew; Glass, Jonathan; Tiptaft, Richard; Dasgupta, Prokar

2008-01-01

A critical appraisal of the management of patients with cystine stones treated in our unit in the past 6 years and to analyze the outcome of multimodality therapies. An observational, single-centre retrospective study. We reviewed the records of all patients with stones referred to our centre over a 6-year period from 1998 to 2005. Data recorded included demographic details, medical therapies received/prescribed, compliance with medical therapies, mode of treatment, stone clearance and any recurrence during this period of study. A total of 30 cystinuric patients were treated in our institution over the period of 6 years from 1998 to early 2005. Of these 16 were males and 14 females with an average age at last follow-up of 39 years (range 15-70). Two patients were successfully managed medically. The remaining patients (n = 28) underwent a total of 237 procedures (pre- and postreferral to our unit), with an average of 7.9 procedures per patient for 126 stone episodes (4.2 episodes/patient). The modes of treatment included extracorporeal shockwave lithotripsy (n = 143), ureterorenoscopy and intracorporeal lithotripsy (n = 50), percutaneous nephrolithotomy (n = 28) and open procedures (n = 16). Two patients needed open surgery at our unit. Prior to referral to our dedicated unit, patients had received treatment with extracorporeal shockwave lithotripsy (multiple sessions), ureteroscopy (n = 14), percutaneous nephrolithotomy (n = 4) and open stone removal (n = 14). Most of the stones at our unit were managed using minimally invasive therapies. Compliance of cystinuric patients with medical treatment is often poor and patients experience recurrent stone episodes requiring multiple interventions. Modern management of cystine calculi should be with staged minimally invasive procedures to avoid the complications of multiple open procedures wherever possible along with appropriate medical prophylaxis.

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.

In vivo effect of shock-waves on the healing of fractured bone.

PubMed

Augat, P; Claes, L; Suger, G

1995-10-01

In a controlled animal experiment we attempted to clarify the question of whether there is a stimulating effect of extracorporeal shock-waves on the repair process of fractured long bones. As a fracture model we used an osteotomy in the diaphysis of the ovine tibia and an external fixation device. Shock-wave treatment at two levels of intensity and with four different numbers of applied shocks was performed with an electromagnetic acoustic source. Healing of the osteotomized bone was evaluated by biomechanical and radiological investigations on the whole bone as well as on bone sections from areas of the fracture gap and the periosteal fracture callus. We found a non-significant tendency to deterioration of the fracture healing with increasing shock-wave intensities. The study of treatment parameters led neither to significantly different biomechanical outcomes nor to altered radiological results in comparison to the untreated control group. RELEVANCE:--While we cannot comment upon the effectiveness of extracorporeal shock-waves in the delayed treatment of fractures or pseudarthrosis, our results suggest that shock-waves have no beneficial effect in acute fracture repair.

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.

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.

Probing mechanobiology with laser-induced shockwaves

NASA Astrophysics Data System (ADS)

Carmona, Christopher; Preece, Daryl C.; Gomez-Godinez, Veronica; Shi, Linda Z.; Berns, Michael W.

2017-08-01

Traumatic Brain Injury (TBI) occurs when an external force injures the brain. While clinical outcomes of TBI can vary widely in severity, few mechanisms of neurodegeneration following TBI have been identified for treatment. We propose a model for studying TBI using laser-induced shockwaves (LISs). An optical system was developed that allows single cells to be studied in response to LISs. Our system utilizes an optically-coupled force measurement component that allows for the visualization of shockwave dynamics. Here, the force measurement system is characterized by imaging stages over the period of violent expansion and collapse of microbubbles responsible for shockwave generation.

Proximal Hamstring Tendinosis and Partial Ruptures.

PubMed

Startzman, Ashley N; Fowler, Oliver; Carreira, Dominic

2017-07-01

Proximal hamstring tendinosis and partial hamstring origin ruptures are painful conditions of the proximal thigh and hip that may occur in the acute, chronic, or acute on chronic setting. Few publications exist related to their diagnosis and management. This systematic review discusses the incidence, treatment, and prognosis of proximal hamstring tendinosis and partial hamstring ruptures. Conservative treatment measures include nonsteroidal anti-inflammatory drugs, physical therapy, rest, and ice. If these measures fail, platelet-rich plasma or shockwave therapy may be considered. When refractory to conservative management, these injuries may be treated with surgical debridement and hamstring reattachment. [Orthopedics. 2017; 40(4):e574-e582.]. Copyright 2017, SLACK Incorporated.

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.

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.

Italian experience on use of E.S.W. therapy for avascular necrosis of femoral head.

PubMed

Russo, Sergio; Sadile, Francesco; Esposito, Roberto; Mosillo, Giuseppe; Aitanti, Emanuele; Busco, Gennaro; Wang, Ching-Jen

2015-12-01

Osteonecrosis (avascular necrosis) of the femoral head is a clinical disease due to a severe bone vascular alteration associated with intense pain and loss of joint function, with an incidence of 0.1% and unknown aetiology. Many classifications exist to describe it and in the final stages the patient will need a total hip arthroplasty. In the early stages, ESWT has given excellent responses.
 The Neapolitan school studied more than 600 patients who had very good results in I and II stages of Ficat and Arlet Classification, with an improve of outcomes in VAS and HSS scores. Moreover it has shown a complete restoration of the signal intensity of the femoral head in MRI. Copyright © 2015. Published by Elsevier Ltd.

Stepwise shockwave velocity determinator

NASA Technical Reports Server (NTRS)

Roth, Timothy E.; Beeson, Harold

1992-01-01

To provide an uncomplicated and inexpensive method for measuring the far-field velocity of a surface shockwave produced by an explosion, a stepwise shockwave velocity determinator (SSVD) was developed. The velocity determinator is constructed of readily available materials and works on the principle of breaking discrete sensors composed of aluminum foil contacts. The discrete sensors have an average breaking threshold of approximately 7 kPa. An incremental output step of 250 mV is created with each foil contact breakage and is logged by analog-to-digital instrumentation. Velocity data obtained from the SSVD is within approximately 11 percent of the calculated surface shockwave velocity of a muzzle blast from a 30.06 rifle.

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.

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.

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.

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

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.

[Peyronie's disease: state of the art and future perspectives].

PubMed

Gulino, G; Sasso, F; Falabella, R; Racioppi, M; Sacco, E; D'Onofrio, A; Bassi, P F

2007-01-01

Peyronie's disease (PD) is characterized by the onset of a fibrous plaque within the tunica albuginea of the penile corpora cavernosa, resulting in pain and bending during the erection, which can make the intercourse difficult or impossible. Evidence from literature supports the autoimmune etiology of PD, and suggests genetic and familiar conditions, penile traumatisms and history of genital tract diseases as risk factors, even though no definitive conclusions arise about the pathogenesis of the disease. Few randomized trials demonstrated that medical therapies, such as Vitamin E, Colchicine, Potassium amminobenzoate, Tamoxifen and injection therapy with Verapamil are effective in stabilizing the acute phase of the disease. Extracorporeal shock wave therapy (ESWT) and ionophoresis cannot be considered as first line or gold standard therapies. Satisfactory results have been published about Nesbit operation in large number of cases with low-stage disease, whereas plication procedures have shown significant rates of relapse. High incidence of long-term penile retraction have been reported in high-stage disease treated with plaque incision and simple graft insertion. Malleable, soft or inflatable prostheses combined with graft implant have given the best results in terms of penile straightening and lengthening and patients' satisfaction. In conclusion, the PD etiopathogenesis hasn't been clearly understood-yet, no medical therapy is fully effective; surgery remains therefore the gold standard in case of severe deformity and/or erectile dysfunction.

[Extracorporeal shock-wave therapy in the treatment of Peyronie's disease].

PubMed

Neĭmark, A I; Astakhov, Iu I; Sidor, M V

2004-01-01

The authors analyse the results of treatment of 28 patients with Peyronie's disease using extracorporeal shock-wave lithotripsy (ESWL) performed on Dornier U15 lithotriptor. A total of 2-6 sessions were made, maximal number--12. The efficacy was controlled by clinical indices and ultrasonic investigation (Doppler mapping of the blood flow). ESWL proved to be efficient in the treatment of Peyronie's disease (PD), primarily, in patients with early disease before appearance of severe fibroplastic alterations. Less plaque vascularization by energetic Doppler mapping due to ESWL is an important diagnostic criterion of PD treatment efficacy. Conservative treatment is not indicated in marked deformities and plaque calcification, erectile dysfunction. Moreover, any injection into the tunica albuginea, especially complicated by hematomas may be a damaging factor which triggers fibrous inflammation. Such patients should be treated surgically. If the patient is interested in immediate results or is not interested in continuation of sexual life, the treatment is prognostically uneffective. Thus, ESWL is an effective, safe method of PD treatment but requires further study and accumulation of clinical experience.

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

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

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.

Repeatability and responsiveness of exercise tests in pulmonary arterial hypertension.

PubMed

Mainguy, Vincent; Malenfant, Simon; Neyron, Anne-Sophie; Bonnet, Sébastien; Maltais, François; Saey, Didier; Provencher, Steeve

2013-08-01

Exercise tolerance in pulmonary arterial hypertension (PAH) is most commonly assessed by the 6-min walk test (6MWT). Whether endurance exercise tests are more responsive than the 6MWT remains unknown. 20 stable PAH patients (mean±sd age 53±15 years and mean pulmonary arterial pressure 44±16 mmHg) already on PAH monotherapy completed the 6MWT, the endurance shuttle walk test (ESWT) and the cycle endurance test (CET) before and after the addition of sildenafil citrate 20 mg three times daily or placebo for 28 days in a randomised double-blind crossover setting. Pre- or post-placebo tests were used to assess repeatability of each exercise test, whereas pre- or post-sildenafil citrate tests were used to assess their responsiveness. Sildenafil citrate led to placebo-corrected changes in exercise capacity of 18±25 m (p = 0.02), 58±235 s (p = 0.58) and 29±77 s (p = 0.09) for the 6MWT, the ESWT and the CET, respectively. The 6MWT was associated with a lower coefficient of variation between repeated measures (3% versus 18% versus 13%), resulting in a higher standardised response mean compared with endurance tests (0.72, 0.25 and 0.38 for the 6MWT, the ESWT and the CET, respectively). The 6MWT had the best ability to capture changes in exercise capacity when sildenafil citrate was combined with patients' baseline monotherapy, supporting its use as an outcome measure in PAH.

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

One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

PubMed Central

Grecco, Marcus Vinicius; Brech, Guilherme Carlos; Greve, Júlia Maria D'Andrea

2013-01-01

OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment. PMID:24037003

Comparison of Radial Shockwaves and Conventional Physiotherapy for Treating Plantar Fasciitis

PubMed Central

Greve, Júlia Maria D’Andréa; Grecco, Marcus Vinicius; Santos-Silva, Paulo Roberto

2009-01-01

OBJECTIVE: To compare radial shockwave treatment and conventional physiotherapy for plantar fasciitis. MATERIALS AND METHODS: Thirty-two patients with plantar fasciitis were included in this study. They were randomly divided into two groups. Group 1 was composed of 16 patients who underwent 10 physiotherapy sessions each, consisting of ultrasound, kinesiotherapy and instruction for stretching exercises at home. Group 2 was composed of 16 patients who underwent three applications of radial shockwaves (once a week) and received instruction for stretching exercises at home. Pain and ability to function were evaluated before treatment, immediately afterwards, and three months later. The mean age of the patients was 47.3 ± 10.3 years (range 25–68); 81% were female, 87% were overweight, 56% had bilateral impairment, and 75% used analgesics regularly. RESULTS: Both treatments were effective for pain reduction and for improving the functional abilities of patients with plantar fasciitis. The effect of the shockwaves was apparent sooner than physiotherapy after the onset of treatment. CONCLUSION: Shockwave treatment was no more effective than conventional physiotherapy treatment when evaluated three months after the end of treatment. PMID:19219314

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

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.

[Inpatient therapy of urinary stones in Germany: development of the G-DRG system].

PubMed

Bauer, J; Kahlmeyer, A; Stredele, R; Volkmer, B G

2014-12-01

The therapy of urinary stones in Germany is mostly a domain of hospitals even now. With the introduction of the German diagnosis-related groups (G-DRG) system in the years 2003/2004 an attempt was made to realize an ever-increasing fair representation and remuneration of treatment costs. Simultaneously, a declared target was to transfer all forms of treatment which did not necessitate hospital admission to the outpatient department. Analysis of the D-DRG data on running invoicing from all German hospitals from 2004/2005 to 2012/2013 showed an increase in case numbers of around 12% with a parallel increase in the volume of revenues of around 37%. A special feature was a reduction in the proportion of extracorporeal shockwave therapy (ESWL) as inpatient treatment with a parallel increase in the proportion of ureteroscopic and percutaneous interventions.

[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.

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.

Extracorporeal shock wave therapy (ESWT) for wound healing: technology, mechanisms, and clinical efficacy.

PubMed

Mittermayr, Rainer; Antonic, Vlado; Hartinger, Joachim; Kaufmann, Hanna; Redl, Heinz; Téot, Luc; Stojadinovic, Alexander; Schaden, Wolfgang

2012-01-01

For almost 30 years, extracorporeal shock wave therapy has been clinically implemented as an effective treatment to disintegrate urinary stones. This technology has also emerged as an effective noninvasive treatment modality for several orthopedic and traumatic indications including problematic soft tissue wounds. Delayed/nonhealing or chronic wounds constitute a burden for each patient affected, significantly impairing quality of life. Intensive wound care is required, and this places an enormous burden on society in terms of lost productivity and healthcare costs. Therefore, cost-effective, noninvasive, and efficacious treatments are imperative to achieve both (accelerated and complete) healing of problematic wounds and reduce treatment-related costs. Several experimental and clinical studies show efficacy for extracorporeal shock wave therapy as means to accelerate tissue repair and regeneration in various wounds. However, the biomolecular mechanism by which this treatment modality exerts its therapeutic effects remains unclear. Potential mechanisms, which are discussed herein, include initial neovascularization with ensuing durable and functional angiogenesis. Furthermore, recruitment of mesenchymal stem cells, stimulated cell proliferation and differentiation, and anti-inflammatory and antimicrobial effects as well as suppression of nociception are considered important facets of the biological responses to therapeutic shock waves. This review aims to provide an overview of shock wave therapy, its history and development as well as its current place in clinical practice. Recent research advances are discussed emphasizing the role of extracorporeal shock wave therapy in soft tissue wound healing. © 2012 by the Wound Healing Society.

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.

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.

Local shock-wave lithotripsy of distal ureteral calculi.

PubMed

Voges, G E; Wilbert, D M; Stöckle, M; Hohenfellner, R

1988-01-01

Since the initiation of the clinical trial utilizing a second-generation lithotripor (Lithostar, Siemens, Erlangen, FRG), 96 patients with distal ureteral calculi (i.e. calculi below the pelvic brim) underwent local shock-wave lithotripsy. Routine treatment was conducted under intravenous sedation and light analgesia only. Complete stone disintegration was achieved in 84 patients (87.5%), 11 requiring two sessions and 1 patient, three. In 7 patients ureteroscopy became necessary after unsuccessful local shock-wave treatment. In 2 of these patients a 9-french flexible ureteroscope and the Storz Q-switched neodymium-YAG laser was used for stone disintegration. In 3 cases loop extraction and in 2 cases open surgery had to be performed for definitive stone removal. All pre- and postoperative manipulations (except open surgery) were done on the Lithostar. Local shock-wave lithotripsy is a highly successful, noninvasive, time-saving and easily applicable technique. It has become our primary approach in the treatment of distal ureteral calculi.

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

Percutaneous Nephrolithotomy in Children

PubMed Central

DeMarco, Romano T.

2011-01-01

The surgical management of pediatric stone disease has evolved significantly over the last three decades. Prior to the introduction of shockwave lithotripsy (SWL) in the 1980s, open lithotomy was the lone therapy for children with upper tract calculi. Since then, SWL has been the procedure of choice in most pediatric centers for children with large renal calculi. While other therapies such as percutaneous nephrolithotomy (PNL) were also being advanced around the same time, PNL was generally seen as a suitable therapy in adults because of the concerns for damage in the developing kidney. However, recent advances in endoscopic instrumentation and renal access techniques have led to an increase in its use in the pediatric population, particularly in those children with large upper tract stones. This paper is a review of the literature focusing on the indications, techniques, results, and complications of PNL in children with renal calculi. PMID:22013438

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

Patellar Tendinopathy

PubMed Central

Schwartz, Aaron; Watson, Jonathan N.; Hutchinson, Mark R.

2015-01-01

Context: Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment. Evidence Acquisition: PubMed spanning 1962-2014. Study Design: Clinical review. Level of Evidence: Level 4. Results: The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities. Conclusion: Physical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients. PMID:26502416

[Treatment of kidney stones using shock-wave lithotripsy with sonographic control].

PubMed

Benes, J; Chmel, J; Simon, V; Stuka, C; Flejsar, P

1991-10-01

Lithotripsy by means of an extracorporeal shock-wave was performed in 128 patients with urolithiasis. In this group for the first time in Czechoslovakia ultrasound control of kidney stones was used in 44 patients; in the remainder X-ray control was used. The authors used equipment designed and manufactured locally. The ultrasonic probe is laterally connected with the shock-wave applicator. Disappearance of the fragments after lithotripsy was achieved in 39 patients where ultrasonic control was used. The paper presents the results, discusses the advantages and limitations of ultrasonic control in extracorporeal lithotripsy of urolithiasis.

[Treatment of kidney calculi using shock-wave lithotripsy with ultrasonic guidance].

PubMed

Benes, J; Chmel, J; Simon, V; Stuka, C; Flejsar, P

1991-01-01

Lithotripsy by means of an extracorporeal shock-wave was performed in 128 patients with urolithiasis. In this group for the first time in Czechoslovakia ultrasound control of kidney stones was used in 44 patients; in the remainder X-ray control was used. The authors used equipment designed and manufactured locally. The ultrasonic probe is laterally connected with the shock-wave applicator. Disappearance of the fragments after lithotripsy was achieved in 39 patients where ultrasonic control was used. The paper presents the results, discusses the advantages and limitations of ultrasonic control in extracorporeal lithotripsy of urolithiasis.

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,

[Renal hematomas after extracorporeal shock-wave lithotripsy (ESWL)].

PubMed

Pastor Navarro, Héctor; Carrión López, Pedro; Martínez Ruiz, Jesús; Pastor Guzmán, José Ma; Martínez Martín, Mariano; Virseda Rodríguez, Julio A

2009-03-01

The use of fragmentation due to shock- waves as a treatment of urinary stone was one of the most important therapeutics findings in the history of urology. It's the first election treatment for most of the calculus at renal and urethral location due to the fact that it is a low invasive treatment and it has a few number of complications, but this method also has a few negative side effects, it can caused a more or less important traumatic lesion at the organs which crosses the shock-waves, including the kidney where it can caused a small contusion or renal hematoma with different resolution and treatment. We reviewed 4815 extracorporeal shock-wave lithotripsy that we performed in our department in which we found six cases with subcapsular and perirenal hematoma which we followed up and treated. After the urological complications (pain, obstruction and infection) the renal and perirenal hematic collections are the most frequent adverse effects of shock-waves used in lithotripsy, these are related to the power of energy used and patient age. Between the years 1992-2007 we performed 4.815 extracorporeal shock-wave lithotripsy finding seven cases of severe hematoma, less then 1%. Treatment of these complications is usually not aggressive though sometimes it is necessary to perform surgical drainage and even nephrectomy.

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.

International Shock-Wave Database: Current Status

NASA Astrophysics Data System (ADS)

Levashov, Pavel

2013-06-01

Shock-wave and related dynamic material response data serve for calibrating, validating, and improving material models over very broad regions of the pressure-temperature-density phase space. Since the middle of the 20th century vast amount of shock-wave experimental information has been obtained. To systemize it a number of compendiums of shock-wave data has been issued by LLNL, LANL (USA), CEA (France), IPCP and VNIIEF (Russia). In mid-90th the drawbacks of the paper handbooks became obvious, so the first version of the online shock-wave database appeared in 1997 (http://www.ficp.ac.ru/rusbank). It includes approximately 20000 experimental points on shock compression, adiabatic expansion, measurements of sound velocity behind the shock front and free-surface-velocity for more than 650 substances. This is still a useful tool for the shock-wave community, but it has a number of serious disadvantages which can't be easily eliminated: (i) very simple data format for points and references; (ii) minimalistic user interface for data addition; (iii) absence of history of changes; (iv) bad feedback from users. The new International Shock-Wave database (ISWdb) is intended to solve these and some other problems. The ISWdb project objectives are: (i) to develop a database on thermodynamic and mechanical properties of materials under conditions of shock-wave and other dynamic loadings, selected related quantities of interest, and the meta-data that describes the provenance of the measurements and material models; and (ii) to make this database available internationally through the Internet, in an interactive form. The development and operation of the ISWdb is guided by an advisory committee. The database will be installed on two mirrored web-servers, one in Russia and the other in USA (currently only one server is available). The database provides access to original experimental data on shock compression, non-shock dynamic loadings, isentropic expansion, measurements of sound speed in the Hugoniot state, and time-dependent free-surface or window-interface velocity profiles. Users are able to search the information in the database and obtain the experimental points in tabular or plain text formats directly via the Internet using common browsers. It is also possible to plot the experimental points for comparison with different approximations and results of equation-of-state calculations. The user can present the results of calculations in text or graphical forms and compare them with any experimental data available in the database. A short history of the shock-wave database will be presented and current possibilities of ISWdb will be demonstrated. Web-site of the project: http://iswdb.info. This work is supported by SNL contracts # 1143875, 1196352.

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

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.

Intracorporeal pneumatic shock application for the treatment of chronic plantar fasciitis: a randomized, double blind prospective clinical trial.

PubMed

Dogramaci, Yunus; Kalaci, Aydiner; Emir, Anil; Yanat, Ahmet Nedim; Gökçe, Ahmet

2010-04-01

Plantar fasciitis (PF) is a common clinical condition that usually resolves with non-operative treatments. Extracorporeal shock wave therapy (ESWT) has been used in the treatment of chronic PF not responding to other conservative measures; however, ESWT devices are expensive and available for daily practice in only few centers (In developing countries). A pneumatic lithotripter is a cheap and readily available device which uses pneumatic shock application for the intracorporeal lithotripsy. The aim of this study was to investigate the clinical efficacy of intracorporeal pneumatic shock therapy (IPST) application for the treatment of chronic PF using a cheap and readily available pneumatic lithotripter. A randomized, double-blind, placebo-controlled study was conducted. A total of 50 patients with clinically and radiologically confirmed PF were randomly allocated to either an active- (treatment) (n = 25) or inactive (placebo) (n = 25) group. Under local anesthesia and posterior tibial nerve block, a rigid probe was directly introduced into the calcaneal spur under fluoroscopic control; a standard protocol of 1,000 shock was applied during a single session into the calcaneal spur. The main outcome measure was the patients' subjective assessment of pain by means of a Visual Analog Scale (VAS) and the Roles and Maudsley Score before the treatment and 6 months later. At the 6 months, the rate of successful outcomes (excellent + good results) in the treatment group (92%) were significantly higher comparing to the control group (24%) (P < 0.001). Heel pain measured 6 months after using the VAS were 2.04 +/- 1.67 in treatment group and 7.16 +/- 1.57 in control group as compared to 8.92 +/- 1.22 and 9.12 +/- 1.23 before the commencement of the treatment. No complications attributable to the procedure such as rupture of the planter fascia, hematoma, or infection were observed during the study. This pilot study showed that IPST is an effective and safe method of treatment of patients with chronic PF not responding to conservative measures. IPST application should be considered before surgical intervention when the extracorporeal shock devices are not available for daily practice. However, further evaluation of this novel treatment is necessary to understand the exact mechanism of action.

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.

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.

The development and pilot testing of the self-management programme of activity, coping and education for chronic obstructive pulmonary disease (SPACE for COPD).

PubMed

Apps, Lindsay D; Mitchell, Katy E; Harrison, Samantha L; Sewell, Louise; Williams, Johanna E; Young, Hannah Ml; Steiner, Michael; Morgan, Mike; Singh, Sally J

2013-01-01

There is no independent standardized self-management approach available for chronic obstructive pulmonary disease (COPD). The aim of this project was to develop and test a novel self-management manual for individuals with COPD. Participants with a confirmed diagnosis of COPD were recruited from primary care. A novel self-management manual was developed with health care professionals and patients. Five focus groups were conducted with individuals with COPD (N = 24) during development to confirm and enhance the content of the prototype manual. The Self-management Programme of Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD) manual was developed as the focus of a comprehensive self-management approach facilitated by health care professionals. Preference for delivery was initial face-to-face consultation with telephone follow-up. The SPACE for COPD manual was piloted with 37 participants in primary care. Outcome measures included the Self-Report Chronic Respiratory Questionnaire, Incremental Shuttle Walk Test, and Endurance Shuttle Walking Test (ESWT); measurements were taken at baseline and 6 weeks. The pilot study observed statistically significant improvements for the dyspnea domain of the Self-Report Chronic Respiratory Questionnaire and ESWT. Dyspnea showed a mean change of 0.67 (95% confidence interval 0.23-1.11, P = 0.005). ESWT score increased by 302.25 seconds (95% confidence interval 161.47-443.03, P < 0.001). This article describes the development and delivery of a novel self-management approach for COPD. The program, incorporating the SPACE for COPD manual, appears to provoke important changes in exercise capacity and breathlessness for individuals with COPD managed in primary care.

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.

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)

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.

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

The Hayabusa, the world first sample-return minor body explorer, came back to the Earth, and reentered into the Earth's atmosphere on June 13, 2010. Following the reentries of the Genesis in 2004 and the Stardust in 2006, the return of the Hayabusa Sample Return Capsule (H-SRC) was the third direct reentry event from the interplanetary transfer orbit to the Earth at a velocity of over 11.2 km/s. In addition, it was the world first case of the direct reentry of the spacecraft (H-S/C) itself from the interplanetary transfer orbit. The H-SRC and the H-S/C reentries are very good analogue for studying bolide size meteors and meteorite falls. We, therefore, conducted a ground observation campaign for aspects of meteor sciences. We carried out multi-site ground observations of the Hayabusa reentry in the Woomera Prohibited Area (WPA), Australia. The observations were configured with optical imaging with still and video recordings, spectroscopies, and shockwave detection with infrasound and seismic sensors. In this study, we report details of the infrasound/seismic observations and those results. To detect shockwaves from the H-SRC and the H-S/C, we installed three small aperture infrasound/seismic arrays as the main stations. In addition, we also installed three single component seismic sub stations and an audible sound recorder. The infrasound and seismic sensors clearly recorded sonic boom type shockwaves from the H-SRC and disrupted fragments of the H-S/C itself. The audible recording also detected those shockwave sounds in the human audible band. Positive overpressure values of shockwaves (corresponding to the H-SRC) recorded at three main stations are 1.3 Pa, 1.0 Pa, and 0.7 Pa with the slant distance of 36.9 km, 54.9 km, and 67.8 km (i.e., the source altitude of 36.5 km, 38.9km, and 40.6 km), respectively. These amplitudes of shockwave overpressures are systematically smaller than those of theoretical predictions. We tried to identify the sources of shockwaves 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.

[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.

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.

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.

[Progress of low-energy shockwave therapy in clinical application].

PubMed

Xin, Zhong-cheng; Liu, Jing; Wang, Lin; Li, Hui-xi

2013-08-18

A shock wave is a transient pressure disturbance that propagates rapidly in three-dimensional space. It is associated with a sudden rise from ambient pressure to its maximum pressure. Shock wave therapy in urology is primarily used to disintegrate urolithiasis. Recently, low-energy shock wave therapy (LESWT), which is a novel convenient and cost-effective therapeutic modality, is extended to treat other pathological conditions including coronary heart disease, musculoskeletal disorders and erectile dysfunction. However, the exact therapeutic mechanisms and clinical safety and efficacy of LESWT remain to be investigated. Based on the results of previous studies, it is suggested that LESWT could regulate angiogenesis-related growth factors expression including endothelial nitric oxide synthase (eNOS), vessel endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA), which might induce the ingrowth of neovascularization that improves blood supply and increases cell proliferation and eventual tissue regeneration for restore pathological changes. The further studies on cellular and molecular biological changes by LESWT for clarification its mechanism and clinical safety and efficacy studies are recommended.

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

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-induced collapse of a bubble inside a deformable vessel

PubMed Central

Coralic, Vedran; Colonius, Tim

2013-01-01

Shockwave lithotripsy repeatedly focuses shockwaves on kidney stones to induce their fracture, partially through cavitation erosion. A typical side effect of the procedure is hemorrhage, which is potentially the result of the growth and collapse of bubbles inside blood vessels. To identify the mechanisms by which shock-induced collapse could lead to the onset of injury, we study an idealized problem involving a preexisting bubble in a deformable vessel. We utilize a high-order accurate, shock- and interface-capturing, finite-volume scheme and simulate the three-dimensional shock-induced collapse of an air bubble immersed in a cylindrical water column which is embedded in a gelatin/water mixture. The mixture is a soft tissue simulant, 10% gelatin by weight, and is modeled by the stiffened gas equation of state. The bubble dynamics of this model configuration are characterized by the collapse of the bubble and its subsequent jetting in the direction of the propagation of the shockwave. The vessel wall, which is defined by the material interface between the water and gelatin/water mixture, is invaginated by the collapse and distended by the impact of the jet. The present results show that the highest measured pressures and deformations occur when the volumetric confinement of the bubble is strongest, the bubble is nearest the vessel wall and/or the angle of incidence of the shockwave reduces the distance between the jet tip and the nearest vessel surface. For a particular case considered, the 40 MPa shockwave utilized in this study to collapse the bubble generated a vessel wall pressure of almost 450 MPa and produced both an invagination and distention of nearly 50% of the initial vessel radius on a 𝒪(10) ns timescale. These results are indicative of the significant potential of shock-induced collapse to contribute to the injury of blood vessels in shockwave lithotripsy. PMID:24015027

Combat Wound Initiative program.

PubMed

Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

2010-07-01

The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.

An Investigation of the High Rate Volumetric Properties of Snow.

DTIC Science & Technology

1981-11-01

experimental data. A number of applications are thenLi Investigated. These applications Include vehicle mobility In shallow anddeep snowpack, steady shockwaves...applications include vehicle mobility : in cb11 low and deep sjnowpack, ,,teady shockwaves, and noiistieady oe.av. -An na, 1, -lromacgnetic -;Lrus...VEHICLE MOBILITY ........................ 48 . III.A. Introductory Remarks .................................... 48 111.0. Tracked Vehicle Mobility in

Prospects in straw disintegration for biogas production.

PubMed

Maroušek, Josef

2013-10-01

The pretreatment methods for enhancing biogas production from oat straw under study include hot maceration, steam explosion, and pressure shockwaves. The micropore area (9, 55, and 64 m(2) g(-1)) inhibitor formations (0, 15, and 0 mL L(-1)) as well as the overall methane yields (67, 179, and 255 CH4 VS t(-1)) were robustly analyzed. It was confirmed that the operating conditions of the steam explosion must be precisely tailored to the substrate. Furthermore, it was beneficial to prepend the hot maceration before the steam explosion and the pressure shockwaves. The second alternative may give increased methane yields (246 in comparison to 273 CH4 VS t(-1)); however, the application of pressure shockwaves still faces limitations for deployment on a commercial scale.

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

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

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

Nonpharmaceutical approaches to pain management.

PubMed

Corti, Lisa

2014-03-01

A nonpharmaceutical approach to managing pain is one that does not employ a medication. The use of such approaches, in conjunction with pharmaceuticals as part of multimodal methods to managing pain, is becoming more popular as evidence is emerging to support their use. Cold therapy, for one, is used to reduce the inflammation and tissue damage seen in acute injuries and can be very effective at reducing acute pain. Incorporating the use of superficial heat therapy when treating pain associated with chronic musculoskeletal conditions is often employed as heat increases blood flow, oxygen delivery, and tissue extensibility. Acupuncture is gaining acceptance in veterinary medicine. Research is confirming that release of endogenous endorphins and enkephalins from the application of needles at specific points around the body can effectively control acute and chronic pain. The use of 2 newer therapies-extracorporeal shockwave therapy and platelet-rich plasma-represent an attempt to eliminate the causes of pain at the tissue level by promoting tissue healing and regeneration. Reviewed in this article, these therapies are intended to be used in conjunction with pharmaceuticals as part of a multimodal approach to pain management. Copyright © 2014 Elsevier Inc. All rights reserved.

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). Furthermore, samples treated with LGS saw an increase in susceptibility to gentamicin, in terms of reduced biofilm bioburden and CFU densities. LGS enhances the efficacy of topical antibiotics in an in vitro model. This has significant implications for clinical applications in the management of chronic soft tissue infections and recalcitrant chronic rhinosinusitis. Lasers Surg. Med. 49:539-547, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

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.

Study on miss distance based on projectile shock wave sensor

NASA Astrophysics Data System (ADS)

Gu, Guohua; Cheng, Gang; Zhang, Chenjun; Zhou, Lei

2017-05-01

The paper establishes miss distance models based on physical characteristic of shock-wave. The aerodynamic theory shows that the shock-wave of flying super-sonic projectile is generated for the projectile compressing and expending its ambient atmosphere. It advances getting miss distance according to interval of the first sensors, which first catches shock-wave, to solve the problem such as noise filtering on severe background, and signals of amplifier vibration dynamic disposal and electromagnetism compatibility, in order to improves the precision and reliability of gathering wave N signals. For the first time, it can identify the kinds of pills and firing units automatically, measure miss distance and azimuth when pills are firing. Application shows that the tactics and technique index is advanced all of the world.

Two-zone elastic-plastic single shock waves in solids.

PubMed

Zhakhovsky, Vasily V; Budzevich, Mikalai M; Inogamov, Nail A; Oleynik, Ivan I; White, Carter T

2011-09-23

By decoupling time and length scales in moving window molecular dynamics shock-wave simulations, a new regime of shock-wave propagation is uncovered characterized by a two-zone elastic-plastic shock-wave structure consisting of a leading elastic front followed by a plastic front, both moving with the same average speed and having a fixed net thickness that can extend to microns. The material in the elastic zone is in a metastable state that supports a pressure that can substantially exceed the critical pressure characteristic of the onset of the well-known split-elastic-plastic, two-wave propagation. The two-zone elastic-plastic wave is a general phenomenon observed in simulations of a broad class of crystalline materials and is within the reach of current experimental techniques.

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.

Investigation of Three-Dimensional Unsteady Flow Characteristics in Transonic Diffusers

NASA Astrophysics Data System (ADS)

Proshchanka, Dzianis; Yonezawa, Koichi; Tsujimoto, Yoshinobu

Three-dimensional characteristics of unsteady flow in supercritical transonic diffuser are investigated. For various pressure ratios three-dimensional flow containing a normal shock/turbulent boundary layer interaction regions with shockwave and pseudo-shockwaves fluctuating in longitudinal and spanwise directions is observed. Experimental and numerical investigations show details of the flowfield in the vicinity of terminal shock, interaction regions and downstream turbulent unsteady flow. Spectral analysis of pressure fluctuations reveals existence of two characteristic frequencies attributed to the shockwave fluctuation in longitudinal direction for the lower frequency case and acoustic resonance in spanwise direction for the higher one. Vortices appear at each corner in transversal sections modifying the core flow. As a result, size and depth of longitudinal and vertical penetration of separation regions impelled by the terminal shock is either increased or decreased.

Shock wave induced damage of a protein by void collapse

DOE PAGES

Lau, Edmond Y.; Berkowitz, Max L.; Schwegler, Eric R.

2016-01-05

In this study, we report on a series of molecular dynamics simulations that were used to examine the effects of shockwaves on a membrane bound ion channel. A planar shockwave was found to compress the ion channel upon impact but the protein geometry resembles the initial structure as soon as the solvent density begins to dissipate. When a void was placed in close proximity to the membrane, the shockwave proved to be much more destructive to the protein due to formation of a nanojet that results from the asymmetric collapse of the void. The nanojet was able to cause significantmore » structural changes to the protein even at low particle velocities that are not able to directly cause poration of the membrane.« less

Evaluation of multidimensional COPD-related subjective fatigue following a pulmonary rehabilitation programme.

PubMed

Lewko, Agnieszka; Bidgood, Penelope L; Jewell, Andy; Garrod, Rachel

2014-01-01

Subjective fatigue has been recognised as an important, multi-component symptom in COPD. Pulmonary Rehabilitation (PR) improves fatigue component of the Chronic Respiratory Questionnaire, a quality of life (QoL) measure. However, it is not clear if all fatigue dimensions are affected equally. This study aims to evaluate changes in subjective multidimensional fatigue among people with COPD who participated in PR. Thirty seven stable COPD patients were recruited; 23 patients (15 male) mean age 68.5 (range 49-86) yrs, mean (SD) %predicted FEV1 45.3 (19.8); completed 7 weeks of PR. Assessments (pre and post PR) consisted of the Multidimensional Fatigue Inventory (MFI-20), QoL (SGRQ), Anxiety and Depression (HADS), the London Chest Activity of Daily Living Scale (LCADL), muscle strength, incremental (ISWT) and endurance (ESWT) shuttle walk tests. The differences between pre and post PR fatigue were tested using Wilcoxon's test and relationships with other outcomes were examined using Spearman's correlation. There were statistically significant improvements in Reduced Activity (RA) (p = 0.01), General (GF) (p < 0.01) and Physical Fatigue (PF) (p = 0.03) components of MFI-20 after PR, but there were no differences in Motivation or Mental Fatigue (p > 0.05). There were significant improvements in ISWT (p < 0.05), ESWT (p < 0.01) and muscle strength (p = 0.03). Statistically significant correlations (p < 0.05) were found between changes in GF and in both ISWT (r = -0.43) and SGRQ impact (r = 0.46); and between RA and ESWT changes (r = -0.45). Some dimensions of fatigue in COPD are modifiable by a 7-week PR programme. Change in fatigue dimensions in COPD may be associated with a change in maximal or endurance walking distances or QoL. Copyright © 2013 Elsevier Ltd. All rights reserved.

Kink-bands: Shock deformation of biotite resulting from a nuclear explosion

USGS Publications Warehouse

Cummings, D.

1965-01-01

Microscopic examination of granodiorite samples from the shock region around a nuclear explosion reveals sharply folded lens-shaped zones (kink-bands) in the mineral biotite. Fifty percent of these zones are oriented approximately 90?? to the direction of shock-wave propagation, but other zones are symmetrically concentrated at shear angles of 50?? and 70?? to the direction of shock-wave propagation.

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.

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.

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.

The Role of PP2A Methylation in Susceptibility and Resistance to TBI and AD-Induced Neurodegeneration

DTIC Science & Technology

2013-09-01

will exert similar effects on shockwave- induced impairments. This effort has required a substantial investment in developing equipment and testing...substantial investment to identify suitable shockwave exposure conditions, confirm biomechanical parameters, and to assess the biochemical...consequences. One of the previously unforeseen benefits of this investment may be the identification of PME-1 over expressing mice as a sensitized background

Medical applications of atomic force microscopy and Raman spectroscopy.

PubMed

Choi, Samjin; Jung, Gyeong Bok; Kim, Kyung Sook; Lee, Gi-Ja; Park, Hun-Kuk

2014-01-01

This paper reviews the recent research and application of atomic force microscopy (AFM) and Raman spectroscopy techniques, which are considered the multi-functional and powerful toolkits for probing the nanostructural, biomechanical and physicochemical properties of biomedical samples in medical science. We introduce briefly the basic principles of AFM and Raman spectroscopy, followed by diagnostic assessments of some selected diseases in biomedical applications using them, including mitochondria isolated from normal and ischemic hearts, hair fibers, individual cells, and human cortical bone. Finally, AFM and Raman spectroscopy applications to investigate the effects of pharmacotherapy, surgery, and medical device therapy in various medicines from cells to soft and hard tissues are discussed, including pharmacotherapy--paclitaxel on Ishikawa and HeLa cells, telmisartan on angiotensin II, mitomycin C on strabismus surgery and eye whitening surgery, and fluoride on primary teeth--and medical device therapy--collagen cross-linking treatment for the management of progressive keratoconus, radiofrequency treatment for skin rejuvenation, physical extracorporeal shockwave therapy for healing of Achilles tendinitis, orthodontic treatment, and toothbrushing time to minimize the loss of teeth after exposure to acidic drinks.

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.

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 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.

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.

Shock Mitigating Seat Single Impact Program

DTIC Science & Technology

2014-04-24

new seats from Shockwave, SHOXS and Zodiac , were tested during the third and fourth phases of the final test program and these were conducted between...test program to the four single jockey style seats from Shockwave, SHOXS, Ullman and Zodiac because of budget and time constraints. The program...along with the Zodiac jockey pod seat that replaced the Ullman seat. 2711 (NETE CS) ZT4110-R 23 April 2014 QF035 32/39 Rev. 05/2011.11.14 69. The

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.

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

Janardhanraj, S.; Jagadeesh, G., E-mail: jaggie@aero.iisc.ernet.in

A novel concept to generate miniature shockwaves in a safe, repeatable, and controllable manner in laboratory confinements using an in situ oxyhydrogen generator has been proposed and demonstrated. This method proves to be more advantageous than existing methods because there is flexibility to vary strength of the shockwave, there is no need for storage of high pressure gases, and there is minimal waste disposal. The required amount of oxyhydrogen mixture is generated using alkaline electrolysis that produces hydrogen and oxygen gases in stoichiometric quantity. The rate of oxyhydrogen mixture production for the newly designed oxyhydrogen generator is found to bemore » around 8 ml/s experimentally. The oxyhydrogen generator is connected to the driver section of a specially designed 10 mm square miniature shock tube assembly. A numerical code that uses CANTERA software package is used to predict the properties of the driver gas in the miniature shock tube. This prediction along with the 1-D shock tube theory is used to calculate the properties of the generated shockwave and matches reasonably well with the experimentally obtained values for oxyhydrogen mixture fill pressures less than 2.5 bars. The miniature shock tube employs a modified tri-clover clamp assembly to facilitate quick changing of diaphragm and replaces the more cumbersome nut and bolt system of fastening components. The versatile nature of oxyhydrogen detonation-driven miniature shock tube opens up new horizons for shockwave-assisted interdisciplinary applications.« 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.

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

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.

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.

Effect of Shock Waves on Dielectric Properties of KDP Crystal

NASA Astrophysics Data System (ADS)

Sivakumar, A.; Suresh, S.; Pradeep, J. Anto; Balachandar, S.; Martin Britto Dhas, S. A.

2018-05-01

An alternative non-destructive approach is proposed and demonstrated for modifying electrical properties of crystal using shock-waves. The method alters dielectric properties of a potassium dihydrogen phosphate (KDP) crystal by loading shock-waves generated by a table-top shock tube. The experiment involves launching the shock-waves perpendicular to the (100) plane of the crystal using a pressure driven table-top shock tube with Mach number 1.9. Electrical properties of dielectric constant, dielectric loss, permittivity, impedance, AC conductivity, DC conductivity and capacitance as a function of spectrum of frequency from 1 Hz to 1 MHz are reported for both pre- and post-shock wave loaded conditions of the KDP crystal. The experimental results reveal that dielectric constant of KDP crystal is sensitive to the shock waves such that the value decreases for the shock-loaded KDP sample from 158 to 147. The advantage of the proposed approach is that it is an alternative to the conventional doping process for tailoring dielectric properties of this type of crystal.

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.

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.

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.

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.

Cytoplasmic molecular delivery with shock waves: importance of impulse.

PubMed Central

Kodama, T; Hamblin, M R; Doukas, A G

2000-01-01

Cell permeabilization using shock waves may be a way of introducing macromolecules and small polar molecules into the cytoplasm, and may have applications in gene therapy and anticancer drug delivery. The pressure profile of a shock wave indicates its energy content, and shock-wave propagation in tissue is associated with cellular displacement, leading to the development of cell deformation. In the present study, three different shock-wave sources were investigated; argon fluoride excimer laser, ruby laser, and shock tube. The duration of the pressure pulse of the shock tube was 100 times longer than the lasers. The uptake of two fluorophores, calcein (molecular weight: 622) and fluorescein isothiocyanate-dextran (molecular weight: 71,600), into HL-60 human promyelocytic leukemia cells was investigated. The intracellular fluorescence was measured by a spectrofluorometer, and the cells were examined by confocal fluorescence microscopy. A single shock wave generated by the shock tube delivered both fluorophores into approximately 50% of the cells (p < 0.01), whereas shock waves from the lasers did not. The cell survival fraction was >0.95. Confocal microscopy showed that, in the case of calcein, there was a uniform fluorescence throughout the cell, whereas, in the case of FITC-dextran, the fluorescence was sometimes in the nucleus and at other times not. We conclude that the impulse of the shock wave (i.e., the pressure integrated over time), rather than the peak pressure, was a dominant factor for causing fluorophore uptake into living cells, and that shock waves might have changed the permeability of the nuclear membrane and transferred molecules directly into the nucleus. PMID:11023888

[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.

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

Burnett-Cattaneo continuum theory for shock waves.

PubMed

Holian, Brad Lee; Mareschal, Michel; Ravelo, Ramon

2011-02-01

We model strong shock-wave propagation, both in the ideal gas and in the dense Lennard-Jones fluid, using a refinement of earlier work, which accounts for the cold compression in the early stages of the shock rise by a nonlinear, Burnett-like, strain-rate dependence of the thermal conductivity, and relaxation of kinetic-temperature components on the hot, compressed side of the shock front. The relaxation of the disequilibrium among the three components of the kinetic temperature, namely, the difference between the component in the direction of a planar shock wave and those in the transverse directions, particularly in the region near the shock front, is accomplished at a much more quantitative level by a rigorous application of the Cattaneo-Maxwell relaxation equation to a reference solution, namely, the steady shock-wave solution of linear Navier-Stokes-Fourier theory, along with the nonlinear Burnett heat-flux term. Our new continuum theory is in nearly quantitative agreement with nonequilibrium molecular-dynamics simulations under strong shock-wave conditions, using relaxation parameters obtained from the reference solution. ©2011 American Physical Society

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.

Aerodynamic Design and Numerical Analysis of Supersonic Turbine for Turbo Pump

NASA Astrophysics Data System (ADS)

Fu, Chao; Zou, Zhengping; Kong, Qingguo; Cheng, Honggui; Zhang, Weihao

2016-09-01

Supersonic turbine is widely used in the turbo pump of modern rocket. A preliminary design method for supersonic turbine has been developed considering the coupling effects of turbine and nozzle. Numerical simulation has been proceeded to validate the feasibility of the design method. As the strong shockwave reflected on the mixing plane, additional numerical simulated error would be produced by the mixing plane model in the steady CFD. So unsteady CFD is employed to investigate the aerodynamic performance of the turbine and flow field in passage. Results showed that the preliminary design method developed in this paper is suitable for designing supersonic turbine. This periodical variation of complex shockwave system influences the development of secondary flow, wake and shock-boundary layer interaction, which obviously affect the secondary loss in vane passage. The periodical variation also influences the strength of reflecting shockwave, which affects the profile loss in vane passage. Besides, high circumferential velocity at vane outlet and short blade lead to high radial pressure gradient, which makes the low kinetic energy fluid moves towards hub region and produces additional loss.

Optical nucleation of bubble clouds in a high pressure spherical resonator.

PubMed

Anderson, Phillip; Sampathkumar, A; Murray, Todd W; Gaitan, D Felipe; Glynn Holt, R

2011-11-01

An experimental setup for nucleating clouds of bubbles in a high-pressure spherical resonator is described. Using nanosecond laser pulses and multiple phase gratings, bubble clouds are optically nucleated in an acoustic field. Dynamics of the clouds are captured using a high-speed CCD camera. The images reveal cloud nucleation, growth, and collapse and the resulting emission of radially expanding shockwaves. These shockwaves are reflected at the interior surface of the resonator and then reconverge to the center of the resonator. As the shocks reconverge upon the center of the resonator, they renucleate and grow the bubble cloud. This process is repeated over many acoustic cycles and with each successive shock reconvergence, the bubble cloud becomes more organized and centralized so that subsequent collapses give rise to stronger, better defined shockwaves. After many acoustic cycles individual bubbles cannot be distinguished and the cloud is then referred to as a cluster. Sustainability of the process is ultimately limited by the detuning of the acoustic field inside the resonator. The nucleation parameter space is studied in terms of laser firing phase, laser energy, and acoustic power used.

Unstable 3D phenomena: Dynamic interactions of a cavitation bubble and Richtmyer-Meshkov unstable divot

NASA Astrophysics Data System (ADS)

Buttler, William; Renner, Dru; Morris, Chris; Manzanares, Ruben; Heidemann, Joel; Kalas, Ryan; Llobet, Anna; Martinez, John; Payton, Jeremy; Saunders, Andy; Schmidt, Derek; Tainter, Amy; Vincent, Samuel; Vogan-McNeil, Wendy

2017-06-01

We radiographically explore a shock-induced Sn cavitation bubble as it interacts with a transverse cavitation wave caused by a Richtmyer-Meshkov unstable spike from a divot. The cavitation bubble forms as two shockwaves collide under the divot, as the shockwaves release to ambient pressure at the surface. The divot inverts and unstably grows, as expected and predicted, but the release waves that form the cavitation bubble reflect from and constrain the cavitation wave growth. As the cavitation wave grows it pierces the cavitation bubble, deflating it onto the unstable transverse cavitation wave.

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.

Semiempirical models for description of shear modulus in wide ranges of temperatures and pressures of shock compression

NASA Astrophysics Data System (ADS)

El'Kin, V. M.; Mikhailov, V. N.; Mikhailova, T. Yu.

2011-12-01

In this paper, we discuss the potentials of the Steinberg-Cochran-Guinan (SCG) and Burakovsky-Preston (BP) models for the description of the shear-modulus behavior at temperatures and pressures that arise behind the shock-wave front. A modernized variant of the SCG model is suggested, which reduces to the introduction of a free parameter and the representation of the model in the volume-temperature coordinates (( V, T) model). A systematic comparison is performed of all three models of shear modulus with experimental data and data of ab initio calculations for metals such as Al, Be, Cu, K, Na, Mg, Mo, W, and Ta in a wide range of pressures. In addition, for Al, Cu, Mo, W, and Ta there is performed a comparison with the known temperature dependences of the shear modulus and with the results of measurements of the velocities of longitudinal sound behind the shock-wave front. It is shown that in the original form the SCG and BP models give overestimated values of the shear modulus as compared to the data of ab initio calculations and shock-wave experiments. The ( V, T) model, due to the use of a free parameter, makes it possible to optimally describe the totality of experimental and calculated data. The same result is achieved in the case of the BP model after a redefining of its initial parameters. The adequate description of the shear modulus in the range of high intermediate pressures characteristic of the solid-phase states behind the shock-wave front is accompanied in both cases by the violation of the correct asymptotic behavior of the shear modulus at ultrahigh compressions which is originally laid into the SCG and BP models.

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.

Shock wave induced sonoporation and gene transfer

NASA Astrophysics Data System (ADS)

Miller, Douglas L.

2003-10-01

During shockwave (SW) treatment, cavitation activity can be applied for cell killing. A bonus is that some surviving cells appear to be briefly permeabilized, or sonoporated, allowing them to take up large molecules including DNA. In vitro research has indicated that as the number of SW increased, survival declined exponentially but the number of sonoporated cells increased to better than 50% of survivors for 1000 SW. In vivo tests have demonstrated SW-induced tumor ablation could indeed be accompanied by the transfection of marker plasmids into mouse B16 melanoma tumors in vivo. With intratumor injection of plasmid DNA and air bubbles, significant results were obtained for only 400 SW. In a trial of cancer therapy, the effects of 500 SW combined with interleukin-12 immuno-gene therapy was observed on the progression of two mouse tumors, B16 melanoma and RENCA renal carcinoma. The combination of SW and IL-12 plasmid injection provided a statistically significant inhibition of tumor growth relative to SW alone for both tumor models, demonstrating feasibility for this treatment method. In the future, the development of intravenous gene delivery and improved transfection, together with image-guided ultrasound treatment, should lead to the clinical application of ultrasound enhanced gene therapy. [Work supported by NIH Grant No. EB002782.

Optodynamic characterization of shock waves after laser-induced breakdown in water.

PubMed

Petkovsek, Rok; Mozina, Janez; Mocnik, Grisa

2005-05-30

Plasma and a cavitation bubble develop at the site of laser-induced breakdown in water. Their formation and the propagation of the shock wave were monitored by a beam-deflection probe and an arm-compensated interferometer. The interferometer part of the setup was used to determine the relative position of the laser-induced breakdown. The time-of-flight data from the breakdown site to the probe beam yielded the velocity, and from the velocity the shock-wave pressure amplitudes were calculated. Two regions were found where the pressure decays with different exponents, pointing to a strong attenuation mechanism in the initial phase of the shock-wave propagation.

Well-posed two-temperature constitutive equations for stable dense fluid shock waves using molecular dynamics and generalizations of Navier-Stokes-Fourier continuum mechanics.

PubMed

Hoover, Wm G; Hoover, Carol G

2010-04-01

Guided by molecular dynamics simulations, we generalize the Navier-Stokes-Fourier constitutive equations and the continuum motion equations to include both transverse and longitudinal temperatures. To do so we partition the contributions of the heat transfer, the work done, and the heat flux vector between the longitudinal and transverse temperatures. With shockwave boundary conditions time-dependent solutions of these equations converge to give stationary shockwave profiles. The profiles include anisotropic temperature and can be fitted to molecular dynamics results, demonstrating the utility and simplicity of a two-temperature description of far-from-equilibrium states.

Microgravity Experiment: The Fate of Confined Shock Waves

NASA Astrophysics Data System (ADS)

Kobel, P.; Obreschkow, D.; Dorsaz, N.; de Bosset, A.; Farhat, M.

2007-11-01

Shockwave induced cavitation is a form of hydrodynamic cavitation generated by the interaction of shock waves with vapor nuclei and microscopic impurities. Both the shock waves and the induced cavitation are known as sources of erosion damage in hydraulic industrial systems and hence represent an important research topic in fluid dynamics. Here we present the first investigation of shock wave induced cavitation inside closed and isolated liquid volumes, which confine the shock wave by reflections and thereby promise a particularly strong coupling with cavitation. A microgravity platform (ESA, 42^nd parabolic flight campaign) was used to produce stable water drops with centimetric diameters. Inside these drops, a fast electrical discharge was generated to release a strong shock wave. This setting results in an amplified form of shockwave induced cavitation, visible in high-speed images as a transient haze of sub-millimetric bubbles synchronized with the shockwave radiation. A comparison between high-speed visualizations and 3D simulations of a shock front inside a liquid sphere reveals that focus zones within the drop lead to a significantly increased density of induced cavitation. Considering shock wave crossing and focusing may hence prove crucially useful to understand the important process of cavitation erosion.

Jumper's knee treatment with extracorporeal shock wave therapy: a long-term follow-up observational study.

PubMed

Vulpiani, M C; Vetrano, M; Savoia, V; Di Pangrazio, E; Trischitta, D; Ferretti, A

2007-09-01

Jumper's knee affects more frequently athletes participating in jumping activities. This pathology is very difficult to treat: various therapeutic treatments are used, often based on the physician's personal experience rather than clinical evidence. The aim of this prospective study is to present our experience with the treatment of jumper's knee using extracorporeal shock wave therapy (ESWT) in a group of patients followed up for 2 years after treatment. In this study, we included 73 sports patients (83 knees), 54 males and 19 females, aged between 15 and 69 years (mean age: 32 years). 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 and according to a 6-stage clinical evaluation range. Shock wave treatment was applied with an electromagnetic shock wave generator. The protocol consisted in an average of 4 sessions (minimum 3, maximum 5), at a 2/7-day interval. In each sessions, 1,500-2,500 impulses were administered with an energy varying between 0.08 and 0.44 mJ/mm(2). We obtained satisfactory results in 73.5% of cases (54.2% excellent results and 19.3 good results). In performing athletes (16 tendons), treatment was satisfactory in 87.5% of cases, with an average time of resuming sport of approximately 6 weeks. 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.

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.

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.

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.

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.

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.

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.

A pilot study to explore the effectiveness of "early" rehabilitation after a hospital admission for chronic heart failure.

PubMed

Houchen, Linzy; Watt, Amye; Boyce, Sally; Singh, Sally

2012-07-01

People with chronic heart failure (CHF) experience acute exacerbations of their symptoms. These episodes are costly to patients and the health service. The study was a single group, pretest and posttest design. Seventeen patients with left ventricular systolic dysfunction (LVSD) started rehabilitation within 4 weeks of hospital discharge. The 6 week rehabilitation programme included exercise and self-management education. The hospital anxiety and depression scale (HADS), the incremental and endurance shuttle walking tests (ISWT/ESWT) were assessed at baseline and after rehabilitation. The number and duration of any CHF admissions in the year before and the year after rehabilitation were also recorded. Improvements in the ISWT, ESWT, and depression were, mean (95% confidence interval [CI]) 60.6 (36.0-85.2) metres, 356.0 (173.0-539.0) seconds (both p≤0.001) and (-)1.0 ((-)1.8-(-)0.2) points (p<0.05), respectively. HADS anxiety improvements failed to reach significance. At 1 year, there was a significant decrease in CHF-related hospitalisations, mean change (95% CI) (-)0.8 ((-)1.1-(-)0.4), p≤0.001 and CHF bed days (-)13.0 ((-)24.4-(-)1.6), p<0.05. Early rehabilitation significantly improved exercise capacity and depression and reduced CHF-associated health care utilisation in patients who had recently been hospitalised. The intervention was safe. However, the sample size was small and results were not compared to a control group. Therefore, the effects of natural recovery are unknown.

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.

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.

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.

Stable aqueous dispersions of functionalized multi-layer graphene by pulsed underwater plasma exfoliation of graphite

NASA Astrophysics Data System (ADS)

Meyer-Plath, Asmus; Beckert, Fabian; Tölle, Folke J.; Sturm, Heinz; Mülhaupt, Rolf

2016-02-01

A process was developed for graphite particle exfoliation in water to stably dispersed multi-layer graphene. It uses electrohydraulic shockwaves and the functionalizing effect of solution plasma discharges in water. The discharges were excited by 100 ns high voltage pulsing of graphite particle chains that bridge an electrode gap. The underwater discharges allow simultaneous exfoliation and chemical functionalization of graphite particles to partially oxidized multi-layer graphene. Exfoliation is caused by shockwaves that result from rapid evaporation of carbon and water to plasma-excited gas species. Depending on discharge energy and locus of ignition, the shockwaves cause stirring, erosion, exfoliation and/or expansion of graphite flakes. The process was optimized to produce long-term stable aqueous dispersions of multi-layer graphene from graphite in a single process step without requiring addition of intercalants, surfactants, binders or special solvents. A setup was developed that allows continuous production of aqueous dispersions of flake size-selected multi-layer graphenes. Due to the well-preserved sp2-carbon structure, thin films made from the dispersed graphene exhibited high electrical conductivity. Underwater plasma discharge processing exhibits high innovation potential for morphological and chemical modifications of carbonaceous materials and surfaces, especially for the generation of stable dispersions of two-dimensional, layered materials.

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

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.

The role of open stone surgery

PubMed Central

El-Husseiny, Tamer; Buchholz, Noor

2012-01-01

Objective To highlight the role of open stone surgery in the management of urolithiasis in the current era of minimally invasive therapies. The introduction and continuous development of extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy and percutaneous nephrolithotomy (PCNL) over the past 30 years have led to a significant change in the current management of urolithiasis, where the indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. Methods We reviewed the most recent guidelines published by the European Association of Urology and the American Urological Association, and reviewed reports through a MEDLINE search to identify the indications and current role of open stone surgery. Results From the MEDLINE search, it was obvious that the number of papers published on open renal stone surgery has decreased during the last three decades, soon after the introduction of ESWL and PCNL. Conclusion Although currently most patients with stones can be managed by minimally invasive therapy, we believe that open surgery still has a role, and therefore it is of great importance to recognise that a small group of patients with complex stone disease, and those with anatomical and physiological anomalies, will benefit from this treatment option. PMID:26558038

Clinical response to dorsal duct drainage via the minor papilla in refractory obstructing chronic calcific pancreatitis

PubMed Central

Kwon, Chang-Il; Gromski, Mark A.; Sherman, Stuart; El Hajj, Ihab I.; Easler, Jeffrey J.; Watkins, James; McHenry, Lee; Lehman, Glen A.; Fogel, Evan L.

2017-01-01

Background and study aims Complete stone removal from the main pancreatic duct might not be achieved in all patients with obstructive chronic calcific pancreatitis. We report our results for endoscopic dorsal pancreatic duct (DPD) bypass of obstructing stones in the ventral pancreatic duct (VPD). Patients and methods 16 patients with obstructive chronic calcific pancreatitis were treated with a DPD bypass. Clinical success was defined as significant pain relief and no hospital admissions for pain management during the ongoing treatment period. Results Among 16 patients meeting entry criteria, 10 (62.5%) had a history of unsuccessful endoscopic therapy, and 8 had failed extracorporeal shockwave lithotripsy (ESWL). Clinical success was achieved in 12 patients (75 %). Among these responders, 10 patients (83.3 %) had markedly improved or complete pain relief after the first stent placement, which persisted throughout the follow-up period; 11 patients (91.7 %) were able to discontinue their daily analgesics. Conclusions In selected patients with obstructive chronic calcific pancreatitis, the DPD bypass may be considered as a rescue endoscopic therapy, potentially obviating the need for surgery when standard endoscopic methods and ESWL fail. PMID:28201840

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.

Planetary atmospheres program

NASA Technical Reports Server (NTRS)

1982-01-01

Non-solar compositional models of the troposphere of Jupiter, halide cloud condensation and volatile element inventories on Venus, and shock-wave processing of interstellar cloud materials are discussed.

Effects of shock-breakout pressure on ejection of micron-scale material from shocked tin surfaces

NASA Astrophysics Data System (ADS)

Zellner, M. B.; Grover, M.; Hammerberg, J. E.; Hixson, R. S.; Iverson, A. J.; Macrum, G. S.; Morley, K. B.; Obst, A. W.; Olson, R. T.; Payton, J. R.; Rigg, P. A.; Routley, N.; Stevens, G. D.; Turley, W. D.; Veeser, L.; Buttler, W. T.

2007-07-01

This effort investigates the relation between ejecta production and shock-breakout pressure (PSB) for Sn shocked with a Taylor shockwave (unsupported) to pressures near the solid-on-release/partial melt-on-release phase transition region. The shockwaves were created by detonation of high explosive (HE) PBX-9501 on the front side of Sn coupons. Ejecta production at the backside or free side of the Sn coupons was characterized through use of piezoelectric pins, optical shadowgraphy, x-ray attenuation radiography, and optical-heterodyne velocimetry. Ejecta velocities, dynamic volume densities, and areal densities were then correlated with the shock-breakout pressure of Sn surfaces characterized by roughness average of Ra=16 μin or Ra=32 μin.

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.

Fast discharge in a plasma gun with hemispherical insulator

NASA Astrophysics Data System (ADS)

Antsiferov, P. S.; Dorokhin, L. A.; Sidelnikov, Yu. V.; Koshelev, K. N.

2009-05-01

A method of creation of hot dense plasma is proposed. It is based on cumulation of a shockwave, which originates on a hemispherical surface of insulator of plasma gun. The results of first experiments are presented. The shock wave is driven by fast electrical discharge (dI /dt>1012 A/s). The inductive storage with semiconductor opening switch is used as a current driver. Time resolved pin-hole images and vacuum ultraviolet (vuv) spectra are studied. Shockwaves from hemispherical insulator with 4 mm radius create plasma with a form of column about 1 mm diameter and 3-4 mm length. vuv spectra contain the lines of Ar ions that corresponds to the electron temperature about 20 eV. Possible practical application is discussed.

Experimental investigation on dynamic characteristics and strengthening mechanism of laser-induced cavitation bubbles.

PubMed

Ren, X D; He, H; Tong, Y Q; Ren, Y P; Yuan, S Q; Liu, R; Zuo, C Y; Wu, K; Sui, S; Wang, D S

2016-09-01

The dynamic features of nanosecond laser-induced cavitation bubbles near the light alloy boundary were investigated with the high-speed photography. The shock-waves and the dynamic characteristics of the cavitation bubbles generated by the laser were detected using the hydrophone. The dynamic features and strengthening mechanism of cavitation bubbles were studied. The strengthening mechanisms of cavitation bubble were discussed when the relative distance parameter γ was within the range of 0.5-2.5. It showed that the strengthening mechanisms caused by liquid jet or shock-waves depended on γ much. The research results provided a new strengthening method based on laser-induced cavitation shotless peening (CSP). Copyright © 2016 Elsevier B.V. All rights reserved.

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.

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.

Finite element method (FEM) model of the mechanical stress on phospholipid membranes from shock waves produced in nanosecond electric pulses (nsEP)

NASA Astrophysics Data System (ADS)

Barnes, Ronald; Roth, Caleb C.; Shadaram, Mehdi; Beier, Hope; Ibey, Bennett L.

2015-03-01

The underlying mechanism(s) responsible for nanoporation of phospholipid membranes by nanosecond pulsed electric fields (nsEP) remains unknown. The passage of a high electric field through a conductive medium creates two primary contributing factors that may induce poration: the electric field interaction at the membrane and the shockwave produced from electrostriction of a polar submersion medium exposed to an electric field. Previous work has focused on the electric field interaction at the cell membrane, through such models as the transport lattice method. Our objective is to model the shock wave cell membrane interaction induced from the density perturbation formed at the rising edge of a high voltage pulse in a polar liquid resulting in a shock wave propagating away from the electrode toward the cell membrane. Utilizing previous data from cell membrane mechanical parameters, and nsEP generated shockwave parameters, an acoustic shock wave model based on the Helmholtz equation for sound pressure was developed and coupled to a cell membrane model with finite-element modeling in COMSOL. The acoustic structure interaction model was developed to illustrate the harmonic membrane displacements and stresses resulting from shockwave and membrane interaction based on Hooke's law. Poration is predicted by utilizing membrane mechanical breakdown parameters including cortical stress limits and hydrostatic pressure gradients.

Overview of Therapeutic Ultrasound Applications and Safety Considerations

PubMed Central

Miller, Douglas; Smith, Nadine; Bailey, Michael; Czarnota, Gregory; Hynynen, Kullervo; Makin, Inder

2013-01-01

Summary Applications of ultrasound in medicine for therapeutic purposes have been an accepted and beneficial use of ultrasonic biological effects for many years. Low power ultrasound of about 1 MHz frequency has been widely applied since the 1950s for physical therapy in conditions such as tendinitis or bursitis. In the 1980s, high pressure-amplitude shockwaves came into use for mechanically resolving kidney stones, and “lithotripsy” rapidly replaced surgery as the most frequent treatment choice. The use of ultrasonic energy for therapy continues to expand, and approved applications now include uterine fibroid ablation, cataract removal (phacoemulsification), surgical tissue cutting and hemostasis, transdermal drug delivery, and bone fracture healing, among others. Undesirable bioeffects can occur including burns for thermal-based therapies and significant hemorrhage for mechanical-based therapies (e. g. lithotripsy). In all these therapeutic applications for bioeffects of ultrasound, standardization, ultrasound dosimetry, benefits assurance and side-effects risk minimization must be carefully considered in order to insure an optimal benefit to risk ratio for the patient. Therapeutic ultrasound typically has well-defined benefits and risks, and therefore presents a tractable safety problem to the clinician. However, safety information can be scattered, confusing or subject to commercial conflict of interest. Of paramount importance for managing this problem is the communication of practical safety information by authoritative groups, such as the AIUM, to the medical ultrasound community. In this overview, the Bioeffects Committee outlines the wide range of therapeutic ultrasound methods, which are in clinical use or under study, and provides general guidance for assuring therapeutic ultrasound safety. PMID:22441920

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.

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

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

Magnetic Fields and Bow Shocks Illustration

NASA Image and Video Library

2013-02-19

This illustration shows quasi-parallel top and quasi-perpendicular bottom magnetic field conditions at a planetary bow shock. Bow shocks are shockwaves created when the solar wind blows on a planet magnetic field.

Quasi-thermal models

NASA Technical Reports Server (NTRS)

Delareza, Ramiro

1987-01-01

Non-local thermodynamics equilibrium (LTE) effects in the photosphere; recent research on the chromosphere of the M and C stars; and elementary shock-waves and pulsation theories and their applications to Mira long-period variables are discussed.

Completely explosive ultracompact high-voltage nanosecond pulse-generating system

NASA Astrophysics Data System (ADS)

Shkuratov, Sergey I.; Talantsev, Evgueni F.; Baird, Jason; Rose, Millard F.; Shotts, Zachary; Altgilbers, Larry L.; Stults, Allen H.

2006-04-01

A conventional pulsed power technology has been combined with an explosive pulsed power technology to produce an autonomous high-voltage power supply. The power supply contained an explosive-driven high-voltage primary power source and a power-conditioning stage. The ultracompact explosive-driven primary power source was based on the physical effect of shock-wave depolarization of high-energy Pb (Zr52Ti48)O3 ferroelectric material. The volume of the energy-carrying ferroelectric elements in the shock-wave ferroelectric generators (SWFEGs) varied from 1.2 to 2.6cm3. The power-conditioning stage was based on the spiral vector inversion generator (VIG). The SWFEG-VIG system demonstrated successful operation and good performance. The amplitude of the output voltage pulse of the SWFEG-VIG system exceeded 90kV, with a rise time of 5.2ns.

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

Fabrication and application of a carbon nanotube/poly(dimethylsiloxane) coated optoacoustic film transducer

NASA Astrophysics Data System (ADS)

Fan, Xiaofeng; Ha, Kanglyeol; Kim, Moojoon; Kang, Gwansuk; Choi, Min Joo; Oh, Junghwan

2018-07-01

An optoacoustic film transducer was fabricated by coating carbon nanotubes (CNTs) and poly(dimethylsiloxane) (PDMS) on the surface of a thin flexible optical poly(ethylene terephthalate) (PET) sheet. When a laser pulse was irradiated on the film transducer, a shockwave, with superimposed waves reflected from the surface and the back of the film, was generated. The shockwave had very small pulse widths of 20–30 ns, and the maximum pressure of 5.4 MPa was obtained at 10 mm from the surface of the transducer. A line-focused optoacoustic source was fabricated using the film transducer, and its characteristics were investigated. A very high maximum pressure of about 35 MPa was obtained using the source. It was demonstrated that the source can engrave a line trace on a chalk surface.

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.

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.

Platelet-rich plasma and plantar fasciitis.

PubMed

Monto, Raymond R

2013-12-01

Plantar fasciitis is the most common cause of heel pain and can prove difficult to treat in its most chronic and severe forms. Advanced cases of plantar fasciitis are often associated with ankle stiffness, heel spurs, and other conditions and can lead to extensive physical disability and financial loss. Most available traditional treatments, including orthoses, nonsteroidal anti-inflammatory drugs, and steroid injections have a paucity of supportive clinical evidence. More invasive treatments, ranging from corticosteroid and botulinum-A toxin injections to shockwave therapy and plantar fasciotomy, have demonstrated varying clinical success in severe cases but carry the potential for serious complication and permanent disability. Platelet-rich plasma has recently been demonstrated to be helpful in managing chronic severe tendinopathies when other techniques have failed. This review examines the pathophysiology, diagnostic options, nonoperative treatment modalities, and surgical options currently used for plantar fasciitis. It also focuses on the clinical rationale and available evidence for using autologous platelet-rich plasma to treat severe refractory chronic plantar fasciitis.

Plantar fasciitis.

PubMed

Cutts, S; Obi, N; Pasapula, C; Chan, W

2012-11-01

In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition. A literature search was performed using PubMed and MEDLINE(®). The following keywords were used, singly or in combination: 'plantar fasciitis', 'plantar heel pain', 'heel spur'. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken. Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques.

Alternatives to the Six-Minute Walk Test in Pulmonary Arterial Hypertension

PubMed Central

Mainguy, Vincent; Malenfant, Simon; Neyron, Anne-Sophie; Saey, Didier; Maltais, François; Bonnet, Sébastien; Provencher, Steeve

2014-01-01

Introduction The physiological response during the endurance shuttle walk test (ESWT), the cycle endurance test (CET) and the incremental shuttle walk test (ISWT) remains unknown in PAH. We tested the hypothesis that endurance tests induce a near-maximal physiological demand comparable to incremental tests. We also hypothesized that differences in respiratory response during exercise would be related to the characteristics of the exercise tests. Methods Within two weeks, twenty-one PAH patients (mean age: 54(15) years; mean pulmonary arterial pressure: 42(12) mmHg) completed two cycling exercise tests (incremental cardiopulmonary cycling exercise test (CPET) and CET) and three field tests (ISWT, ESWT and six-minute walk test (6MWT)). Physiological parameters were continuously monitored using the same portable telemetric device. Results Peak oxygen consumption (VO2peak) was similar amongst the five exercise tests (p = 0.90 by ANOVA). Walking distance correlated markedly with the VO2peak reached during field tests, especially when weight was taken into account. At 100% exercise, most physiological parameters were similar between incremental and endurance tests. However, the trends overtime differed. In the incremental tests, slopes for these parameters rose steadily over the entire duration of the tests, whereas in the endurance tests, slopes rose sharply from baseline to 25% of maximum exercise at which point they appeared far less steep until test end. Moreover, cycling exercise tests induced higher respiratory exchange ratio, ventilatory demand and enhanced leg fatigue measured subjectively and objectively. Conclusion Endurance tests induce a maximal physiological demand in PAH. Differences in peak respiratory response during exercise are related to the modality (cycling vs. walking) rather than the progression (endurance vs. incremental) of the exercise tests. PMID:25111294

Alternatives to the six-minute walk test in pulmonary arterial hypertension.

PubMed

Mainguy, Vincent; Malenfant, Simon; Neyron, Anne-Sophie; Saey, Didier; Maltais, François; Bonnet, Sébastien; Provencher, Steeve

2014-01-01

The physiological response during the endurance shuttle walk test (ESWT), the cycle endurance test (CET) and the incremental shuttle walk test (ISWT) remains unknown in PAH. We tested the hypothesis that endurance tests induce a near-maximal physiological demand comparable to incremental tests. We also hypothesized that differences in respiratory response during exercise would be related to the characteristics of the exercise tests. Within two weeks, twenty-one PAH patients (mean age: 54(15) years; mean pulmonary arterial pressure: 42(12) mmHg) completed two cycling exercise tests (incremental cardiopulmonary cycling exercise test (CPET) and CET) and three field tests (ISWT, ESWT and six-minute walk test (6MWT)). Physiological parameters were continuously monitored using the same portable telemetric device. Peak oxygen consumption (VO(2peak)) was similar amongst the five exercise tests (p = 0.90 by ANOVA). Walking distance correlated markedly with the VO(2peak) reached during field tests, especially when weight was taken into account. At 100% exercise, most physiological parameters were similar between incremental and endurance tests. However, the trends overtime differed. In the incremental tests, slopes for these parameters rose steadily over the entire duration of the tests, whereas in the endurance tests, slopes rose sharply from baseline to 25% of maximum exercise at which point they appeared far less steep until test end. Moreover, cycling exercise tests induced higher respiratory exchange ratio, ventilatory demand and enhanced leg fatigue measured subjectively and objectively. Endurance tests induce a maximal physiological demand in PAH. Differences in peak respiratory response during exercise are related to the modality (cycling vs. walking) rather than the progression (endurance vs. incremental) of the exercise tests.

Tendinopathy in Sport

PubMed Central

Ackermann, Paul W.; Renström, Per

2012-01-01

Context: Tendinopathy is increasing in prevalence and accounts for a substantial part of all sports injuries and occupational disorders. Despite the magnitude of the disorder, high-quality scientific data on etiology and available treatments have been limited. Evidence Acquisition: The authors conducted a MEDLINE search on tendinopathy, or “tendonitis” or “tendinosis” or “epicondylitis” or “jumpers knee” from 1980 to 2011. The emphasis was placed on updates on epidemiology, etiology, and recent patient-oriented Level 1 literature. Results: Repetitive exposure in combination with recently discovered intrinsic factors, such as genetic variants of matrix proteins, and metabolic disorders is a risk factor for the development of tendinopathy. Recent findings demonstrate that tendinosis is characterized by a fibrotic, failed healing response associated with pathological vessel and sensory nerve ingrowth. This aberrant sensory nerve sprouting may partly explain increased pain signaling and partly, by release of neuronal mediators, contribute to the fibrotic alterations observed in tendinopathy. The initial nonoperative treatment should involve eccentric exercise, which should be the cornerstone (basis) of treatment of tendinopathy. Eccentric training combined with extracorporeal shockwave treatment has in some reports shown higher success rates compared to any therapies alone. Injection therapies (cortisone, sclerosing agents, blood products including platelet-rich plasma) may have short-term effects but have no proven long-term treatment effects or meta-analyses to support them. For epicondylitis, cortisone injections have demonstrated poorer long-time results than conservative physiotherapy. Today surgery is less indicated because of successful conservative therapies. New minioperative procedures that, via the endoscope, remove pathologic tissue or abnormal neoinnervation demonstrate promising results but need confirmation by Level 1 studies. Conclusions: Novel targeted therapies are emerging, but multicenter trials are needed to confirm the results of exercise and mini-invasive treatments. PMID:23016086

Genetic and molecular basis of diabetic foot ulcers: Clinical review.

PubMed

Jhamb, Shaurya; Vangaveti, Venkat N; Malabu, Usman H

2016-11-01

Diabetic Foot Ulcers (DFUs) are major complications associated with diabetes and often correlate with peripheral neuropathy, trauma and peripheral vascular disease. It is necessary to understand the molecular and genetic basis of diabetic foot ulcers in order to tailor patient centred care towards particular patient groups. This review aimed to evaluate whether current literature was indicative of an underlying molecular and genetic basis for DFUs and to discuss clinical applications. From a molecular perspective, wound healing is a process that transpires following breach of the skin barrier and is usually mediated by growth factors and cytokines released by specialised cells activated by the immune response, including fibroblasts, endothelial cells, phagocytes, platelets and keratinocytes. Growth factors and cytokines are fundamental in the organisation of the molecular processes involved in making cutaneous wound healing possible. There is a significant role for single nucleotide polymorphism (SNPs) in the fluctuation of these growth factors and cytokines in DFUs. Furthermore, recent evidence suggests a key role for epigenetic mechanisms such as DNA methylation from long standing hyperglycemia and non-coding RNAs in the complex interplay between genes and the environment. Genetic factors and ethnicity can also play a significant role in the development of diabetic neuropathy leading to DFUs. Clinically, interventions which have improved outcomes for people with DFUs or those at risk of DFUs include some systemic therapeutic drug interventions which improve microvascular blood flow, surgical interventions, human growth factors, and hyperbaric oxygen therapy, negative pressure wound therapy, skin replacement or shockwave therapy and the use of topical treatments. Future treatment modalities including stem cell and gene therapies are promising in the therapeutic approach to prevent the progression of chronic diabetic complications. Copyright © 2016 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

A Supernova Shockwaves

NASA Image and Video Library

2007-06-13

Supernovae are the explosive deaths of the universe most massive stars. This false-color composite from NASA Spitzer Space Telescope and NASA Chandra X-ray Observatory shows the remnant of N132D, the wispy pink shell of gas at center.

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.

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.

Optical pin apparatus for measuring the arrival time and velocity of shock waves and particles

DOEpatents

Benjamin, R.F.

1983-10-18

An apparatus for the detection of the arrival and for the determination of the velocity of disturbances such as shock-wave fronts and/or projectiles. Optical pins using fluid-filled microballoons as the light source and an optical fiber as a link to a photodetector have been used to investigate shock-waves and projectiles. A microballoon filled with a noble gas is affixed to one end of a fiber-optic cable, and the other end of the cable is attached to a high-speed streak camera. As the shock-front or projectile compresses the microballoon, the gas inside is heated and compressed producing a bright flash of light. The flash of light is transmitted via the optic cable to the streak camera where it is recorded. One image-converter streak camera is capable of recording information from more than 100 microballoon-cable combinations simultaneously.

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.

Atomistic material behavior at extreme pressures

DOE PAGES

Beland, Laurent K.; Osetskiy, Yury N.; Stoller, Roger E.

2016-08-05

Computer simulations are routinely performed to model the response of materials to extreme environments, such as neutron (or ion) irradiation. The latter involves high-energy collisions from which a recoiling atom creates a so-called atomic displacement cascade. These cascades involve coordinated motion of atoms in the form of supersonic shockwaves. These shockwaves are characterized by local atomic pressures >15 GPa and interatomic distances <2 Å. Similar pressures and interatomic distances are observed in other extreme environment, including short-pulse laser ablation, high-impact ballistic collisions and diamond anvil cells. Displacement cascade simulations using four different force fields, with initial kinetic energies ranging frommore » 1 to 40 keV, show that there is a direct relationship between these high-pressure states and stable defect production. An important shortcoming in the modeling of interatomic interactions at these short distances, which in turn determines final defect production, is brought to light.« less

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.

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.

Optical pin apparatus for measuring the arrival time and velocity of shock waves and particles

DOEpatents

Benjamin, Robert F.

1987-01-01

An apparatus for the detection of the arrival and for the determination of the velocity of disturbances such as shock-wave fronts and/or projectiles. Optical pins using fluid-filled microballoons as the light source and an optical fiber as a link to a photodetector have been used to investigate shock-waves and projectiles. A microballoon filled with a noble gas is affixed to one end of a fiber-optic cable, and the other end of the cable is attached to a high-speed streak camera. As the shock-front or projectile compresses the microballoon, the gas inside is heated and compressed producing a bright flash of light. The flash of light is transmitted via the optic cable to the streak camera where it is recorded. One image-converter streak camera is capable of recording information from more than 100 microballoon-cable combinations simultaneously.

Optical pin apparatus for measuring the arrival time and velocity of shock waves and particles

DOEpatents

Benjamin, R.F.

1987-03-10

An apparatus is disclosed for the detection of the arrival and for the determination of the velocity of disturbances such as shock-wave fronts and/or projectiles. Optical pins using fluid-filled microballoons as the light source and an optical fiber as a link to a photodetector have been used to investigate shock-waves and projectiles. A microballoon filled with a noble gas is affixed to one end of a fiber-optic cable, and the other end of the cable is attached to a high-speed streak camera. As the shock-front or projectile compresses the microballoon, the gas inside is heated and compressed producing a bright flash of light. The flash of light is transmitted via the optic cable to the streak camera where it is recorded. One image-converter streak camera is capable of recording information from more than 100 microballoon-cable combinations simultaneously. 3 figs.

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

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.

Optoheterodyne Doppler measurements of the ballistic expansion of the products of the shock wave-induced surface destruction: Experiment and theory

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

Andriyash, A. V.; Astashkin, M. V.; Baranov, V. K.

2016-06-15

The results of optoheterodyne Doppler measurements of the ballistic expansion of the products of surface destruction under shock-wave loading are presented. The possibility of determining the physical characteristics of a rapidly flying dust cloud, including the microparticle velocities, the microparticle sizes, and the areal density of the dust cloud, is shown. A compact stand for performing experiments on shock-wave loading of metallic samples is described. Shock-wave loading is performed by a 100-µm-thick tantalum flyer plate accelerated to a velocity of 2.8 km/s. As the samples, lead plates having various thicknesses and the same surface roughness are used. At a shock-wavemore » pressure of 31.5 GPa, the destruction products are solid microparticles about 50 µm in size. At a pressure of 42 and 88 GPa, a liquid-drop dust cloud with a particle size of 10–15 µm is formed. To interpret the spectral data on the optoheterodyne Doppler measurements of the expansion of the surface destruction products (spalled fragments, dust microparticles), a transport equation for the function of mutual coherence of a multiply scattered field is used. The Doppler spectra of a backscattered signal are calculated with the model developed for the dust cloud that appears when a shock wave reaches the sample surface at the parameters that are typical of an experimental situation. Qualitative changes are found in the spectra, depending on the optical thickness of the dust cloud. The obtained theoretical results are in agreement with the experimental data.« less

EASI - EQUILIBRIUM AIR SHOCK INTERFERENCE

NASA Technical Reports Server (NTRS)

Glass, C. E.

1994-01-01

New research on hypersonic vehicles, such as the National Aero-Space Plane (NASP), has raised concerns about the effects of shock-wave interference on various structural components of the craft. State-of-the-art aerothermal analysis software is inadequate to predict local flow and heat flux in areas of extremely high heat transfer, such as the surface impingement of an Edney-type supersonic jet. EASI revives and updates older computational methods for calculating inviscid flow field and maximum heating from shock wave interference. The program expands these methods to solve problems involving the six shock-wave interference patterns on a two-dimensional cylindrical leading edge with an equilibrium chemically reacting gas mixture (representing, for example, the scramjet cowl of the NASP). The inclusion of gas chemistry allows for a more accurate prediction of the maximum pressure and heating loads by accounting for the effects of high temperature on the air mixture. Caloric imperfections and specie dissociation of high-temperature air cause shock-wave angles, flow deflection angles, and thermodynamic properties to differ from those calculated by a calorically perfect gas model. EASI contains pressure- and temperature-dependent thermodynamic and transport properties to determine heating rates, and uses either a calorically perfect air model or an 11-specie, 7-reaction reacting air model at equilibrium with temperatures up to 15,000 K for the inviscid flowfield calculations. EASI solves the flow field and the associated maximum surface pressure and heat flux for the six common types of shock wave interference. Depending on the type of interference, the program solves for shock-wave/boundary-layer interaction, expansion-fan/boundary-layer interaction, attaching shear layer or supersonic jet impingement. Heat flux predictions require a knowledge (from experimental data or relevant calculations) of a pertinent length scale of the interaction. Output files contain flow-field information for the various shock-wave interference patterns and their associated maximum surface pressure and heat flux predictions. EASI is written in FORTRAN 77 for a DEC VAX 8500 series computer using the VAX/VMS operating system, and requires 75K of memory. The program is available on a 9-track 1600 BPI magnetic tape in DEC VAX BACKUP format. EASI was developed in 1989. DEC, VAX, and VMS are registered trademarks of the Digital Equipment Corporation.

The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent--a comparative study.

PubMed

Mohayuddin, Nazim; Malik, Hamad Afzal; Hussain, Manzoor; Tipu, Salman Ahmed; Shehzad, Asad; Hashmi, Altaf; Naqvi, Syed Ali Anwar; Rizvi, Syed Adibul Hasan

2009-03-01

To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent. A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost. Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups. Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly high in the patients having a JJ stent. The cost of the treatment doubled in the stented group which is an important factor in our country. JJ stenting does not prove to be a cost effective procedure when compared to the reduction in complications.

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 were subjected to laser-generated shockwaves. There was no relationship between the scores received by the samples and the energy with which they were shocked. Preliminary investigation into the safety of the LGS treatment for biofilm delamination appears promising. Additional investigation will continue on ex vivo porcine samples, followed by an in vivo animal trial to better understand the physiological response to LGS treatment. © 2014 Wiley Periodicals, Inc.

International comparison of cost effectiveness of medical management strategies for nephrolithiasis.

PubMed

Lotan, Yair; Cadeddu, Jeffrey A; Pearle, Margaret S

2005-06-01

Although medical therapy is known to reduce the risk of kidney stone recurrence, the cost effectiveness of medical prophylaxis is controversial. We evaluated medical treatment strategies including dietary measures (conservative), empiric medical therapy (empiric) or directed medical therapy (directed) based on comprehensive metabolic evaluation (CME) for patients with recurrent kidney stones, and compared the costs of these strategies using cost data from ten different countries. We previously established rates of stone formation in recurrent stone-formers, risk reduction of medical therapy, sensitivity of CME and rates of spontaneous stone passage from a comprehensive literature search (Lotan et al. 2004 J Urol 172: 2275). The costs of medication, surgical therapy, emergency room visits and CME for ten different countries were obtained from a published report of an international cost survey (Chandhoke 2002 J Urol 168: 937) as well as from our own county hospital in the US. Medication costs in the US were obtained from two national pharmacy chains. A decision tree model was created to compare the costs of different treatment strategies assuming cost accrual for metabolic evaluation, medical therapy and surgery or emergency room visits. For medical therapy, we assumed the distribution of medication use described in the published report, consisting of potassium citrate (60%), thiazide (30%) and allopurinol (10%). A nearly 20-fold difference in the costs of shock-wave lithotripsy, ureteroscopy and medication was found among different countries. From the model (US dollars/patient/year), conservative therapy alone was the most cost effective approach followed by empiric and directed medical therapy in all countries except in the UK. In the UK, the cost of drug therapy (estimated at dollar 29/patient/year) resulted in empiric therapy being the most cost effective strategy for recurrent stone formers. The low likelihood of surgical intervention, as well as the low relative cost of surgery to medication, contributed to the higher cost of empiric and directed medical therapy strategies. Of note, despite the higher cost, drug treatment strategies were associated with significantly lower stone recurrence rates. We found that drug treatment strategies are more costly than conservative treatment but produce good control of stone formation. In all but one country (UK), dietary therapy was the most cost effective approach due to the relatively low cost of surgery compared with medication. The differential resource allocation to different components of a healthcare system (i.e. subsidized medication versus surgical treatment) in different countries determines the cost effectiveness of various treatment strategies.

A Cooperative V2V Alert System to Mitigate Vehicular Traffic ShockWaves

DOT National Transportation Integrated Search

2017-03-01

Vehicle traffic on highway systems are typically not uniformly distributed. In our work, we introduce a protocol that exploits this phenomenon by considering the formations of shock waves and opportunities in adjacent lanes. The objective of this pro...

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 by John Wiley & Sons Ltd.

[Color processing of ultrasonographic images in extracorporeal lithotripsy].

PubMed

Lardennois, B; Ziade, A; Walter, K

1991-02-01

A number of technical difficulties are encountered in the ultrasonographic detection of renal stones which unfortunately limit its performance. The margin of error of firing in extracorporeal shock-wave lithotripsy (ESWL) must be reduced to a minimum. The role of the ultrasonographic monitoring during lithotripsy is also essential: continuous control of the focussing of the short-wave beamand assessment if the quality of fragmentation. The authors propose to improve ultrasonographic imaging in ESWL by means of intraoperative colour processing of the stone. Each shot must be directed to its target with an economy of vision avoiding excessive fatigue. The principle of the technique consists of digitalization of the ultrasound video images using a Macintosh Mac 2 computer. The Graphis Paint II program is interfaced directly with the Quick Capture card and recovers the images on its work surface in real time. The program is then able to attribute to each of these 256 shades of grey any one of the 16.6 million colours of the Macintosh universe with specific intensity and saturation. During fragmentation, using the principle of a palette, the stone changes colour from green to red indicating complete fragmentation. A Color Space card converts the digital image obtained into a video analogue source which is visualized on the monitor. It can be superimposed and/or juxtaposed with the source image by means of a multi-standard mixing table. Colour processing of ultrasonographic images in extracoporeal shockwave lithotripsy allows better visualization of the stones and better follow-up of fragmentation and allows the shockwave treatment to be stopped earlier. It increases the stone-free performance at 6 months. This configuration will eventually be able to integrate into the ultrasound apparatus itself.

Inflammatory mechanisms and oxidative stress in Peyronie's disease: therapeutic "rationale" and related emerging treatment strategies.

PubMed

Paulis, Gianni; Brancato, Tommaso

2012-02-01

Peyronie's disease (PD) is a connective tissue disorder characterized by a fibrous plaque involving the tunica albuginea of the penis. The inelastic fibrous plaque leads to a penile curvature. Several Authors have suggested an immunological genesis of this disease, others have linked PD with Dupuytren's contracture. Signs of this disease are curvature, penile pain, penile deformity, difficulty with coitus, shortening, hinging, narrowing and erectile dysfunction. The natural history of PD and the clinical course can develop from spontaneous resolution of symptoms to progressive penile deformity and impotence. Surgical treatment is indicated when patients fail the conservative medical treatment and however, only in case of disease stabilization with a condition of impossibility of penetration. The medical treatment is indicated in the development stage of PD for at least one year after diagnosis and whenever in case of penile pain. Current non-surgical therapy includes vitamin-E, verapamil, para-aminobenzoate, propoleum, colchicine, carnitine, tamoxifen, interferons, collagenase, hyaluronidase, cortisone, pentoxifylline, superoxide dismutase, iontophoresis, radiation, extracorporeal shock wave therapy (ESWT) and the penile extender. The etiology of this fibrotic disease is not widely known, although in recent years pathophysiological knowledge has evolved and new studies propose the penile trauma as cause of the disease. The penile trauma results in a delamination of the tunica albuginea with a consequent small hematoma, then the process evolves as an inflammation with accumulation of inflammatory cells and production of reactive oxygen species (ROS). In the course of the inflammation, Peyronie's disease occurs due to the activation of nuclear factor kappa-B, that induces the production of inducible nitric oxide synthase (iNOS), with an increase of nitric oxide, leading to increased production of peroxynitrite anion. All these processes result in the proliferation of fibroblasts and myo-fibroblasts and excessive production of collagen between the layers of the tunica albuginea (penile plaque). Referring to the current knowledge of inflammatory and oxidative mechanisms of PD, a possible therapeutic strategy is then analyzed. © 2012 Bentham Science Publishers

COLLABORATIVE HYDROLOGIC RESEARCH IN THE CLARKSBURG SPECIAL PROTECTION AREA

EPA Science Inventory

This research project is focused on the Clarksburg Special Protection Area (CSPA) in Montgomery County, Maryland. The CSPA subwatersheds are on the outer edge of the urban development shockwave expanding outward from the Washington DC metropolitan area. This is an area of rapid d...

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.

Flow-around modes for a rhomboid wing with a stall vortex in the shock layer

NASA Astrophysics Data System (ADS)

Zubin, M. A.; Maximov, F. A.; Ostapenko, N. A.

2017-12-01

The results of theoretical and experimental investigation of an asymmetrical hypersonic flow around a V-shaped wing with the opening angle larger than π on the modes with attached shockwaves on forward edges, when the stall flow is implemented on the leeward wing cantilever behind the kink point of the cross contour. In this case, a vortex of nonviscous nature is formed in which the velocities on the sphere exceeding the speed of sound and resulting in the occurrence of pressure shocks with an intensity sufficient for the separation of the turbulent boundary layer take place in the reverse flow according to the calculations within the framework of the ideal gas. It is experimentally established that a separation boundary layer can exist in the reverse flow, and its structure is subject to the laws inherent to the reverse flow in the separation region of the turbulent boundary layer arising in the supersonic conic flow under the action of a shockwave incident to the boundary layer.

Large-eddy simulation of the passage of a shock wave through homogeneous turbulence

NASA Astrophysics Data System (ADS)

Braun, N. O.; Pullin, D. I.; Meiron, D. I.

2017-11-01

The passage of a nominally plane shockwave through homogeneous, compressible turbulence is a canonical problem representative of flows seen in supernovae, supersonic combustion engines, and inertial confinement fusion. The interaction of isotropic turbulence with a stationary normal shockwave is considered at inertial range Taylor Reynolds numbers, Reλ = 100 - 2500 , using Large Eddy Simulation (LES). The unresolved, subgrid terms are approximated by the stretched-vortex model (Kosovic et al., 2002), which allows self-consistent reconstruction of the subgrid contributions to the turbulent statistics of interest. The mesh is adaptively refined in the vicinity of the shock to resolve small amplitude shock oscillations, and the implications of mesh refinement on the subgrid modeling are considered. Simulations are performed at a range of shock Mach numbers, Ms = 1.2 - 3.0 , and turbulent Mach numbers, Mt = 0.06 - 0.18 , to explore the parameter space of the interaction at high Reynolds number. The LES shows reasonable agreement with linear analysis and lower Reynolds number direct numerical simulations. LANL Subcontract 305963.

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.

Relating climate change policy to poverty policy: assessing the global exposure of the poor to floods and droughts

NASA Astrophysics Data System (ADS)

Winsemius, Hessel; Jongman, Brenden; Veldkamp, Ted; Hallegatte, Stéphane; Bangalore, Mook; Ward, Philip

2016-04-01

Prior to the COP21 conference in Paris this year, the World Bank published a report called "Shockwaves - Managing the Impacts of Climate Change on Poverty". The report flagged that ending poverty and stabilizing climate change should be jointly tackled and that without a good joint policy, a further 100 million people could become trapped in poverty by 2050. As part of the "Shockwaves" report, we investigated whether low-income households are disproportionately overrepresented in hazard-prone areas compared to households with higher income. Furthermore, the hazardous conditions under which poor households are exposed to now may become worse due to climate change with resulting increases in intensity and frequency of floods and droughts. We also show how the amount of affected people to these natural hazards change in the future if nothing is done. We use recent advances in the global spatial modeling of flood and drought hazard and a large sample of household surveys containing asset and income data to explore the relationships.

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

Jones, David R.; Morrow, Benjamin M.; Trujillo, Carl P.

Here, we present a series of experiments probing the martensitic α–ω (hexagonal close-packed to simple hexagonal) transition in titanium under shock-loading to peak stresses around 15 GPa. Gas-gun plate impact techniques were used to locate the α–ω transition stress with a laser-based velocimetry diagnostic. A change in the shock-wave profile at 10.1 GPa suggests the transition begins at this stress. A second experiment shock-loaded and then soft-recovered a similar titanium sample. We then analyzed this recovered material with electron-backscatter diffraction methods, revealing on average approximately 65% retained ω phase. Furthermore, based on careful analysis of the microstructure, we propose thatmore » the titanium never reached a full ω state, and that there was no observed phase-reversion from ω to α. Texture analysis suggests that any α titanium found in the recovered sample is the original α. The data show that both the α and ω phases are stable and can coexist even though the shock-wave presents as steady-state, at these stresses.« less

Navier-Stokes structure of merged layer flow on the spherical nose of a space vehicle

NASA Technical Reports Server (NTRS)

Jain, A. C.; Woods, G. H.

1988-01-01

Hypersonic merged layer flow on the forepart of a spherical surface of a space vehicle has been investigated on the basis of the full steady-state Navier-Stokes equations using slip and temperature jump boundary conditions at the surface and free-stream conditions far from the surface. The shockwave-like structure was determined as part of the computations. Using an equivalent body concept, computations were carried out under conditions that the Aeroassist Flight Experiment (AFE) Vehicle would encounter at 15 and 20 seconds in its flight path. Emphasis was placed on understanding the basic nature of the flow structure under low density conditions. Particular attention was paid to the understanding of the structure of the outer shockwave-like region as the fluid expands around the sphere. Plots were drawn for flow profiles and surface characteristics to understand the role of dissipation processes in the merged layer of the spherical nose of the vehicle.

Plantar fasciitis

PubMed Central

Cutts, S; Obi, N; Pasapula, C; Chan, W

2012-01-01

INTRODUCTION In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition. METHODS A literature search was performed using PubMed and MEDLINE®. The following keywords were used, singly or in combination: ‘plantar fasciitis’, ‘plantar heel pain’, ‘heel spur’. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken. FINDINGS Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques. PMID:23131221

Novel two-step laser ablation and ionization mass spectrometry (2S-LAIMS) of actor-spectator ice layers: Probing chemical composition of D{sub 2}O ice beneath a H{sub 2}O ice layer

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

Yang, Rui, E-mail: ryang73@ustc.edu; Gudipati, Murthy S., E-mail: gudipati@jpl.nasa.gov

2014-03-14

In this work, we report for the first time successful analysis of organic aromatic analytes imbedded in D{sub 2}O ices by novel infrared (IR) laser ablation of a layered non-absorbing D{sub 2}O ice (spectator) containing the analytes and an ablation-active IR-absorbing H{sub 2}O ice layer (actor) without the analyte. With these studies we have opened up a new method for the in situ analysis of solids containing analytes when covered with an IR laser-absorbing layer that can be resonantly ablated. This soft ejection method takes advantage of the tenability of two-step infrared laser ablation and ultraviolet laser ionization mass spectrometry,more » previously demonstrated in this lab to study chemical reactions of polycyclic aromatic hydrocarbons (PAHs) in cryogenic ices. The IR laser pulse tuned to resonantly excite only the upper H{sub 2}O ice layer (actor) generates a shockwave upon impact. This shockwave penetrates the lower analyte-containing D{sub 2}O ice layer (spectator, a non-absorbing ice that cannot be ablated directly with the wavelength of the IR laser employed) and is reflected back, ejecting the contents of the D{sub 2}O layer into the vacuum where they are intersected by a UV laser for ionization and detection by a time-of-flight mass spectrometer. Thus, energy is transmitted from the laser-absorbing actor layer into the non-absorbing spectator layer resulting its ablation. We found that isotope cross-contamination between layers was negligible. We also did not see any evidence for thermal or collisional chemistry of PAH molecules with H{sub 2}O molecules in the shockwave. We call this “shockwave mediated surface resonance enhanced subsurface ablation” technique as “two-step laser ablation and ionization mass spectrometry of actor-spectator ice layers.” This method has its roots in the well-established MALDI (matrix assisted laser desorption and ionization) method. Our method offers more flexibility to optimize both the processes—ablation and ionization. This new technique can thus be potentially employed to undertake in situ analysis of materials imbedded in diverse media, such as cryogenic ices, biological samples, tissues, minerals, etc., by covered with an IR-absorbing laser ablation medium and study the chemical composition and reaction pathways of the analyte in its natural surroundings.« less

[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.

MEASURING HYDROLOGICAL CHANGE DURING EXURBAN DEVELOPMENT: COLLABORATIVE HYDROLOGIC RESEARCH IN THE CLARKSBURG SPECIAL PROTECTION AREA

EPA Science Inventory

This research project is focused on the Clarksburg Special Protection Area (CSPA) in Montgomery County, Maryland. The CSPA subwatersheds are on the outer edge of the exurban development shockwave expanding outward from the Washington DC metropolitan area. The CSPA is an area of ...

MEASURING HYDROLOGICAL CHANGE DURING EXURBAN DEVELOPMENT: COLLABORATIVE HYDROLOGIC RESEARCH IN THE CLARKSBURG SPECIAL PROTECTION AREA

EPA Science Inventory

This research project is focused on the Clarksburg Special Protection Area (CSPA) in Montgomery County, Maryland. The CSPA subwatersheds are on the outer edge of the exurban development shockwave expanding outward from the Washington, DC, metropolitan area. The CSPA is an area o...

COLLABORATIVE SCIENCE FOR ENVIRONMENTAL SOLUTIONS: COLLABORATIVE HYDROLOGIC RESEARCH IN THE CLARKSBURG SPECIAL PROTECTION AREA

EPA Science Inventory

This research project is focused on the Clarksburg Special Protection Area (CSPA) in Montgomery County, Maryland. The CSPA subwatersheds are on the outer edge of the exurban development shockwave expanding outward from the Washington DC metropolitan area. The CSPA is an area of...

The 2010 Canterbury Earthquake: Curriculum Shockwaves

ERIC Educational Resources Information Center

Taylor, Mike; Moeed, Azra

2013-01-01

This paper reports data from an exploratory questionnaire designed to capture "curriculum P-waves"--those curriculum responses that were the fastest and therefore measured first--following a significant earthquake in New Zealand. As well as taking a professional interest in a major disaster in their backyard, it is assumed that social…

Signal Processing of Shock-Wave Overpressure Records

DTIC Science & Technology

1981-08-01

SUPERPOSED GAGE-MOUNT RINGING. UNCLASSIFIED FIG. . FORIERSPECRUM O AN - WAV WIT SUPRPSE GAE-OUT RNGNG UNCLASSIFIED SM No. 1021 󈨏- 925 Pa E 0. 00 0"a... midi rfit-valotinrent pmn -ri or grant number oquiprancr mcxlel designation. firnite iamem. militlary project codte irlri ir. I, tir, IlII. 46winl

Tenderization of beef loins using a high efficiency sparker

USDA-ARS?s Scientific Manuscript database

The objective of this study was to determine the effectiveness of tenderizing beef strip loins using high-pressure shockwaves generated from a sparker source. A total of 117 steaks from 16 beef strip loins were utilized with each treated steak having an adjacent steak as a non-treated control. Ste...

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 persistent TB have been reported, including bursectomy (n = 2), longitudinal release of the iliotibial band (n = 2), proximal or distal Z-plasty (n = 4), osteotomy (n = 1), and repair of gluteus medius tears (n = 4). Efficacy among surgical techniques varied depending on the clinical outcome measure, but all were superior to corticosteroid therapy and physical therapy according to the VAS and HHS in both comparison studies and between studies. This systematic review found that traditional nonoperative treatment helped most patients, SWT was a good alternative, and surgery was effective in refractory cases.

Efficacy of low-intensity shock wave therapy for erectile dysfunction: A systematic review and meta-analysis.

PubMed

Angulo, J C; Arance, I; de Las Heras, M M; Meilán, E; Esquinas, C; Andrés, E M

2017-10-01

The low-intensity shockwave (LISW) therapy is a recently developed modality for treating erectile dysfunction. To assess the efficacy of LISW therapy for treating erectile dysfunction as described in the literature. Two independent reviewers identified studies eligible for a systematic review and meta-analysis of various sources written in English and Spanish, using the databases of PubMed, EMBASE and Web of Science. We excluded studies on Peyronie's disease. We employed the DerSimonian-Laird method for defining heterogeneity, calculating the grouped standard deviation of the mean (SDM). The primary objective of this review is to assess efficacy based on the change in the International Index of Erectile Function (IIEF-EF) over baseline at 1 month from the start of treatment, both for the treatment arm and the placebo arm. The secondary objective is focused on analysing IIEF-EF at 3-6 months from the start of the therapy. The pooled data of 636 patients from 12 studies showed that treatment with LISW resulted in a significant increase in IIEF-EF at 1 month with respect to baseline (SDM, -2.92; P=.000), to a greater degree than placebo (SDM, -.99; P=.000). The IIEF-EF at 3-6 months for the treated patients was significantly greater than baseline (SDM, -2.78; P=.000). Only one study compared the efficacy of placebo at 3-6 months versus baseline (SDM, -9.14). The comparison between LISW and placebo favours active treatment (SDM, 2.53; P=.000) at 1 month. There are insufficient data in the literature to assess the response over placebo at 3-6 months. According to the literature, treatment with LISW for erectile dysfunction is effective, both in the short and medium term. LISW has been described as more effective than placebo in the short term. The long-term efficacy data are insufficient. More studies are needed to explain the role of this therapy according to specific causes of erectile dysfunction. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs.

PubMed

Steuri, Ruedi; Sattelmayer, Martin; Elsig, Simone; Kolly, Chloé; Tal, Amir; Taeymans, Jan; Hilfiker, Roger

2017-09-01

To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement. Systematic review and meta-analysis of randomised trials. Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017. Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments. For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) -0.94, 95% CI -1.69 to -0.19). Specific exercises were superior to generic exercises (SMD -0.65, 95% CI -0.99 to -0.32). Corticosteroid injections were superior to no treatment (SMD -0.65, 95% CI -1.04 to -0.26), and ultrasound guided injections were superior to non-guided injections (SMD -0.51, 95% CI -0.89 to -0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of -0.29 (95% CI -0.53 to -0.05) compared with placebo. Manual therapy was superior to placebo (SMD -0.35, 95% CI -0.69 to -0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD -0.32, 95% CI -0.62 to -0.01). Laser was superior to sham laser (SMD -0.88, 95% CI -1.48 to -0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (-0.39, 95% CI -0.78 to -0.01) and tape was superior to sham (-0.64, 95% CI -1.16 to -0.12), with small to moderate SMDs. Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Electrode cartridge for pulse welding

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

Bonnen, John Joseph Francis; Golovashchenko, Sergey Fedorovich; Mamutov, Alexander

A cartridge assembly for a tool includes a cartridge body or casing that contains a conductor. A conductor is connected to a pulse generator or source of stored charge that is discharged to vaporize the conductor and create an electro-hydraulic or electro-magnetic shockwave that is used to impact or pulse weld two parts together.

An Implementation of Interactive Objects on the Web.

ERIC Educational Resources Information Center

Fritze, Paul

With the release of ShockWave, MacroMedia Director animations can now be incorporated directly into Web pages to provide high quality animation and interactivity, to support, for example, tutorial style questions and instantaneous feedback. This paper looks at the application of this technique in the translation of a traditional computer-based…

Numerical study of unsteady shockwave reflections using an upwind TVD scheme

NASA Technical Reports Server (NTRS)

Hsu, Andrew T.; Liou, Meng-Sing

1990-01-01

An unsteady TVD Navier-Stokes solver was developed and applied to the problem of shock reflection on a circular cylinder. The obtained numerical results were compared with the Schlieren photos from an experimental study. These results show that the present computer code has the ability of capturing moving shocks.

Training over the Intranet--A Shockwave Case Study.

ERIC Educational Resources Information Center

Snydar, Sean

This case study explains how the Boeing Company has used the World Wide Web to deliver flight and maintenance computer-based training (CBT) that was originally created on a Macintosh computer and converted to Windows format. The case study begins with a brief discussion of the advantages of using corporate and institutional internal networks…

Hydrodynamic pressure processing: Impact on the quality attributes of fresh and further-processed meat products

USDA-ARS?s Scientific Manuscript database

This book chapter reviews hydrodynamic pressure processing (HDP) as an innovative, postharvest technology for enhancing the quality attributes of fresh and further-processed meat products. A variety of meat products have been tested for their response to the high pressure shockwaves of HDP. The st...

The Earth's Core: How Does It Work? Perspectives in Science. Number 1.

ERIC Educational Resources Information Center

Carnegie Institution of Washington, Washington, DC.

Various research studies designed to enhance knowledge about the earth's core are discussed. Areas addressed include: (1) the discovery of the earth's core; (2) experimental approaches used in studying the earth's core (including shock-wave experiments and experiments at high static pressures), the search for the core's light elements, the…

Generation of shockwave and vortex structures at the outflow of a boiling water jet

NASA Astrophysics Data System (ADS)

Alekseev, M. V.; Lezhnin, S. I.; Pribaturin, N. A.; Sorokin, A. L.

2014-12-01

Results of numerical simulation for shock waves and generation of vortex structures during unsteady outflow of boiling liquid jet are presented. The features of evolution of shock waves and vortex structures formation during unsteady outflow of boiling water are compared with corresponding structures during unsteady gas outflow.

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.

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).

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.

Modeling Dynamic Anisotropic Behaviour and Spall Failure in Commercial Aluminium Alloys AA7010

NASA Astrophysics Data System (ADS)

Mohd Nor, M. K.; Ma'at, N.; Ho, C. S.

2018-04-01

This paper presents a finite strain constitutive model to predict a complex elastoplastic deformation behaviour involves very high pressures and shockwaves in orthotropic materials of aluminium alloys. The previous published constitutive model is used as a reference to start the development in this work. The proposed formulation that used a new definition of Mandel stress tensor to define Hill's yield criterion and a new shock equation of state (EOS) of the generalised orthotropic pressure is further enhanced with Grady spall failure model to closely predict shockwave propagation and spall failure in the chosen commercial aluminium alloy. This hyperelastic-plastic constitutive model is implemented as a new material model in the Lawrence Livermore National Laboratory (LLNL)-DYNA3D code of UTHM's version, named Material Type 92 (Mat92). The implementations of a new EOS of the generalised orthotropic pressure including the spall failure are also discussed in this paper. The capability of the proposed constitutive model to capture the complex behaviour of the selected material is validated against range of Plate Impact Test data at 234, 450 and 895 ms-1 impact velocities.

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.

First-principles modeling of laser-matter interaction and plasma dynamics in nanosecond pulsed laser shock processing

NASA Astrophysics Data System (ADS)

Zhang, Zhongyang; Nian, Qiong; Doumanidis, Charalabos C.; Liao, Yiliang

2018-02-01

Nanosecond pulsed laser shock processing (LSP) techniques, including laser shock peening, laser peen forming, and laser shock imprinting, have been employed for widespread industrial applications. In these processes, the main beneficial characteristic is the laser-induced shockwave with a high pressure (in the order of GPa), which leads to the plastic deformation with an ultrahigh strain rate (105-106/s) on the surface of target materials. Although LSP processes have been extensively studied by experiments, few efforts have been put on elucidating underlying process mechanisms through developing a physics-based process model. In particular, development of a first-principles model is critical for process optimization and novel process design. This work aims at introducing such a theoretical model for a fundamental understanding of process mechanisms in LSP. Emphasis is placed on the laser-matter interaction and plasma dynamics. This model is found to offer capabilities in predicting key parameters including electron and ion temperatures, plasma state variables (temperature, density, and pressure), and the propagation of the laser shockwave. The modeling results were validated by experimental data.

The Experimental Study of Dynamics of Scaled Gas-Filled Bubble Collapse in Liquid

NASA Astrophysics Data System (ADS)

Pavlenko, Alexander

2011-06-01

The article provides results of analyzing special features of the single-bubble sonoluminescence, developing the special apparatus to investigate this phenomenon on a larger-scale basis. Certain very important effects of high energy density physics, i.e. liquid compressibility, shock-wave formation under the collapse of the gas cavity in liquid, shock-wave focusing in the gas-filled cavity, occurrence of hot dense plasma in the focusing area, and high-temperature radiation yield are observed in this phenomenon. Specificity of the process is conditioned by the ``ideal'' preparation and sphericity of the gas-and-liquid contact boundary what makes the collapse process efficient due to the reduced influence of hydrodynamic instabilities. Results of experimental investigations; results of developing the facilities, description of methods used to register parameters of facilities and the system under consideration; analytical estimates how gas-filled bubbles evolve in liquid with the regard for scale effects; results of preliminary 1-D gas dynamic calculations of the gas bubble evolution are presented. The work supported by ISTC Project #2116.

Shock tube and shock wave research; Proceedings of the Eleventh International Symposium, University of Washington, Seattle, Wash., July 11-14, 1977

NASA Technical Reports Server (NTRS)

Ahlborn, B. (Editor); Hertzberg, A.; Russell, D.

1978-01-01

Papers are presented on the applications of shock-wave technology to the study of hydrodynamics, the use of the pressure-wave machine for charging diesel engines, and measurements of the heat-transfer rate in gas-turbine components. Consideration is given to shock propagation along 90-degree bends, the explosive dissemination of liquids, and rotational and vibrational relaxation behind weak shock waves in water vapor. Shock phenomena associated with expansion flows are described and stratospheric-related research using the shock tube is outlined. Attention is given to shock-wave ignition of magnesium powders, Mach reflection and boundary layers, and transition in the shock-induced unsteady boundary layer on a flat plate. Shock-tube measurements of induction and post-induction rates for low-Btu gas mixtures are presented and shock-initiated ignition in COS-N2O-Ar mixtures is described. Cluster growth rates in supersaturated lead vapor are presented and a study of laser-induced plasma motion in a solenoidal magnetic field is reviewed.

Shock tube Multiphase Experiments

NASA Astrophysics Data System (ADS)

Middlebrooks, John; Allen, Roy; Paudel, Manoj; Young, Calvin; Musick, Ben; McFarland, Jacob

2017-11-01

Shock driven multiphase instabilities (SDMI) are unique physical phenomena that have far-reaching practical applications in engineering and science. The instability is present in high energy explosions, scramjet combustors, and supernovae events. The SDMI arises when a multiphase interface is impulsively accelerated by the passage of a shockwave. It is similar in development to the Richtmyer-Meshkov (RM) instability however, particle-to-gas coupling is the driving mechanism of the SDMI. As particle effects such as lag and phase change become more prominent, the SDMI's development begins to significantly deviate from the RM instability. We have developed an experiment for studying the SDMI in our shock tube facility. In our experiments, a multiphase interface is created using a laminar jet and flowed into the shock tube where it is accelerated by the passage of a planar shockwave. The interface development is captured using CCD cameras synchronized with planar laser illumination. This talk will give an overview of new experiments conducted to examine the development of a shocked cylindrical multiphase interface. The effects of Atwood number, particle size, and a second acceleration (reshock) of the interface will be discussed.

Design and Construction of a Shock Tube Experiment for Multiphase Instability Experiments

NASA Astrophysics Data System (ADS)

Middlebrooks, John; Black, Wolfgang; Avgoustopoulos, Constantine; Allen, Roy; Kathakapa, Raj; Guo, Qiwen; McFarland, Jacob

2016-11-01

Hydrodynamic instabilities are important phenomena that have a wide range of practical applications in engineering and physics. One such instability, the shock driven multiphase instability (SDMI), arises when a shockwave accelerates an interface between two particle-gas mixtures with differing multiphase properties. The SDMI is present in high energy explosives, scramjets, and supernovae. A practical way of studying shock wave driven instabilities is through experimentation in a shock tube laboratory. This poster presentation will cover the design and data acquisition process of the University of Missouri's Fluid Mixing Shock Tube Laboratory. In the shock tube, a pressure generated shockwave is passed through a multiphase interface, creating the SDMI instability. This can be photographed for observation using high speed cameras, lasers, and advance imaging techniques. Important experimental parameters such as internal pressure and temperature, and mass flow rates of gases can be set and recorded by remotely controlled devices. The experimental facility provides the University of Missouri's Fluid Mixing Shock Tube Laboratory with the ability to validate simulated experiments and to conduct further inquiry into the field of shock driven multiphase hydrodynamic instabilities. Advisor.

Experimental investigation of the micro-ramp based shock wave and turbulent boundary layer interaction control

NASA Astrophysics Data System (ADS)

Bo, Wang; Weidong, Liu; Yuxin, Zhao; Xiaoqiang, Fan; Chao, Wang

2012-05-01

Using a nanoparticle-based planar laser-scattering technique and supersonic particle image velocimetry, we investigated the effects of micro-ramp control on incident shockwave and boundary-layer interaction (SWBLI) in a low-noise supersonic wind-tunnel with Mach number 2.7 and Reynolds number Rθ = 5845. High spatiotemporal resolution wake structures downstream of the micro-ramps were detected, while a complex evolution process containing a streamwise counter-rotating vortex pair and large-scale hairpin-like vortices with Strouhal number Stδ of about 0.5-0.65 was revealed. The large-scale structures could survive while passing through the SWBLI region. Reflected shockwaves are clearly seen to be distorted accompanied by high-frequency fluctuations. Micro-ramp applications have a distinct influence on flow patterns of the SWBLI field that vary depending on spanwise locations. Both the shock foot and separation line exhibit undulations corresponding with modifications of the velocity distribution of the incoming boundary layer. Moreover, by energizing parts of the boundary flow, the micro-ramp is able to dampen the separation.

The α–ω phase transition in shock-loaded titanium

DOE PAGES

Jones, David R.; Morrow, Benjamin M.; Trujillo, Carl P.; ...

2017-07-28

Here, we present a series of experiments probing the martensitic α–ω (hexagonal close-packed to simple hexagonal) transition in titanium under shock-loading to peak stresses around 15 GPa. Gas-gun plate impact techniques were used to locate the α–ω transition stress with a laser-based velocimetry diagnostic. A change in the shock-wave profile at 10.1 GPa suggests the transition begins at this stress. A second experiment shock-loaded and then soft-recovered a similar titanium sample. We then analyzed this recovered material with electron-backscatter diffraction methods, revealing on average approximately 65% retained ω phase. Furthermore, based on careful analysis of the microstructure, we propose thatmore » the titanium never reached a full ω state, and that there was no observed phase-reversion from ω to α. Texture analysis suggests that any α titanium found in the recovered sample is the original α. The data show that both the α and ω phases are stable and can coexist even though the shock-wave presents as steady-state, at these stresses.« less

Calculation of reinforced-concrete frame strength under a simultaneous static cross section load and a column lateral impact

NASA Astrophysics Data System (ADS)

Belov, Nikolay; Yugov, Nikolay; Kopanitsa, Dmitry; Kopanitsa, Georgy; Yugov, Alexey; Kaparulin, Sergey; Plyaskin, Andrey; Kalichkina, Anna; Ustinov, Artyom

2016-01-01

When designing buildings with reinforced concrete that are planned to resist dynamic loads it is necessary to calculate this structural behavior under operational static and emergency impact and blast loads. Calculations of the structures under shock-wave loads can be performed by solving dynamic equations that do not consider static loads. Due to this fact the calculation of reinforced concrete frame under a simultaneous static and dynamic load in full 3d settings becomes a very non trivial and resource consuming problem. This problem can be split into two tasks. The first one is a shock-wave problem that can be solved using software package RANET-3, which allows solving the problem using finite elements method adapted for dynamic task. This method calculates strain-stress state of the material and its dynamic destruction, which is considered as growth and consolidation of micro defects under loading. On the second step the results of the first step are taken as input parameters for quasi static calculation of simultaneous static and dynamic load using finite elements method in AMP Civil Engineering-11.

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.

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.

Reduction of Bubble Cavitation by Modifying the Diffraction Wave from a Lithotripter Aperture

PubMed Central

2012-01-01

Abstract Purpose A new method was devised to suppress the bubble cavitation in the lithotripter focal zone to reduce the propensity of shockwave-induced renal injury. Materials and Methods An edge extender was designed and fabricated to fit on the outside of the ellipsoidal reflector of an electrohydraulic lithotripter to disturb the generation of diffraction wave at the aperture, but with little effect on the acoustic field inside the reflector. Results Although the peak negative pressures at the lithotripter focus using the edge extender at 20 kV were similar to that of the original configuration (-11.1±0.9 vs −10.6±0.7 MPa), the duration of the tensile wave was shortened significantly (3.2±0.54 vs 5.83±0.56 μs, P<0.01). There is no difference, however, in both the amplitude and duration of the compressive shockwaves between these two configurations as well as the −6 dB beam width in the focal plane. The significant suppression effect of bubble cavitation was confirmed by the measured bubble collapse time using passive cavitation detection. At the lithotripter focus, while only about 30 shocks were needed to rupture a blood vessel phantom using the original HM-3 reflector at 20 kV, no damage could be produced after 300 shocks using the edge extender. Meanwhile, the original HM-3 lithotripter at 20 kV can achieve a stone comminution efficiency of 50.4±2.0% on plaster-of-Paris stone phantom after 200 shocks, which is comparable to that of using the edge extender (46.8±4.1%, P=0.005). Conclusions Modifying the diffraction wave at the lithotripter aperture can suppress the shockwave-induced bubble cavitation with significant reduced damage potential on the vessel phantom but satisfactory stone comminution ability. PMID:22332839

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

A Multi-Mode Shock Tube for Investigation of Blast-Induced Traumatic Brain Injury

PubMed Central

Reneer, Dexter V.; Hisel, Richard D.; Hoffman, Joshua M.; Kryscio, Richard J.; Lusk, Braden T.

2011-01-01

Abstract Blast-induced mild traumatic brain injury (bTBI) has become increasingly common in recent military conflicts. The mechanisms by which non-impact blast exposure results in bTBI are incompletely understood. Current small animal bTBI models predominantly utilize compressed air-driven membrane rupture as their blast wave source, while large animal models use chemical explosives. The pressure-time signature of each blast mode is unique, making it difficult to evaluate the contributions of the different components of the blast wave to bTBI when using a single blast source. We utilized a multi-mode shock tube, the McMillan blast device, capable of utilizing compressed air- and compressed helium-driven membrane rupture, and the explosives oxyhydrogen and cyclotrimethylenetrinitramine (RDX, the primary component of C-4 plastic explosives) as the driving source. At similar maximal blast overpressures, the positive pressure phase of compressed air-driven blasts was longer, and the positive impulse was greater, than those observed for shockwaves produced by other driving sources. Helium-driven shockwaves more closely resembled RDX blasts, but by displacing air created a hypoxic environment within the shock tube. Pressure-time traces from oxyhydrogen-driven shockwaves were very similar those produced by RDX, although they resulted in elevated carbon monoxide levels due to combustion of the polyethylene bag used to contain the gases within the shock tube prior to detonation. Rats exposed to compressed air-driven blasts had more pronounced vascular damage than those exposed to oxyhydrogen-driven blasts of the same peak overpressure, indicating that differences in blast wave characteristics other than peak overpressure may influence the extent of bTBI. Use of this multi-mode shock tube in small animal models will enable comparison of the extent of brain injury with the pressure-time signature produced using each blast mode, facilitating evaluation of the blast wave components contributing to bTBI. PMID:21083431

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.

A multi-mode shock tube for investigation of blast-induced traumatic brain injury.

PubMed

Reneer, Dexter V; Hisel, Richard D; Hoffman, Joshua M; Kryscio, Richard J; Lusk, Braden T; Geddes, James W

2011-01-01

Blast-induced mild traumatic brain injury (bTBI) has become increasingly common in recent military conflicts. The mechanisms by which non-impact blast exposure results in bTBI are incompletely understood. Current small animal bTBI models predominantly utilize compressed air-driven membrane rupture as their blast wave source, while large animal models use chemical explosives. The pressure-time signature of each blast mode is unique, making it difficult to evaluate the contributions of the different components of the blast wave to bTBI when using a single blast source. We utilized a multi-mode shock tube, the McMillan blast device, capable of utilizing compressed air- and compressed helium-driven membrane rupture, and the explosives oxyhydrogen and cyclotrimethylenetrinitramine (RDX, the primary component of C-4 plastic explosives) as the driving source. At similar maximal blast overpressures, the positive pressure phase of compressed air-driven blasts was longer, and the positive impulse was greater, than those observed for shockwaves produced by other driving sources. Helium-driven shockwaves more closely resembled RDX blasts, but by displacing air created a hypoxic environment within the shock tube. Pressure-time traces from oxyhydrogen-driven shockwaves were very similar those produced by RDX, although they resulted in elevated carbon monoxide levels due to combustion of the polyethylene bag used to contain the gases within the shock tube prior to detonation. Rats exposed to compressed air-driven blasts had more pronounced vascular damage than those exposed to oxyhydrogen-driven blasts of the same peak overpressure, indicating that differences in blast wave characteristics other than peak overpressure may influence the extent of bTBI. Use of this multi-mode shock tube in small animal models will enable comparison of the extent of brain injury with the pressure-time signature produced using each blast mode, facilitating evaluation of the blast wave components contributing to bTBI.

Extracorporeal shock wave therapy in orthopedics, basic research, and clinical implications

NASA Astrophysics Data System (ADS)

Hausdorf, Joerg; Jansson, Volkmar; Maier, Markus; Delius, Michael

2005-04-01

The molecular events following shock wave treatment of bone are widely unknown. Nevertheless patients with osteonecrosis and non unions are already treated partly successful with shock waves. Concerning the first indication, the question of the permeation of the shock wave into the bone was addressed. Therefore shockwaves were applied to porcine femoral heads and the intraosseous pressure was measured. A linear correlation of the pressure to the intraosseous distance was found. Approximately 50% of the pressure are still measurable 10 mm inside the femoral head. These findings should encourage continued shock wave research on this indication. Concerning the second indication (non union), osteoblasts were subjected to 250 or 500 shock waves at 25 kV. After 24, 48, and 72 h the levels of the bone and vascular growth factors bFGF, TGFbeta1, and VEGF were examined. After 24 h there was a significant increase in bFGF levels (p<0.05) with significant correlation (p<0.05) to the number of impulses. TGFbeta1, and VEGF showed no significant changes. This may be one piece in the cascade of new bone formation following shock wave treatment and may lead to a more specific application of shock waves in orthopedic surgery.

Nephrolithiasis and Osteomalacia associated with adefovir-induced Fanconi syndrome in a patient with hepatitis B.

PubMed

Lin, Jueying; Zhuo, Yufeng; Zhang, Dongdong

2017-08-29

An increasing number of case reports suggest that acquired renal Fanconi syndrome may be associated with prolonged use of adefovir against hepatitis B virus. Renal Fanconi syndrome is an uncommon disease, and its complication with nephrolithiasis is quite rare. Herein, we report a rare coexistence of nephrolithiasis and acquired renal Fanconi syndrome in a chronic hepatitis B-positive patient with prolonged adefovir therapy. The patient presented with osteomalacia and nephrolithiasis. Consequently, extracorporeal shock-wave lithotripsy and left double-J ureteral stent insertion were considered for obstructive nephropathy, which was caused by nephrolithiasis. However, osteomalacia had been misdiagnosed as osteoporosis before admission to our hospital. On admission, a complexity of multiple fractures, hypophosphataemia, glycosuria without hyperglycaemia and non-anion-gap metabolic acidosis indicated a diagnosis of acquired renal Fanconi syndrome induced by adefovir. After switching from adefovir to entecavir, the patient's symptoms and laboratory findings improved significantly. The mechanism responsible for nephrolithiasis in renal Fanconi syndrome is still unclear. We recommend regularly monitoring renal function and serum calcium and serum phosphate to prevent renal Fanconi syndrome during the prolonged use of adefovir for hepatitis B virus.

Adapting Reference for a Unique Group of Distance Learners: Serving the American Institute of Certified Public Accountants (AICPA)

ERIC Educational Resources Information Center

Martin, Maria Mathilde

2004-01-01

When a university acquires the library of a national institute and the institute's active and worldwide membership expects continued and uninterrupted access to services from the collection, shockwaves can reverberate throughout the university's main library and among its staff. This was especially true for the Reference Department of the…

Shock-wave structure based on the Navier-Stokes-Fourier equations.

PubMed

Uribe, F J; Velasco, R M

2018-04-01

We use the Navier-Stokes-Fourier constitutive equations to study plane shock waves in dilute gases. It is shown that the experimental information on the normalized density profiles can be fit by using the so-called soft sphere model, in which the viscosity and thermal conductivity are proportional to a power of the temperature.

Shock-wave structure based on the Navier-Stokes-Fourier equations

NASA Astrophysics Data System (ADS)

Uribe, F. J.; Velasco, R. M.

2018-04-01

We use the Navier-Stokes-Fourier constitutive equations to study plane shock waves in dilute gases. It is shown that the experimental information on the normalized density profiles can be fit by using the so-called soft sphere model, in which the viscosity and thermal conductivity are proportional to a power of the temperature.

The Structure of a Hypersonic Air Flow near a Plane Surface at Various Intensities of Magnetogasdynamic Interaction

NASA Astrophysics Data System (ADS)

Fomichev, V. P.; Yadrenkin, M. A.

2017-12-01

This Letter presents a systematization of the effects observed in experiments on the magnetogasdynamic interaction near the surface of a plate in a high-speed gas flow. Ranges of the hydromagnetic-interaction parameter determining various levels of influence on the shock-wave structure of the flow are established.

Control of the flow over wing airfoils in transonic regimes by means of force action of surface elements on the flow

NASA Astrophysics Data System (ADS)

Aul'chenko, S. M.; Zamuraev, V. P.

2012-09-01

Mathematical modeling of the effect of force oscillations of surface elements of a wing airfoil on the shock-wave structure of the transonic flow over it is implemented. The qualitative and quantitative effect of the oscillation parameters on the airfoil wave drag is investigated.

Assessing Homegrown Library Collections: Using Google Analytics to Track Use of Screencasts and Flash-Based Learning Objects

ERIC Educational Resources Information Center

Betty, Paul

2009-01-01

Increasing use of screencast and Flash authoring software within libraries is resulting in "homegrown" library collections of digital learning objects and multimedia presentations. The author explores the use of Google Analytics to track usage statistics for interactive Shockwave Flash (.swf) files, the common file output for screencast and Flash…

Career Guidance in Unstable Times: Linking Economic, Social and Individual Benefits. Briefing Note

ERIC Educational Resources Information Center

Cedefop - European Centre for the Development of Vocational Training, 2014

2014-01-01

The economic crisis that peaked in 2009 sent shockwaves that will be felt for years to come. It affected businesses, increased social risk for many and destabilised job and career prospects. Young people, particularly, have been badly affected. They are suffering the highest unemployment rates and their prospects have been damaged most. But,…

Plasma discharge self-cleaning filtration system

DOEpatents

Cho, Young I.; Fridman, Alexander; Gutsol, Alexander F.; Yang, Yong

2014-07-22

The present invention is directed to a novel method for cleaning a filter surface using a plasma discharge self-cleaning filtration system. The method involves utilizing plasma discharges to induce short electric pulses of nanoseconds duration at high voltages. These electrical pulses generate strong Shockwaves that disintegrate and dislodge particulate matter located on the surface of the filter.

Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial

PubMed Central

Vahdatpour, Babak; Mokhtarian, Arghavan; Raeissadat, Seyed Ahmad; Dehghan, Farnaz; Nasr, Nafiseh; Mazaheri, Mahsa

2018-01-01

Background: Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Materials and Methods: Patients in both groups (n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. Results: One month after intervention, VAS morning showed significant improvement in intervention group (P = 0.006) and RMS showed better improvement in intervention group (P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups (P = 0.292). Conclusions: This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis. PMID:29862211

Enhancement of the Effectiveness of Extracorporeal Shock Wave Therapy with Topical Corticosteroid in Treatment of Chronic Plantar Fasciitis: A Randomized Control Clinical Trial.

PubMed

Vahdatpour, Babak; Mokhtarian, Arghavan; Raeissadat, Seyed Ahmad; Dehghan, Farnaz; Nasr, Nafiseh; Mazaheri, Mahsa

2018-01-01

Chronic recalcitrant plantar fasciitis is a disabling condition. We presumed if shock wave could increase the permeability of skin and facilitate penetration of topical corticosteroid through the skin; the combinational therapeutic effect would be stronger than using shock wave alone. The study purpose was to utilize the synergistic effect of shock wave and topical corticosteroid in treatment of plantar fasciitis. Patients in both groups ( n = 40) received four sessions of shock wave with the same protocol at weekly intervals. At 30 min before each session, we used an occlusive dressing of topical clobetasol for the intervention group and Vaseline oil for the control group. Pain severity was assessed with visual analog scale (VAS) and modified Roles and Maudsley score (RMS) at baseline and 1 month and 3 months after intervention. Plantar fascia (PF) thickness was measured with ultrasonography at baseline and 3 months after intervention. One month after intervention, VAS morning showed significant improvement in intervention group ( P = 0.006) and RMS showed better improvement in intervention group ( P = 0.026). There was no significant difference between the two groups after 3 months in RMS or VAS score. PF thickness was decreased significantly in both groups, but it was not significant between the two groups ( P = 0.292). This combinational therapy yielded earlier pain reduction and functional improvement than using shock wave alone; topical corticosteroid could enhance the effectiveness of shockwave in short-term in the treatment of recalcitrant plantar fasciitis.

Administration of an Herbal Complex, Jakyak-Gamcho-Tang (JGT), for Plantar Fasciitis in Military Medical Service: A Case Report.

PubMed

Kwon, Seungwon; Jung, Woo-Sang; Moon, Sang-Kwan; Cho, Ki-Ho; Shin, Kyoung-Ho

Plantar fasciitis is a common disease affecting the heel and plantar side of the foot. This condition can be improved within 6 months with conservative treatments such as stretching, nonsteroidal anti-inflammatory drugs (NSAIDs), extracorporeal shockwave therapy, and corticosteroid injection. However, soldiers need a faster and safer therapy for symptomatic relief to meet the requirements of their occupation. In this report, we reveal that Jakyak-Gamcho-Tang (JGT), an herbal complex, had a positive effect in a case series of 10 military patients with plantar fasciitis. We treated 10 patients with chronic and acute plantar fasciitis with the JGT herbal complex for 21.00 ± 5.72 days. During JGT administration, the patients continued to perform calf-strengthening exercises. After JGT administration, the average foot function index (FFI) score was reduced from 41.11 ± 7.86 to 1.65 ± 3.60 and the average facial rating scale (FRS) was reduced from 5.65 ± 0.88 to 0.40 ± 0.70. A statistically significant difference was observed between the average FFI and FRS measured before and after treatment (paired t test, P < .001). At the conclusion of JGT treatment, all 10 patients (100%) had reduced symptoms of plantar fasciitis. In 7 out of the 10 patients (70%), no pain was experienced after the treatment. In this case series, we show the clinical effects of JGT on pain control in patients with plantar fasciitis. Further clinical studies investigating the effects of JGT are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

[Experience of use of prolit super septo in the rehabilitation of patients after endoscopic surgery].

PubMed

Martov, A G; Ergakov, D V

2014-01-01

Numerous publications on the successful application of prolit super septo ( Greenwood, RF) in metaphylaxis of urolithiasis after extracorporeal shockwave lithotripsy, and in infectiousand inflammatory diseases of the upper and lower urinary tract gave rise to research aimed at investigating the efficacy and safety of long-term use of prolit super septo in patients undergoing various transurethral and percutaneous interventions. From September 2012, to March 2013, 894 transurethral and percutaneous endoscopic interventions were performed. The main group (n=450) consisted of patients treating with prolit super septo at a dose of 2 capsules 2 times a day for a one month in addition to standard uroantiseptic therapy after endourological interventions. The control group (n=444) consisted of patients receiving standard therapy for the same period after same interventions. The evaluation of patients both main and control group was focused on pyuria, daily diuresis, symptoms and quality of life of patients. It was found that after transurethral surgery of the lower urinary tract, the use of prolit super septo reduces the severity of irritative symptoms, improves the quality of life, reduces the leucocyturia, and increases the diuresis. Application of prolit super septo after operations on the upper urinary tract leads to a decrease of leucocyturia, increase of dieresis, and improves the discharge of residual fragments. In patients with oxalate and urate calculi, persistent increase in the pH of urine was noteda, which may be a part of metaphylaxis of urolithiasis. Adverse effects associated with taking of prolit super septo were not observed.

Reducing the wave drag of wing airfoils in transonic flow regimes by the force action of airfoil surface elements on the flow

NASA Astrophysics Data System (ADS)

Aul'chenko, S. M.; Zamuraev, V. P.

2012-11-01

Mathematical modeling of the influence of forced oscillations of surface elements of a wing airfoil on the shock-wave structure of transonic flow past it has been carried out. The qualitative and quantitative influence of the oscillation parameters on the wave drag of the airfoil has been investigated.

Explosive boiling of liquid nitrogen

NASA Astrophysics Data System (ADS)

Nakoryakov, V. E.; Tsoy, A. N.; Mezentsev, I. V.; Meleshkin, A. V.

2014-12-01

The present paper deals with experimental investigation of processes that occur when injecting a cryogenic fluid into water. The optical recording of the process of injection of a jet of liquid nitrogen into water has revealed the structure and the stages of this process. The results obtained can be used when studying a new method for producing gas hydrates based on the shock-wave method.

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.

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.

Modeling multiscale evolution of numerous voids in shocked brittle material.

PubMed

Yu, Yin; Wang, Wenqiang; He, Hongliang; Lu, Tiecheng

2014-04-01

The influence of the evolution of numerous voids on macroscopic properties of materials is a multiscale problem that challenges computational research. A shock-wave compression model for brittle material, which can obtain both microscopic evolution and macroscopic shock properties, was developed using discrete element methods (lattice model). Using a model interaction-parameter-mapping procedure, qualitative features, as well as trends in the calculated shock-wave profiles, are shown to agree with experimental results. The shock wave splits into an elastic wave and a deformation wave in porous brittle materials, indicating significant shock plasticity. Void collapses in the deformation wave were the natural reason for volume shrinkage and deformation. However, media slippage and rotation deformations indicated by complex vortex patterns composed of relative velocity vectors were also confirmed as an important source of shock plasticity. With increasing pressure, the contribution from slippage deformation to the final plastic strain increased. Porosity was found to determine the amplitude of the elastic wave; porosity and shock stress together determine propagation speed of the deformation wave, as well as stress and strain on the final equilibrium state. Thus, shock behaviors of porous brittle material can be systematically designed for specific applications.

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

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.

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.

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.

Optical distortion in the field of a lithotripter shock wave

NASA Astrophysics Data System (ADS)

Carnell, M. T.; Emmony, D. C.

1995-10-01

The schlieren observation of cavitation phenomena produced in the tail of a lithotripter shock wave has indicated the presence of some interesting features. The images produced appear to indicate that cavitation transients in the field of a shock wave propagate nonsymmetrically; this is not the case. The apparent lack of symmetry exhibited by the primary cavitation transients is due to a complex optical lensing effect, which is brought about by the change in refractive index associated with the pressure profile of the shock wave. Objects seen through or immersed in the shock-wave field of an electromagnetic acoustic transducer, such as cavitation, appear highly distorted because of the strong positive and negative lensing effects of the compression and rarefaction cycles of the shock wave. A modification of the schlieren technique called the scale method has been used to model the distortion introduced by the shock wave and consequently explain the cavitation distortion. The technique has also been used to quantitatively analyze and partially reconstruct the lithotripter shock wave. The combination of schlieren and scale imaging gives more information about the refractive index field and therefore the shock-wave structure itself.

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.

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.

Chelyabinsk meteoroid entry and airburst damage

NASA Astrophysics Data System (ADS)

Popova, O.; Jenniskens, P.; Shuvalov, V.; Emel'yanenko, V.; Rybnov, Y.; Kharlamov, V.; Kartashova, A.; Biryukov, E.; Khaibrakhmanov, S.; Glazachev, D.; Trubetskaya, I.

2014-07-01

A field study of the Chelyabinsk Airburst was conducted in the weeks following the event on February 15, 2013. To measure the impact energy, the extent of the glass damage was mapped by visiting over 50 villages in the area. To determine how that energy was deposited in the atmosphere, the most suitable dash-cam and video security camera footage was calibrated by taking star background images at the sites where video was taken. Shadow obstacles in videos taken at Chelyabinsk and Chebarkul were calibrated. To measure the nature of the damaging shockwave, arrival times were measured from the footage of 34 traffic cameras, data saved on a single timed server. To measure the impact of the shockwave, some 150 eyewitnesses were interviewed to ask about their personal experiences, smells, sense of heat, sunburn, etc. Meteorite find locations, shape, and size were documented by interviewing the finders and photographing the collections. Some of these meteorites were analyzed in a consortium study to determine what material properties contributed to the manner in which the meteoroid broke in the atmosphere. The results paint the first detailed picture of an asteroid impact airburst over a populated area. This information may help better prepare for future impact hazard mitigation scenarios.

Calculation of reinforced-concrete frame strength under a simultaneous static cross section load and a column lateral impact

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

Belov, Nikolay, E-mail: n.n.belov@mail.ru; Kopanitsa, Dmitry, E-mail: kopanitsa@mail.ru; Yugov, Alexey, E-mail: yugalex@mail.ru

When designing buildings with reinforced concrete that are planned to resist dynamic loads it is necessary to calculate this structural behavior under operational static and emergency impact and blast loads. Calculations of the structures under shock-wave loads can be performed by solving dynamic equations that do not consider static loads. Due to this fact the calculation of reinforced concrete frame under a simultaneous static and dynamic load in full 3d settings becomes a very non trivial and resource consuming problem. This problem can be split into two tasks. The first one is a shock-wave problem that can be solved usingmore » software package RANET-3, which allows solving the problem using finite elements method adapted for dynamic task. This method calculates strain-stress state of the material and its dynamic destruction, which is considered as growth and consolidation of micro defects under loading. On the second step the results of the first step are taken as input parameters for quasi static calculation of simultaneous static and dynamic load using finite elements method in AMP Civil Engineering-11.« less

Development of the symmetrical laser shock test for weak bond inspection.

NASA Astrophysics Data System (ADS)

Sagnard, Maxime; Berthe, Laurent; Ecault, Romain; Touchard, Fabienne; Boustie, Michel

2017-06-01

This paper presents the LAser Shock Adhesion Test (LASAT) using symmetrical laser shocks. The study is part of ComBoNDT European project that develops new Non-Destructive Tests (NDT) to assess adherence properties of bonded composite structures. This NDT technique relies on the creation of a plasma on both side of the sample using two lasers. The plasma expands and generates shockwaves inside the material. When combined, the shockwaves create a local tensile strength. Properly set, this stress can be used to test interfaces adherence. Numerous experiments have shown that this adaptive technique can discriminate a good bond from a weak one, without damaging the composite structure. Weak bonds are usually created by contaminated surfaces (residues of release agent, finger prints, ...) and were artificially recreated for ComBoNDT test samples. Numerical simulations are being developed as well, to improve the comprehension of the physical phenomenon. And ultimately, using these numerical results, one should be able to find the correct laser parameters (intensity, laser spot diameter) to generate the right tensile strength at the desired location. This project has received funding from the European Union's Horizon 2020 research and innovation program under Grant agreement N 63649.

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 superior to other nonoperative modalities. Multiple surgical options for persistent TB have been reported, including bursectomy (n = 2), longitudinal release of the iliotibial band (n = 2), proximal or distal Z-plasty (n = 4), osteotomy (n = 1), and repair of gluteus medius tears (n = 4). Conclusions Efficacy among surgical techniques varied depending on the clinical outcome measure, but all were superior to corticosteroid therapy and physical therapy according to the VAS and HHS in both comparison studies and between studies. This systematic review found that traditional nonoperative treatment helped most patients, SWT was a good alternative, and surgery was effective in refractory cases. PMID:21814140

Safety and efficacy of extracorporeal shock wave myocardial revascularization therapy for refractory angina pectoris.

PubMed

Cassar, Andrew; Prasad, Megha; Rodriguez-Porcel, Martin; Reeder, Guy S; Karia, Darshak; DeMaria, Anthony N; Lerman, Amir

2014-03-01

To assess the safety and efficacy of extracorporeal shockwave myocardial revascularization (ESMR) therapy in treating patients with refractory angina pectoris. A single-arm multicenter prospective trial to assess safety and efficacy of the ESMR therapy in patients with refractory angina (class III/IV angina) was performed. Screening exercise treadmill tests and pharmacological single-photon emission computed tomography (SPECT) were performed for all patients to assess exercise capacity and ischemic burden. Patients were treated with 9 sessions of ESMR to ischemic areas over 9 weeks. Efficacy end points were exercise capacity by using treadmill test as well as ischemic burden on pharmacological SPECT at 4 months after the last ESMR treatment. Safety measures included electrocardiography, echocardiography, troponin, creatine kinase, and brain natriuretic peptide testing, and pain questionnaires. Fifteen patients with medically refractory angina and no revascularization options were enrolled. There was a statistically significant mean increase of 122.3±156.9 seconds (38% increase compared with baseline; P=.01) in exercise treadmill time from baseline (319.8±157.2 seconds) to last follow-up after the ESMR treatment (422.1±183.3 seconds). There was no improvement in the summed stress perfusion scores after pharmacologically induced stress SPECT at 4 months after the last ESMR treatment in comparison to that at screening; however, SPECT summed stress score revealed that untreated areas had greater progression in ischemic burden vs treated areas (3.69±6.2 vs 0.31±4.5; P=.03). There was no significant change in the mean summed echo score from baseline to posttreatment (0.4±5.1; P=.70). The ESMR therapy was performed safely without any adverse events in electrocardiography, echocardiography, troponins, creatine kinase, or brain natriuretic peptide. Pain during the ESMR treatment was minimal (a score of 0.5±1.2 to 1.1±1.2 out of 10). In this multicenter feasibility study, ESMR seems to be a safe and efficacious treatment for patients with refractory angina pectoris. However, larger sham-controlled trials will be required to confirm these findings. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Ground Observation of the Hayabusa Reentry: The Third Opportunity of Man-made Fireball from Interplanetary Orbit

NASA Astrophysics Data System (ADS)

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

2010-12-01

After 7 years and 6,000,000,000 km of challenging cruise in the solar system, the Hayabusa did come back to the Earth on June 13, 2010. The Hayabusa, the first sample-return explorer to NEA, landed on 25243 Itokawa in 2005, capturing surface particles on the S-type asteroid into its sample return capsule (SRC). Following to the reentries of the Genesis in 2004 and the Stardust in 2006, the return of the Hayabusa SRC was the third direct reentry event from the interplanetary transfer orbit to the Earth at a velocity of over 11.2 km/s. In addition, it was world first case of direct reentry of spacecraft from interplanetary transfer orbit. After the successful resumption of the SRC, it was carefully sent to ISAS/JAXA, and at present, small particles expected to be the first sample-return materials from the minor planet are carefully investigated. In order to obtain precise trajectory information to ensure the quick procedure for the Hayabusa SRC resumption team, we observed the Hayabusa SRC reentry by optically in Australian night sky. High-resolution imaging and spectroscopy were carried out with several high-sensitivity instruments to investigate thermal-protection process of thermal protection ablator (TPA) as well as interaction process between SRC surface materials and upper atmospheric neutral and plasma components. Moreover, shockwaves were observed by infrasound/seismic sensor arrays on ground to investigate reentry related shockwaves as well as air-to-ground coupling process at the extremely rare opportunity. With respect to nominal trajectory of the Hayabusa SRC reentry, four optical stations were set inside and near the Woomera Prohibited Area, Australia, targeting on peak-heat and/or front-heat profiles of ablating TPA for engineering aspect. Infrasound and seismic sensors were also deployed as three arrayed stations and three single stations to realize direction findings of sonic boom type shockwaves from the SRC and spacecraft and point source type shockwaves from explosion of the Hayabusa itself as well as investigate precise parameters of pressure waves and energy transforming processes through the air-to-ground couplings. At 23:21 local time (13:51 UT) on June 13, 2010, the reentry of the SRC and the Hayabusa itself were successfully operated on the exact schedule and trajectory, giving us fruitful images and signals on almost all cameras and infrasound/seismic sensors. Moreover, several audible sound signals were detected at an observation site about 70 km apart from the trajectory. In this talk, we introduce our ground observations and preliminary results of infrasound/seismic observation part of this ground observation campaign. Acknowledgement: This research was partially supported by the Ministry of Education, Science, Sports and Culture, Grant-in-Aid for Scientific Research (B), Field Research in Abroad, 22403005, 2010 (PI: Y.H.).

Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.

PubMed

Franco, Juan Va; Turk, Tarek; Jung, Jae Hung; Xiao, Yu-Tian; Iakhno, Stanislav; Garrote, Virginia; Vietto, Valeria

2018-01-26

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure commonly used to measure CP/CPPS symptoms. To assess the effects of non-pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). We performed a comprehensive search using multiple databases, trial registries, grey literature and conference proceedings with no restrictions on the language of publication or publication status. The date of the latest search of all databases was August 2017. We included randomised controlled trials. Inclusion criteria were men with a diagnosis of CP/CPPS. We included all available non-pharmacological interventions. Two review authors independently classified studies and abstracted data from the included studies, performed statistical analyses and rated quality of evidence (QoE) according to the GRADE methods. We included 38 unique studies with 3290 men with CP/CPPS across 23 comparisons.1. Acupuncture: (three studies, 204 participants) based on short-term follow-up, acupuncture reduces prostatitis symptoms in an appreciable number of participants compared with sham procedure (mean difference (MD) in total NIH-CPSI score -5.79, 95% confidence interval (CI) -7.32 to -4.26, high QoE). Acupuncture likely results in little to no difference in adverse events (moderate QoE). It probably also decreases prostatitis symptoms compared with standard medical therapy in an appreciable number of participants (MD -6.05, 95% CI -7.87 to -4.24, two studies, 78 participants, moderate QoE).2. Circumcision: (one study, 713 participants) based on short-term follow-up, early circumcision probably decreases prostatitis symptoms slightly (NIH-CPSI score MD -3.00, 95% CI -3.82 to -2.18, moderate QoE) and may not be associated with a greater incidence of adverse events compared with control (a waiting list to be circumcised, low QoE).3. Electromagnetic chair: (two studies, 57 participants) based on short-term follow-up, we are uncertain of the effects of the use of an electromagnetic chair on prostatitis symptoms. It may be associated with a greater incidence of adverse events compared with sham procedure (low to very low QoE).4. Lifestyle modifications: (one study, 100 participants) based on short-term follow-up, lifestyle modifications may be associated with a greater improvement in prostatitis symptoms in an appreciable number of participants compared with control (risk ratio (RR) for improvement in NIH-CPSI scores 3.90, 95% CI 2.20 to 6.92, very low QoE). We found no information regarding adverse events.5. Physical activity: (one study, 85 participants) based on short-term follow-up, a physical activity programme may cause a small reduction in prostatitis symptoms compared with control (NIH-CPSI score MD -2.50, 95% CI -4.69 to -0.31, low QoE). We found no information regarding adverse events.6. Prostatic massage: (two studies, 115 participants) based on short-term follow-up, we are uncertain whether the prostatic massage reduces or increases prostatitis symptoms compared with control (very low QoE). We found no information regarding adverse events.7. Extracorporeal shockwave therapy: (three studies, 157 participants) based on short-term follow-up, extracorporeal shockwave therapy reduces prostatitis symptoms compared with control (NIH-CPSI score MD -6.18, 95% CI -7.46 to -4.89, high QoE). These results may not be sustained at medium-term follow-up (low QoE). This treatment may not be associated with a greater incidence of adverse events (low QoE).8. Transrectal thermotherapy compared to medical therapy: (two studies, 237 participants) based on short-term follow-up, transrectal thermotherapy alone or in combination with medical therapy may decrease prostatitis symptoms slightly when compared with medical therapy alone (NIH-CPSI score MD -2.50, 95% CI -3.82 to -1.18, low QoE). One included study reported that participants may experience transient adverse events.9. Other interventions: there is uncertainty about the effects of other interventions included in this review. We found no information regarding psychological support or prostatic surgery. Some of the interventions can decrease prostatitis symptoms in an appreciable number without a greater incidence of adverse events. The QoE was mostly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes.

Three Dimensional Analysis of Induced Detonation of Cased Explosive

DTIC Science & Technology

2014-10-16

hardness and ductility . RHA steel is largely used in military applications to manufacture armoured vehicles. The Johnson Cook (JC) constitutive...armour (RHA) steel were investigated through the LS-DYNA. The investigation focused on shock to detonation simulations of Composition B, with the... hot spots caused by the compression of the explosive from the initial shockwave. Detonation was also caused by pressure waves reflecting against the

Frontiers in Anisotropic Shock-Wave Modeling

DTIC Science & Technology

2012-02-01

Nowadays, some models incorporate a user-defined subroutine within the commercial software (e.g., ABAQUS ) to take into account either a homogenous...and temperature on the mass density. The specific internal energy can be decomposed into potentials describing the cold compression, ec (ρ, S); thermal ...Taylor’s series expansion of the Hugoniot pressure P . Assume that the linear approximation between the shock velocity US 24 and particle velocity up

Ignition Behavior of alpha-AlH3

DTIC Science & Technology

2010-01-01

nitromethane (Weiser et al., 2007) and Ammonium Perchlorate= HTPB propellants (Deluca et al., 2007) compared to similarly aluminized versions may...aluminum burning times. Combustion, Explosives , and Shockwaves, 41, 533–546. Benson, S.W. 1976. Thermochemical Kinetics, 2nd ed., Wiley Interscience, New...flat-flame burner. 16th International Colloquium on the Dynamic Explosions and Reactive Systems, Krakow, Poland. Brzustowski, T.A., and Glassman, I. 1964

[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.

Alliance for Computational Science Collaboration: HBCU Partnership at Alabama A&M University Continuing High Performance Computing Research and Education at AAMU

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

Qian, Xiaoqing; Deng, Z. T.

2009-11-10

This is the final report for the Department of Energy (DOE) project DE-FG02-06ER25746, entitled, "Continuing High Performance Computing Research and Education at AAMU". This three-year project was started in August 15, 2006, and it was ended in August 14, 2009. The objective of this project was to enhance high performance computing research and education capabilities at Alabama A&M University (AAMU), and to train African-American and other minority students and scientists in the computational science field for eventual employment with DOE. AAMU has successfully completed all the proposed research and educational tasks. Through the support of DOE, AAMU was able tomore » provide opportunities to minority students through summer interns and DOE computational science scholarship program. In the past three years, AAMU (1). Supported three graduate research assistants in image processing for hypersonic shockwave control experiment and in computational science related area; (2). Recruited and provided full financial support for six AAMU undergraduate summer research interns to participate Research Alliance in Math and Science (RAMS) program at Oak Ridge National Lab (ORNL); (3). Awarded highly competitive 30 DOE High Performance Computing Scholarships ($1500 each) to qualified top AAMU undergraduate students in science and engineering majors; (4). Improved high performance computing laboratory at AAMU with the addition of three high performance Linux workstations; (5). Conducted image analysis for electromagnetic shockwave control experiment and computation of shockwave interactions to verify the design and operation of AAMU-Supersonic wind tunnel. The high performance computing research and education activities at AAMU created great impact to minority students. As praised by Accreditation Board for Engineering and Technology (ABET) in 2009, ?The work on high performance computing that is funded by the Department of Energy provides scholarships to undergraduate students as computational science scholars. This is a wonderful opportunity to recruit under-represented students.? Three ASEE papers were published in 2007, 2008 and 2009 proceedings of ASEE Annual Conferences, respectively. Presentations of these papers were also made at the ASEE Annual Conferences. It is very critical to continue the research and education activities.« less

Periodic shock-emission from acoustically driven cavitation clouds: a source of the subharmonic signal.

PubMed

Johnston, Keith; Tapia-Siles, Cecilia; Gerold, Bjoern; Postema, Michiel; Cochran, Sandy; Cuschieri, Alfred; Prentice, Paul

2014-12-01

Single clouds of cavitation bubbles, driven by 254kHz focused ultrasound at pressure amplitudes in the range of 0.48-1.22MPa, have been observed via high-speed shadowgraphic imaging at 1×10(6) frames per second. Clouds underwent repetitive growth, oscillation and collapse (GOC) cycles, with shock-waves emitted periodically at the instant of collapse during each cycle. The frequency of cloud collapse, and coincident shock-emission, was primarily dependent on the intensity of the focused ultrasound driving the activity. The lowest peak-to-peak pressure amplitude of 0.48MPa generated shock-waves with an average period of 7.9±0.5μs, corresponding to a frequency of f0/2, half-harmonic to the fundamental driving. Increasing the intensity gave rise to GOC cycles and shock-emission periods of 11.8±0.3, 15.8±0.3, 19.8±0.2μs, at pressure amplitudes of 0.64, 0.92 and 1.22MPa, corresponding to the higher-order subharmonics of f0/3, f0/4 and f0/5, respectively. Parallel passive acoustic detection, filtered for the fundamental driving, revealed features that correlated temporally to the shock-emissions observed via high-speed imaging, p(two-tailed) < 0.01 (r=0.996, taken over all data). Subtracting the isolated acoustic shock profiles from the raw signal collected from the detector, demonstrated the removal of subharmonic spectral peaks, in the frequency domain. The larger cavitation clouds (>200μm diameter, at maximum inflation), that developed under insonations of peak-to-peak pressure amplitudes >1.0MPa, emitted shock-waves with two or more fronts suggesting non-uniform collapse of the cloud. The observations indicate that periodic shock-emissions from acoustically driven cavitation clouds provide a source for the cavitation subharmonic signal, and that shock structure may be used to study intra-cloud dynamics at sub-microsecond timescales. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Cavitation clouds created by shock scattering from bubbles during histotripsy

PubMed Central

Maxwell, Adam D.; Wang, Tzu-Yin; Cain, Charles A.; Fowlkes, J. Brian; Sapozhnikov, Oleg A.; Bailey, Michael R.; Xu, Zhen

2011-01-01

Histotripsy is a therapy that focuses short-duration, high-amplitude pulses of ultrasound to incite a localized cavitation cloud that mechanically breaks down tissue. To investigate the mechanism of cloud formation, high-speed photography was used to observe clouds generated during single histotripsy pulses. Pulses of 5−20 cycles duration were applied to a transparent tissue phantom by a 1-MHz spherically focused transducer. Clouds initiated from single cavitation bubbles that formed during the initial cycles of the pulse, and grew along the acoustic axis opposite the propagation direction. Based on these observations, we hypothesized that clouds form as a result of large negative pressure generated by the backscattering of shockwaves from a single bubble. The positive-pressure phase of the wave inverts upon scattering and superimposes on the incident negative-pressure phase to create this negative pressure and cavitation. The process repeats with each cycle of the incident wave, and the bubble cloud elongates toward the transducer. Finite-amplitude propagation distorts the incident wave such that the peak-positive pressure is much greater than the peak-negative pressure, which exaggerates the effect. The hypothesis was tested with two modified incident waves that maintained negative pressure but reduced the positive pressure amplitude. These waves suppressed cloud formation which supported the hypothesis. PMID:21973343

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception.

PubMed

Akbas, Alpaslan; Gulpinar, Murat Tolga; Sancak, Eyup Burak; Karakan, Tolga; Demirbas, Arif; Utangac, Mehmet Mazhar; Dede, Onur; Sancaktutar, Ahmet A; Simsek, Tuncer; Sahin, Basak; Resorlu, Berkan

2016-01-01

To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction. The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed. There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

Polymeric Cups for Cavitation-mediated Delivery of Oncolytic Vaccinia Virus

PubMed Central

Myers, Rachel; Coviello, Christian; Erbs, Philippe; Foloppe, Johann; Rowe, Cliff; Kwan, James; Crake, Calum; Finn, Seán; Jackson, Edward; Balloul, Jean-Marc; Story, Colin; Coussios, Constantin; Carlisle, Robert

2016-01-01

Oncolytic viruses (OV) could become the most powerful and selective cancer therapies. However, the limited transport of OV into and throughout tumors following intravenous injection means their clinical administration is often restricted to direct intratumoral dosing. Application of physical stimuli, such as focused ultrasound, offers a means of achieving enhanced mass transport. In particular, shockwaves and microstreaming resulting from the instigation of an ultrasound-induced event known as inertial cavitation can propel OV hundreds of microns. We have recently developed a polymeric cup formulation which, when delivered intravenously, provides the nuclei for instigation of sustained inertial cavitation events within tumors. Here we report that exposure of tumors to focused ultrasound after intravenous coinjection of cups and oncolytic vaccinia virus , leads to substantial and significant increases in activity. When cavitation was instigated within SKOV-3 or HepG2 xenografts, reporter gene expression from vaccinia virus was enhanced 1,000-fold (P < 0.0001) or 10,000-fold (P < 0.001), respectively. Similar increases in the number of vaccinia virus genomes recovered from tumors were also observed. In survival studies, the application of cup mediated cavitation to a vaccinia virus expressing a prodrug converting enzyme provided significant (P < 0.05) retardation of tumor growth. This technology could improve the clinical utility of all biological therapeutics including OV. PMID:27375160

Endovascular management of iatrogenic native renal arterial pseudoaneurysms.

PubMed

Sildiroglu, Onur; Saad, Wael E; Hagspiel, Klaus D; Matsumoto, Alan H; Turba, Ulku Cenk

2012-12-01

Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes. This retrospective study (2003-2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24-68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography. We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n = 3), surgery (n = 3), percutaneous nephrolithotomy (n = 1), and endoscopic shock-wave lithotripsy (n = 1). In six patients, the pseudoaneurysms were small-sized (<20 mm) and peripherally located and were treated solely with coil embolization (n = 5). In one patient, coil embolization was preceded by embolization with 500-700 micron embospheres to control active bleeding. The remaining two patients had large-sized (≥50 mm), centrally located renal pseudoaneurysms treated with thrombin ± coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1-67) months). Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.

Electromagnetic and Electrohydraulic Shock Wave Lithotripsy-Induced Urothelial Damage: Is There a Difference?

PubMed

Mustafa, Mahmoud; Aburas, Honood; Helo, Fatima M; Qarawi, Lailah

2017-02-01

To evaluate and compare the acute effect of electromagnetic and electrohydraulic extracorporeal shockwave lithotripsy (SWL) on the urothelial layers of kidney and ureter. Fifty patients, 29 males (58%) and 21 females (42%), with an average age of 51.68 years (range: 37-70) who underwent SWL application in two different centers were included. Twenty-eight patients (56%) were treated with electrohydraulic and 22 (44%) were treated with electromagnetic lithotripsy. Urinary cytologic examinations were done immediately before and after SWL therapy and 10 days later. The average numbers of epithelial cells, red blood cells (RBC), and myocytes were counted under 40 × magnification. There were significant differences in the number of epithelial cells and RBC before and after immediate application of SWL: 1.66 and 14.9 cells/field, (p = 0.001), 5.44 and 113.45 cells/field, respectively (p = 0.001). The number of RBC was significantly higher in patients treated with electromagnetic lithotripsy than those treated with electrohydraulic: 141.9 and 93.4 cells/field, respectively (p = 0.02). No myocyte or basement membrane elements were detected in any of the cytologic examinations. Cytologic examinations done after 10 days of SWL therapy revealed recovery of all abnormal cytologic findings. The acute increments in the number of epithelial cells and RBC after SWL were statistically significant but it was not permanent. SWL-induced urinary urothelial lesion is limited to the mucosal layer and there was no evidence of damage to the basal membrane or muscle layer. Electromagnetic lithotripsy caused high numbers of RBC than the electrohydraulic device on the postimmediate urine cytologic examination.

Understanding and Predicting Shockwave and Turbulent Boundary Layer Interactions

DTIC Science & Technology

2008-11-30

Rayleigh scattering measurements using a MHz rate pulse - burst laser system," AIAA Paper 1997-0500. 33. Lesieur, M., and Metais, O. (1996) "New... Beresh , Clemens, & Dolling, 2002; Ganapathisubramani, Clemens & Dolling, 2007) and (b) the downstream separated flow (Thomas, Putnam & Chu, 1994...large eddy simulation," AIAA Paper 1980-1357. 5. Beresh , S.J., Clemens, N.T., and Dolling, D.S. (2002) "Relationship between upstream turbulent

Initial Results from the Variable Intensity Sonic Boom Database

NASA Technical Reports Server (NTRS)

Haering, Edward A., Jr.; Cliatt, Larry J., II; Gabrielson, Thomas; Sparrow, Victor W.; Locey, Lance L.; Bunce, Thomas J.

2008-01-01

43 sonic booms generated (a few were evanescent waves) a) Overpressures of 0.08 to 2.20 lbf/sq ft; b) Rise-times of about 0.7 to 50 ms. Objectives: a) Structural response of a house of modern construction; b) Sonic boom propagation code validation. Approach: a) Measure shockwave directionality; b) Determine effect of height above ground on acoustic level; c) Generate atmospheric turbulence filter functions.

Probe Beam Deflection Optical Imaging of Thermal and mechanical Phenomena Resulting from Nanosecond Electric Pulse (nsEP) Exposure In-Vitro

DTIC Science & Technology

of plasma membranes of eukaryotic cells in vitro and in vivo. The physical to biological driving mechanisms behind nanoporation still remain unclear...but could be a result of a multitude of stimuli, including mechanical (shockwaves, electrode formation), thermal, and electrical (ion transport...channel gating). Experimentally quantifying and characterizing mechanical fields with piezoelectric transducers proves difficult due to electromagnetic

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.

Consistent Temperature Coupling with Thermal Fluctuations of Smooth Particle Hydrodynamics and Molecular Dynamics

PubMed Central

Ganzenmüller, Georg C.; Hiermaier, Stefan; Steinhauser, Martin O.

2012-01-01

We propose a thermodynamically consistent and energy-conserving temperature coupling scheme between the atomistic and the continuum domain. The coupling scheme links the two domains using the DPDE (Dissipative Particle Dynamics at constant Energy) thermostat and is designed to handle strong temperature gradients across the atomistic/continuum domain interface. The fundamentally different definitions of temperature in the continuum and atomistic domain – internal energy and heat capacity versus particle velocity – are accounted for in a straightforward and conceptually intuitive way by the DPDE thermostat. We verify the here-proposed scheme using a fluid, which is simultaneously represented as a continuum using Smooth Particle Hydrodynamics, and as an atomistically resolved liquid using Molecular Dynamics. In the case of equilibrium contact between both domains, we show that the correct microscopic equilibrium properties of the atomistic fluid are obtained. As an example of a strong non-equilibrium situation, we consider the propagation of a steady shock-wave from the continuum domain into the atomistic domain, and show that the coupling scheme conserves both energy and shock-wave dynamics. To demonstrate the applicability of our scheme to real systems, we consider shock loading of a phospholipid bilayer immersed in water in a multi-scale simulation, an interesting topic of biological relevance. PMID:23300586

Modelling Dynamic Behaviour and Spall Failure of Aluminium Alloy AA7010

NASA Astrophysics Data System (ADS)

Ma'at, N.; Nor, M. K. Mohd; Ismail, A. E.; Kamarudin, K. A.; Jamian, S.; Ibrahim, M. N.; Awang, M. K.

2017-10-01

A finite strain constitutive model to predict the dynamic deformation behaviour of Aluminium Alloy 7010 including shockwaves and spall failure is developed in this work. The important feature of this newly hyperelastic-plastic constitutive formulation is a new Mandel stress tensor formulated using new generalized orthotropic pressure. This tensor is combined with a shock equation of state (EOS) and Grady spall failure. The Hill’s yield criterion is adopted to characterize plastic orthotropy by means of the evolving structural tensors that is defined in the isoclinic configuration. This material model was developed and integration into elastic and plastic parts. The elastic anisotropy is taken into account through the newly stress tensor decomposition of a generalized orthotropic pressure. Plastic anisotropy is considered through yield surface and an isotropic hardening defined in a unique alignment of deviatoric plane within the stress space. To test its ability to describe shockwave propagation and spall failure, the new material model was implemented into the LLNL-DYNA3D code of UTHM’s. The capability of this newly constitutive model were compared against published experimental data of Plate Impact Test at 234m/s, 450m/s and 895m/s impact velocities. A good agreement is obtained between experimental and simulation in each test.

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.

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.

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.

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

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

Delay-and-sum beamforming for direction of arrival estimation applied to gunshot acoustics

NASA Astrophysics Data System (ADS)

Ramos, António L. L.; Holm, Sverre; Gudvangen, Sigmund; Otterlei, Ragnvald

2011-06-01

Sniper positioning systems described in the literature use a two-step algorithm to estimate the sniper's location. First, the shockwave and the muzzle blast acoustic signatures must be detected and recognized, followed by an estimation of their respective direction-of-arrival (DOA). Second, the actual sniper's position is calculated based on the estimated DOA via an iterative algorithm that varies from system to system. The overall performance of such a system, however, is highly compromised when the first step is not carried out successfully. Currently available systems rely on a simple calculation of differences of time-of-arrival to estimate angles-of-arrival. This approach, however, lacks robustness by not taking full advantage of the array of sensors. This paper shows how the delay-and-sum beamforming technique can be applied to estimate the DOA for both the shockwave and the muzzle blast. The method has the twofold advantage of 1) adding an array gain of 10 logM, i.e., an increased SNR of 6 dB for a 4-microphone array, which is equivalent to doubling the detection range assuming free-field propagation; and 2) offering improved robustness in handling single- and multi-shots events as well as reflections by taking advantage of the spatial filtering capability.

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.

The multipath propagation effect in gunshot acoustics and its impact on the design of sniper positioning systems

NASA Astrophysics Data System (ADS)

Ramos, António L. L.; Holm, Sverre; Gudvangen, Sigmund; Otterlei, Ragnvald

2013-06-01

Counter sniper systems rely on the detection and parameter estimation of the shockwave and the muzzle blast in order to determine the sniper location. In real-world situations, these acoustical signals can be disturbed by natural phenomena like weather and climate conditions, multipath propagation effect, and background noise. While some of these issues have received some attention in recent publications with application to gunshot acoustics, the multipath propagation phenomenon whose effect can not be neglected, specially in urban environments, has not yet been discussed in details in the technical literature in the same context. Propagating sound waves can be reflected at the boundaries in the vicinity of sound sources or receivers, whenever there is a difference in acoustical impedance between the reflective material and the air. Therefore, the received signal can be composed of a direct-path signal plus N scaled delayed copies of that signal. This paper presents a discussion on the multipath propagation effect and its impact on the performance and reliability of sniper positioning systems. In our formulation, propagation models for both the shockwave and the muzzle blast are considered and analyzed. Conclusions following the theoretical analysis of the problem are fully supported by actual gunshots acoustical signatures.

A multi-band spectral subtraction-based algorithm for real-time noise cancellation applied to gunshot acoustics

NASA Astrophysics Data System (ADS)

Ramos, António L. L.; Holm, Sverre; Gudvangen, Sigmund; Otterlei, Ragnvald

2013-06-01

Acoustical sniper positioning is based on the detection and direction-of-arrival estimation of the shockwave and the muzzle blast acoustical signals. In real-life situations, the detection and direction-of-arrival estimation processes is usually performed under the influence of background noise sources, e.g., vehicles noise, and might result in non-negligible inaccuracies than can affect the system performance and reliability negatively, specially when detecting the muzzle sound under long range distance and absorbing terrains. This paper introduces a multi-band spectral subtraction based algorithm for real-time noise reduction, applied to gunshot acoustical signals. The ballistic shockwave and the muzzle blast signals exhibit distinct frequency contents that are affected differently by additive noise. In most real situations, the noise component is colored and a multi-band spectral subtraction approach for noise reduction contributes to reducing the presence of artifacts in denoised signals. The proposed algorithm is tested using a dataset generated by combining signals from real gunshots and real vehicle noise. The noise component was generated using a steel tracked military tank running on asphalt and includes, therefore, the sound from the vehicle engine, which varies slightly in frequency over time according to the engine's rpm, and the sound from the steel tracks as the vehicle moves.

Micron-scale Reactive Atomistic Simulation of Void Collapse and Hotspot Growth in PETN

NASA Astrophysics Data System (ADS)

Thompson, Aidan; Shan, Tzu-Ray; Wixom, Ryan

2015-06-01

Material defects and other heterogeneities such as dislocations, micro-porosity, and grain boundaries play key roles in the shock-induced initiation of detonation in energetic materials. We performed non-equilibrium molecular dynamics simulations to explore the effect of nanoscale voids on hotspot growth and initiation in micron-scale pentaerythritol tetranitrate (PETN) crystals under weak shock loading (Up = 1.25 km/s; Us = 4.5 km/s). We used the ReaxFF potential implemented in LAMMPS. We built a pseudo-2D PETN crystal with dimensions 0.3 μm × 0.22 μm × 1.3 nm containing a 20 nm cylindrical void. Once the initial shockwave traversed the entire sample, the shock-front absorbing boundary condition was applied, allowing the simulation to continue beyond 1 nanosecond. Results show an exponentially increasing hotspot growth rate. The hotspot morphology is initially symmetric about the void axis, but strong asymmetry develops at later times, due to strong coupling between exothermic chemistry, temperature, and divergent secondary shockwaves emanating from the collapsing void. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. DOE National Nuclear Security Administration under Contract DE-AC04-94AL85000.

Molecular-dynamic simulations of the thermophysical properties of hexanitrohexaazaisowurtzitane single crystal at high pressures and temperatures

NASA Astrophysics Data System (ADS)

Kozlova, S. A.; Gubin, S. A.; Maklashova, I. V.; Selezenev, A. A.

2017-11-01

Molecular dynamic simulations of isothermal compression parameters are performed for a hexanitrohexaazaisowurtzitane single crystal (C6H6O12N12) using a modified ReaxFF-log reactive force field. It is shown that the pressure-compression ratio curve for a single C6H6O12N12 crystal at constant temperature T = 300 K in pressure range P = 0.05-40 GPa is in satisfactory agreement with experimental compression isotherms obtained for a single C6H6O12N12 crystal. Hugoniot molecular-dynamic simulations of the shock-wave hydrostatic compression of a single C6H6O12N12 crystal are performed. Along with Hugoniot temperature-pressure curves, calculated shock-wave pressure-compression ratios for a single C6H6O12N12 crystal are obtained for a wide pressure range of P = 1-40 GPa. It is established that the percussive adiabat obtained for a single C6H6O12N12 crystal is in a good agreement with the experimental data. All calculations are performed using a LAMMPS molecular dynamics simulation software package that provides a ReaxFF-lg reactive force field to support the approach.

Shock Interaction with Random Spherical Particle Beds

NASA Astrophysics Data System (ADS)

Neal, Chris; Mehta, Yash; Salari, Kambiz; Jackson, Thomas L.; Balachandar, S. "Bala"; Thakur, Siddharth

2016-11-01

In this talk we present results on fully resolved simulations of shock interaction with randomly distributed bed of particles. Multiple simulations were carried out by varying the number of particles to isolate the effect of volume fraction. Major focus of these simulations was to understand 1) the effect of the shockwave and volume fraction on the forces experienced by the particles, 2) the effect of particles on the shock wave, and 3) fluid mediated particle-particle interactions. Peak drag force for particles at different volume fractions show a downward trend as the depth of the bed increased. This can be attributed to dissipation of energy as the shockwave travels through the bed of particles. One of the fascinating observations from these simulations was the fluctuations in different quantities due to presence of multiple particles and their random distribution. These are large simulations with hundreds of particles resulting in large amount of data. We present statistical analysis of the data and make relevant observations. Average pressure in the computational domain is computed to characterize the strengths of the reflected and transmitted waves. We also present flow field contour plots to support our observations. U.S. Department of Energy, National Nuclear Security Administration, Advanced Simulation and Computing Program, as a Cooperative Agreement under the Predictive Science Academic Alliance Program, under Contract No. DE-NA0002378.

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.

Development of Photon Doppler Velocimeter for Explosives Research

DTIC Science & Technology

2013-01-01

free surface of the steel plate as a rarefaction wave. This rarefaction wave pulls back the particles of the metal plate which manifests itself in the...reduction of the free surface velocity by ∆ufs in Figure 12. The rarefaction wave interacts with the still oncoming rarefaction wave behind the...material stipulates that the shockwave consists of the region where the pressure suddenly rises, and a release, or rarefaction behind the peak pressure

NASA Test Flights Examine Effect of Atmospheric Turbulence on Sonic Booms

NASA Image and Video Library

2016-07-20

NASA’s SonicBAT team poses in front of the TG-14 motor glider and F/A-18 research aircraft, sitting side-by-side in front of Rogers Dry Lake prior to a SonicBAT flight at Armstrong Flight Research Center on Edwards Air Force Base, California. The TG-14 collected sound signatures of shockwaves created by the F/A-18, to compare with signatures collected on the ground.

Molecular-level Simulations of Shock Generation and Propagation in Polyurea

DTIC Science & Technology

2011-01-26

homepage: www.e lsev ier .com/ locate /msea Molecular-level simulations of shock generation and propagation in polyurea M. Grujicica,∗, B. Pandurangana... Polyurea Shock-wave generation and propagation Molecular-level calculations a b s t r a c t A non-equilibrium molecular dynamics method is employed in order...to study various phenomena accompanying the generation and propagation of shock waves in polyurea (a micro-phase segregated elastomer). Several

Impact factor for high-energy two and three jets diffractive production

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

Boussarie, R.; Grabovsky, A.V.; Szymanowski, L.

2015-04-10

We present the calculation of the impact factor for the photon to quark, antiquark and gluon transition within Balitsky’s shock-wave formalism. We also rederive the impact factor for photon to quark and antiquark transition. These results provide the necessary building blocks for further phenomenological studies of inclusive diffractive deep inelastic scattering as well as for two and three jets diffractive production which go beyond approximations discussed in the literature.

Blast-Induced Acceleration in a Shock Tube: Distinguishing Primary and Tertiary Blast Injury

DTIC Science & Technology

2016-10-01

objects of varied areal densities to define relations of blast flow conditions to acceleration and displacement , we have begun examination of the effects... displacement from other biomechanical components and effects of the shockwave. 15. SUBJECT TERMS Key words or phrases identifying major concepts in the...and total pressure, positive phase duration, and impulse) and acceleration and displacement of a wide range of inanimate objects, we have continued

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.

Shock-Wave Boundary Layer Interactions

DTIC Science & Technology

1986-02-01

Security Classification of Document UNCLASSIFIED 6. Title TURBULENT SHOCK-WAVE/BOUNDARY-LAYER INTERACTION 7. Presented at 8. Author(s)/Editor(s...contrary effects. The above demonstration puts an emphasis on inertia forces in the sense that the "fullness" for the Incoming boundary-layer profile is...expression "quasi-normal" means that in most transonic streams, the shocks are strong oblique shock, in the sense of the strong solution of the oblique shock

Ideal gas behavior of a strongly coupled complex (dusty) plasma.

PubMed

Oxtoby, Neil P; Griffith, Elias J; Durniak, Céline; Ralph, Jason F; Samsonov, Dmitry

2013-07-05

In a laboratory, a two-dimensional complex (dusty) plasma consists of a low-density ionized gas containing a confined suspension of Yukawa-coupled plastic microspheres. For an initial crystal-like form, we report ideal gas behavior in this strongly coupled system during shock-wave experiments. This evidence supports the use of the ideal gas law as the equation of state for soft crystals such as those formed by dusty plasmas.

Hazards and Possibilities of Optical Breakdown Effects Below the Threshold for Shockwave and Bubble Formation

DTIC Science & Technology

2006-07-01

precision of the determination of Rmax, we established a refined method based on the model of bubble formation described above in section 3.6.1 and the...development can be modeled by hydrodynamic codes based on tabulated equation-of-state data . This has previously demonstrated on ps optical breakdown...per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and

A detonation wave in the system liquid-gas bubbles

NASA Astrophysics Data System (ADS)

Sychev, A. I.

1985-06-01

The shock-wave ignition of a system consisting of a liquid (H2O) and bubbles of an explosive gas mixture (C2H2+2.5O2) is investigated experimentally and analytically. The possibility of the existence of a detonation wave, a supersonic self-sustaining process, in a gas-liquid system is demonstrated. The conditions for the existence of a detonation wave are determined, and the initiation mechanism is analyzed.

The sequential changes in myocardial thickness and thickening which occur during acute transmural infarction, infarct reperfusion and the resultant expression of reperfusion injury.

PubMed

Turschner, Oliver; D'hooge, Jan; Dommke, Christoph; Claus, Piet; Verbeken, Erik; De Scheerder, Ivan; Bijnens, Bart; Sutherland, George R

2004-05-01

Successful primary PTCA (with TIMI 3 reflow) in patients with acute transmural infarction has been observed to result in an immediate abnormal increase in wall thickness associated with persisting abnormal post-systolic thickening. To understand the sequential changes in regional deformation during: (i) the development of acute transmural infarction, (ii) upon TIMI grade 3 infarct reperfusion and (iii) during the subsequent expression of reperfusion injury the following correlative experimental study was performed in a pure animal model in which there was no distal dispersion of thrombotic material causing either no reflow or secondary microvascular obstruction. In 10 closed-chest pigs, a 90 min PTCA circumflex occlusion was used to induce a transmural infarction. This was followed by 60 min of TIMI 3 infarct reperfusion. M-mode ultrasound data from the "at risk" posterior wall infarct segment and from a control remote non-ischemic septal segment were acquired at standardized time intervals. Changes in regional deformation (end-diastolic (EDWT), end-systolic (ESWT) and post-systolic (PSWT) wall thickness, end-systolic strain (epsilonES) and post-systolic strain (epsilonps)) were measured. In this pure animal model of acute transmural infarction/infarct reperfusion (with no pre-existing intra-luminal thrombus), the induced changes in wall thickness and thickening were complex. During prolonged occlusion, after an initial acute fall in ESWT, there was no further change in systolic deformation to indicate the progression of ischaemia to infarction. Both transmurally infarcted and reperfused-infarcted myocardium retained post-systolic thickening indicating that this parameter, taken in isolation, is not a consistent marker of segmental viability and, in this regard, should be interpreted only in combination with other indices of segmental function. The most striking abnormality induced by reperfusion was an immediate increase in EDWT which then increased logarithmically over a 60 min period as reperfusion injury was further expressed. PS did not change significantly during reperfusion. Histology confirmed the wall thickness changes on reperfusion to be due to massive extra-cellular oedema. The identification of an acute increase in regional wall thickness in a reperfused infarct zone by cardiac ultrasound following primary PTCA might be used in patients to both identify successful infarct reperfusion and to monitor the presence, extent and resolution of the oedema associated with reperfusion injury.

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 the shallow water equations, J. Comput. Phys. 290 (2015) 188-218. A. Navas-Montilla, J. Murillo, Asymptotically and exactly energy balanced augmented flux-ADER schemes with application to hyperbolic conservation laws with geometric source terms, J. Comput. Phys. 317 (2016) 108-147. J. Murillo and A. Navas-Montilla, A comprehensive explanation and exercise of the source terms in hyperbolic systems using Roe type solutions. Application to the 1D-2D shallow water equations, Advances in Water Resources {98} (2016) 70-96.

Calculation of external-internal flow fields for mixed-compression inlets

NASA Technical Reports Server (NTRS)

Chyu, W. J.; Kawamura, T.; Bencze, D. P.

1986-01-01

Supersonic inlet flows with mixed external-internal compressions were computed using a combined implicit-explicit (Beam-Warming-Steger/MacCormack) method for solving the three-dimensional unsteady, compressible Navier-Stokes equations in conservation form. Numerical calculations were made of various flows related to such inlet operations as the shock-wave intersections, subsonic spillage around the cowl lip, and inlet started versus unstarted conditions. Some of the computed results were compared with wind tunnel data.

Calculation of external-internal flow fields for mixed-compression inlets

NASA Technical Reports Server (NTRS)

Chyu, W. J.; Kawamura, T.; Bencze, D. P.

1987-01-01

Supersonic inlet flows with mixed external-internal compressions were computed using a combined implicit-explicit (Beam-Warming-Steger/MacCormack) method for solving the three-dimensional unsteady, compressible Navier-Stokes equations in conservation form. Numerical calculations were made of various flows related to such inlet operations as the shock-wave intersections, subsonic spillage around the cowl lip, and inlet started versus unstarted conditions. Some of the computed results were compared with wind tunnel data.

Transurethral ultrasonic ureterolithotripsy using a solid-wire probe.

PubMed

Chaussy, C; Fuchs, G; Kahn, R; Hunter, P; Goodfriend, R

1987-05-01

A multicenter study evaluates a new technique for transurethral ultrasonic ureterolithotripsy utilizing a solid-wire probe. The transverse vibrations of the probe cause greater stone disintegration. A small ureteroscope is used and a basket is not required. There was a 96.6 per cent success rate in 118 cases. This technique has significantly improved ultrasonic lithotripsy. It has proved to be useful for upper ureteral stones not amenable to extracorporeal shock-wave lithotripsy and lower ureteral stones including "steinstrasse."