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Sample records for shockwave treatment compared

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

    PubMed

    van der Worp, Henk; Zwerver, Johannes; van den Akker-Scheek, Inge; Diercks, Ron L

    2011-10-11

    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. 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. The TOPSHOCK study is the first randomised controlled trial that

  2. 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

  3. Comparative effectiveness of autologous blood-derived products, shock-wave therapy and corticosteroids for treatment of plantar fasciitis: a network meta-analysis.

    PubMed

    Hsiao, Ming-Yen; Hung, Chen-Yu; Chang, Ke-Vin; Chien, Kuo-Liong; Tu, Yu-Kang; Wang, Tyng-Guey

    2015-09-01

    To compare the efficacy of autologous blood-derived products (ABPs), CSs and shock-wave (SW) therapy in the treatment of plantar fasciitis. Electronic databases were searched for studies that compared ABPs, CSs and SW therapy for the treatment of plantar fasciitis, published up to June 2014. The primary and secondary outcomes were reduction in visual analogue scale (VAS) score at 3 and 6 months and odds ratio of treatment success, respectively. Groups were compared by traditional pair-wise meta-analysis and by network meta-analysis. Seven randomized controlled trials and three quasi-experimental studies that included 604 patients were enrolled. Pair-wise meta-analysis indicated a trend favouring ABPs over CSs regarding VAS reduction at 3 months; this benefit was significant in a subgroup analysis of platelet-rich plasma (PRP) vs CSs. There were no significant between-group differences in VAS reduction at 6 months and in treatment success. Network meta-analysis showed that ABPs had the highest probability of being the best treatment at 3 months, but ABPs were slightly inferior to SW for VAS reduction at 6 months. Although SW therapy had the highest likelihood of treatment success, the between-group differences in probabilities were less remarkable than those for pain reduction at 3 and 6 months. ABPs, followed by CSs, were best in providing relief from pain at 3 months. SW therapy and ABPs had similar probabilities of providing pain relief at 6 months, and were better than CSs at that time. Subgroup analysis indicated that an ABP regimen consisting of platelet-rich plasma improves treatment efficacy. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions.

    PubMed

    Cacchio, Angelo; Giordano, Lucio; Colafarina, Olivo; Rompe, Jan D; Tavernese, Emanuela; Ioppolo, Francesco; Flamini, Stefano; Spacca, Giorgio; Santilli, Valter

    2009-11-01

    The authors of several studies have recommended extracorporeal shock-wave therapy as an alternative to surgical treatment for long-bone nonunions. This study was performed to compare the results of extracorporeal shock-wave therapy produced by two different devices with those of surgical treatment in the management of long-bone nonunions. One hundred and twenty-six patients with a long-bone nonunion were randomly assigned to receive either extracorporeal shock-wave therapy (Groups 1 and 2) or surgical treatment (Group 3). The patients in the shock-wave groups received four treatments with 4000 impulses of shock waves with an energy flux density of 0.40 mJ/mm(2) (Group 1) or 0.70 mJ/mm(2) (Group 2). The patients in the three groups had similar demographic characteristics, durations of nonunion, and durations of follow-up. Radiographic results (the primary outcome) and clinical results (the secondary outcomes) were determined before and three, six, twelve, and twenty-four months after treatment. The radiographic findings did not differ among the three groups of patients. At six months, 70% of the nonunions in Group 1, 71% of the nonunions in Group 2, and 73% of the nonunions in Group 3 had healed. Three and six months after treatment, the clinical outcomes in the two shock-wave groups were significantly better than those in the surgical group (p < 0.001). However, at both twelve and twenty-four months after treatment, there were no differences among the three groups, with the exception of the DASH score, which differed significantly between Groups 1 and 3 (p = 0.038) and between Groups 2 and 3 (p = 0.021) at twelve months. Extracorporeal shock-wave therapy is as effective as surgery in stimulating union of long-bone hypertrophic nonunions and yields better short-term clinical outcomes.

  5. Extracorporeal shockwave treatment for chronic diabetic foot ulcers.

    PubMed

    Wang, Ching-Jen; Kuo, Yur-Ren; Wu, Re-Wen; Liu, Rue-Tsuan; Hsu, Chi-Shiung; Wang, Feng-Sheng; Yang, Kuender D

    2009-03-01

    This prospective study compared extracorporeal shockwave treatment (ESWT) with hyperbaric oxygen therapy (HBO) in chronic diabetic foot ulcers. Seventy-two patients with 72 chronic diabetic foot ulcers were randomly divided into two groups of similar demographics with 34 patients with 36 ulcers in the ESWT group and 36 patients with 36 ulcers in the HBO group. Patients in the ESWT group received 300 + 100/cm(2) impulses of shockwave at 0.11 mJ/cm(2) energy flux density every 2 wk for 6 wk, whereas patients in the HBO group received HBO daily for 20 treatments. The evaluations included clinical assessment of the ulcers with photo-documentation, blood flow perfusion scan, bacteriological examination, histological study, and immunohistochemical analysis. The overall results showed completely healed in 31%, improved in 58%, and unchanged in 11% for the ESWT group and 22% completely healed, 50% improved, and 28% unchanged for the HBO group. The ESWT group showed significantly better clinical results and local blood flow perfusion, higher cell concentration, and activity than the HBO group. On immunohistochemical analysis, the ESWT group demonstrated significant increases in endothelial nitric oxide synthase, vessel endothelial growth factor, and proliferation cell nuclear antigen expressions and a decrease in transference-mediated digoxigenin-deoxy-UTP nick end-labeling expression than the HBO group. ESWT appears to be more effective than HBO in chronic diabetic foot ulcers.

  6. 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

  7. Is extracorporeal shockwave lithotripsy suitable treatment for lower ureteric stones?

    PubMed

    Cole, R S; Shuttleworth, K E

    1988-12-01

    Forty patients with lower ureteric calculi for which intervention was considered desirable have been treated by in situ extracorporeal shockwave lithotripsy (ESWL) on the Dornier HM3 Lithotripter using a modified technique. Stone localisation was satisfactory in all patients. Adequate disintegration was achieved in 90% of patients following one treatment; 34 patients have been followed up for at least 3 months and 27 of these are stone-free (79%). Treatment failed in 4 patients and 2 of these had dense lower ureteric stone streets as a result of previous ESWL. The retreatment rate, post-treatment auxiliary procedure rate and complication rate were minimal. It was concluded that in situ ESWL is an effective and safe method for treating certain selected lower ureteric stones and should be considered as a feasible alternative to the more conventional methods of treatment.

  8. Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome.

    PubMed

    Weckström, Kristoffer; Söderström, Johan

    2016-01-01

    Although different conservative treatment options have been proposed, there is a paucity of research on the management of iliotibial band syndrome (ITBS) in runners. To compare two treatment protocols for ITBS; radial shockwave therapy (RSWT) and manual therapy (ManT). Both therapies were administered concurrently with an exercise rehabilitation programme. The study was designed as a randomised controlled clinical trial. Twenty-four runners with ITBS received 3 treatments at weekly intervals of either RSWT (n= 11) or ManT (n= 13). In addition, all subjects followed an exercise programme for at least 4 weeks. Main outcome measures were established as mean differences (MD) in pain during treadmill running. There was no significant difference in pain reduction between the two interventions at 4 weeks (p= 0.796), and 8 weeks (p= 0.155) follow-up. Thus, both groups reported similar magnitude of reduced pain during the intervention (p= 0.864). The shockwave therapy (SWT) group reported a 51% decrease in pain at week 4 (p= 0.022), and a 75% decrease at week 8 (p= 0.004). The ManT group showed a 61% reduction in pain at week 4 (p= 0.059), and a 56% reduction at week 8 (p= 0.067). RSWT and ManT were equally effective in reducing pain in subjects with ITBS.

  9. Side effects of high-energy shockwaves in the human kidney: first experience with model comparing two shockwave sources.

    PubMed

    Roessler, W; Wieland, W F; Steinbach, P; Hofstaedter, F; Thüroff, S; Chaussy, C

    1996-12-01

    The side effects of high-energy shockwaves (HESW) from two different sources on kidney parenchyma obtained from 10 patients treated by radical nephrectomy for renal cell carcinoma were examined. Immediately after nephrectomy, the kidneys were perfused with cold HTK solution and kept in hypothermia (8 degrees C) for a maximum of 4 hours. In five cases, the tumor-free parenchyma was treated at the upper or lower renal pole with 2000 shocks, energy output 21 kV, in an experimental electromagnetic shockwave system (Siemens Co., Erlangen). In the other five cases, the upper or lower poles were treated with 2000 shocks, energy output 24 kV, in an electrohydraulic spark gap system (MFL 5000; Dornier Medizintechnik, Germering). The resulting tissue defects were analyzed by histologic examinations. Changes after treatment with the electromagnetic system were found mainly in the tubules and midsized blood vessels in a well-defined focal area. Treatment with the electrohydraulic system was followed by tubular and glomerular lesions combined with vessel defects in a patchy pattern. The model is able to define the side effects of HESW in the human kidney and to test the side effects of different lithotripters.

  10. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature☆

    PubMed Central

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed. PMID:26229889

  11. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature.

    PubMed

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed.

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

    PubMed

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

    2017-04-12

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

  13. Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid.

    PubMed

    Notarnicola, A; Moretti, L; Tafuri, S; Gigliotti, S; Russo, S; Musci, L; Moretti, B

    2010-08-01

    The peculiar anatomical characteristics and precarious vascularization of the carpal scaphoid are responsible for a difficult healing of fractures and a fairly frequent subsequent evolution to pseudoarthrosis. Recently, extracorporeal shockwaves therapy (ESWT) has yielded encouraging results in the treatment of pseudoarthrosis of various bone segments. We report a retrospective study comparing the results of application of three sessions of shockwaves therapy (SW) with energy flux density (EFD) impulses of 0.09 (SD = 0.02) mJ/mm(2) ESWT emitted by an electromagnetic generator in 58 patients (group I) affected by pseudoarthrosis of the carpal scaphoid, with the results of surgical treatment consisting of stabilization and bone graft according to the Matti-Russe technique, performed in 60 subjects (controls, group II). There were no statistically significant differences in the mean duration of the pseudoarthrosis (p = 0.46), sex distribution (p = 0.41) and mean age at recruitment (p = 0.95) between the two patient groups. Posttreatment clinical-functional assessment, based on the Mayo Wrist Score, showed a significantly improved score, rising from 28-74.6 in group I already after 2 mo (p < 0.001), with 86.3% of the results judged as satisfactory or excellent; in group II the mean score rose from 27.5-74.2 after 2 mo, with 83.4% of the results judged as satisfactory or excellent (p < 0.001). At the same two-months follow-up (FU), radiographic consolidation was shown in 75.9% of patients in group I and 76.7% in group II. These improvements persisted at the subsequent controls at six and 12 mo in both groups. The Mayo Wrist Score and X-rays did not show statistically significant differences at the various FU visits in the two groups (p > 0.05). On the basis of our data, we can conclude that the results of ESWT are comparable with those of surgical stabilization and bone graft in the treatment of scaphoid pseudoarthrosis. In view of their minimal invasiveness, shockwaves

  14. [Trigger points - Diagnosis and treatment concepts with special reference to extracorporeal shockwaves].

    PubMed

    Gleitz, M; Hornig, K

    2012-02-01

    The 70-year-old trigger point theory has experienced a growing scientific confirmation and clinical significance as a consequence of recent muscle pain research. The trigger point pain formation is caused by high levels of vasoneuroactive substances. Depending on intensity and duration of the muscle stimulus the central pain processing is modified and leads to characteristic referred pain patterns. The most effective conventional forms of treatment are aimed at a direct mechanical manipulation of the trigger point as are new forms of therapy with focused and radial shockwaves. By using high pressures the focused shockwaves in particular are suitable to provoke local and referred pain and thus simplify the trigger point diagnosis. The empirically found therapeutic effect of shockwaves on muscles is hypothetical and can be explained in analogy with validated reactions of shockwaves in non-muscle tissues. Overall, the shockwave therapy on muscles represents a confirmation and extension of the existing trigger point therapy. It seems to be suitable for treating functional muscular disorders and myofascial pain syndromes within the locomotor system.

  15. Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

    PubMed Central

    Charig, C R; Webb, D R; Payne, S R; Wickham, J E

    1986-01-01

    This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life. PMID:3083922

  16. Extracorporeal shock-wave treatment for tennis elbow. A randomised double-blind study.

    PubMed

    Melikyan, E Y; Shahin, E; Miles, J; Bainbridge, L C

    2003-08-01

    The efficacy of extracorporeal shock-wave therapy for tennis elbow was investigated using a single fractionated dosage in a randomised, double-blind study. Outcomes were assessed using the Disabilities of Arm, Shoulder and Hand questionnaire, measurements of grip strength, levels of pain, analgesic usage and the rate of progression to surgery. Informed consent was obtained before patients were randomised to either the treatment or placebo group. In the final assessment, 74 patients (31 men and 43 women) with a mean age of 43.4 years (35 to 71), were included. None of the outcome measures showed a statistically significant difference between the treatment and control groups (p > 0.05). All patients improved significantly over time, regardless of treatment. Our study showed no evidence that extracorporeal shock-wave therapy for tennis elbow is better than placebo.

  17. 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

  18. Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy.

    PubMed Central

    Rickford, J. K.; Speedy, H. M.; Tytler, J. A.; Lim, M.

    1988-01-01

    The results of a prospective randomised evaluation of general anaesthesia (GA), epidural anaesthesia (EA) and spinal anaesthesia (SA) for extracorporeal shockwave lithotripsy are presented. GA provided speed and reliability but resulted in a high incidence of postoperative nausea, vomiting and sore throat. Both regional techniques conferred the advantages of an awake, cooperative patient, but EA required a longer preparation time than SA and more supplementary treatment with fentanyl or midazolam. A major drawback associated with the use of SA was a 42% incidence of postspinal headache. All three techniques were associated with hypotension on placement in the hoisl; bath immersion resulted in significant rises in blood pressure in the EA and SA groups and a more variable (overall non-significant) response in the GA group. PMID:3044238

  19. Treatment efficacy and outcomes using a third generation shockwave lithotripter.

    PubMed

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

    2013-11-01

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

  20. High-energy Extracorporeal Shock-Wave Therapy (ESWT) for the treatment of chronic plantar fasciitis.

    PubMed

    Metzner, Gerald; Dohnalek, Christian; Aigner, Elmar

    2010-09-01

    Few reports about the success of high-energy extracorporeal shock-wave therapy in cases of plantar fasciitis exist, even fewer about long-term results. This study investigated results of high-energy extracorporeal shock wave therapy applied to patients with recalcitrant plantar fasciitis. Ninety ESWT were applied to 63 patients (73 heels; 25 male and 38 female; average age 54 (29 to 77) years) from November 1999 to July 2003. All patients had plantar fasciitis for more than 6 months and failure of all non-surgical treatment for more than 3 months. A Dornier Lithotripter S, equipped with an electromagnetic shock-wave emitter was used. Routinely, 1000 shock wave impulses (frequency 2 per second, energy flux density (ED) 0.35 mJ/mm² at 10.5 kV, total dose 350 mJ/mm²) were applied per treatment. Followup was carried out 6 weeks after ESWT, then a second clinic evaluation and a final followup at an average of 73 months after ESWT by telephone. The success of ESWT, defined as a 30% VAS reduction, was seen in 81% at 6-week followup, at 88% at last clinic followup and in 96% at final phone followup. High-energy ESWT (0.35 mJ/mm²) was successful in the treatment of plantar fasciitis and the good short-term results seemed to be maintained over time.

  1. Ultrasound-guided, high-energy extracorporeal - shock-wave treatment of symptomatic calcareous tendinopathy of the shoulder.

    PubMed

    Jakobeit, Christian; Winiarski, Barbara; Jakobeit, Susanne; Welp, Lars; Spelsberg, Gerhard

    2002-07-01

    The objective of the present study was to test the effectiveness of ultrasound-guided high-energy extracorporeal shock-wave treatment in symptomatic chronic calcareous tendinopathy of the shoulder rotator cuff, and to assess the morphology of the hydroxyapatite deposits before and after this treatment. The study involved 80 patients who suffered from calcification of the rotator cuff. These patients were treated with an instrument with electromagnetic induction of shock-waves (Doli-Lithotripter, Dornier, Munich, Germany) under continuous ultrasound location of the treatment focus. The treatments were carried out in one to five sessions at an interval of 4-6 weeks. Each patient received a total of 1800 shock waves in each therapy. The flow density of the energy in the therapy focus was 0.08-0.42 mJ/mm2. Sixty-eight patients (85%) attained complete freedom from symptoms or only had minimal residual symptoms when stressing their shoulder joint. The calcification suffered by 57 (71.2%) patients was completely resorbed after treatment and partially resorbed in 16 patients (20%). Complete resorption of the calcareous deposits led to freedom from symptoms. In all patients with amorphous calcareous deposits, there was complete resorption of the calcification. Mixed calcareous foci were eliminated in 64.7-77% of the cases, depending on the extent of amorphous structures. Complete resorption was achieved in 44.4% of patients where homogeneous calcareous deposits were >1 cm in size. Shock-wave treatment in periarthritis of the shoulder is a new and very effective method for symptomatic calcareous tendinopathy. Extracorporeal shock-wave treatment has good prospects of success in any type of calcification. As a non-invasive technique with a high success rate, shock-wave treatment is an alternative to surgical operations in patients who remain symptomatic after exhaustive conservative treatment.

  2. 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

    2017-09-05

    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.

  3. Extracorporeal shockwave therapy shows a number of treatment related chondroprotective effect in osteoarthritis of the knee in rats

    PubMed Central

    2013-01-01

    Background Extracorporeal shockwave therapy (ESWT) shows chondroprotective effect in osteoarthritis of the rat knees. However, the ideal number of ESWT is unknown. This study investigated the effects of different numbers of ESWT in osteoarthritis of the knee in rats. Methods Forty-five male Sprague-Dawley rats were divided into five groups. Group I underwent sham arthrotomy without anterior cruciate ligament transection (ACLT) or medial meniscectomy (MM) and received no ESWT. Group II underwent ACLT + MM and received no ESWT. Group III underwent ACLT + MM, and received ESWT once a week for one treatment. Group IV underwent ACLT + MM and received ESWT twice a week for 2 treatments. Group V underwent ACLT + MM and received ESWT three times a week for 3 treatments. Each treatment consisted of 800 impulses of shockwave at 14 Kv to the medial tibia condyle. The evaluations included radiographs of the knee, histomorphological examination and immunohistochemical analysis at 12 weeks. Results At 12 weeks, group II and V showed more radiographic arthritis than groups I, III and IV. On histomorphological examination, the Safranin O matrix staining in groups III and IV are significantly better than in groups II and V, and the Mankin scores in groups III and IV are less than groups II and V. Groups III and IV showed significant decreases of Mankin score and increase of Safranin O stain as compared to group I. Group V showed significant increases of Mankin score and a decrease of Safranin O stain as compared to group II. In articular cartilage, group II showed significant increase of MMP13 and decrease of collagen II as compared to group I. Groups III and IV showed significant decrease of MMP13 and increase of collagen II as compared to group I. Group V showed significant increase of MMP13 and decrease of collagen II as compared to group II. In subchondral bone, vWF, VEGF, BMP-2 and osteocalcin significantly decreased in groups II and V, but increased in groups

  4. 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.

  5. SHOCK-WAVE THERAPY APPLICATION IN CLINICAL PRACTICE (REVIEW).

    PubMed

    Sheveleva, N; Minbayeva, L; Belyayeva, Y

    2016-03-01

    The article presents literature review on the use of extracorporeal shock-wave therapy in physiotherapeutic practice. The basic mechanisms of shock waves influence on the organism are spotlighted. Studies proving high efficacy of the method in treatment of wide variety of inflammatory diseases and traumatic genesis are presented. The data on comparative assessment of shock-wave therapy efficacy, and results of researches on possibility of extracorporeal shock-wave therapy effect potentiating in combination with other therapeutic methods are reflected. Recent years, the range of indications for shock-wave therapy application had been significantly widened. However, further study of the method is still relevant because mechanisms of action of the factor are studied insufficiently; methods of therapy parameters selection (energy flux density, number of pulses per treatment, duration of a course) are either advisory or empirical.

  6. 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).

  7. Lower calyceal and renal pelvic stones in preschool children: A comparative study of mini-percutaneous nephrolithotomy versus extracorporeal shockwave lithotripsy.

    PubMed

    ElSheemy, Mohammed S; Daw, Kareem; Habib, Enmar; Aboulela, Waseem; Fathy, Hesham; Shouman, Ahmed M; El Ghoneimy, Mohamed; Shoukry, Ahmed I; Morsi, Hany A; Badawy, Hesham

    2016-07-01

    To compare outcomes of the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy for lower calyceal and renal pelvic stones in preschool children. From January 2010 to December 2014, single renal pelvic or lower calyceal calculi 10-25 mm in size in children (age ≤6 years) treated by either extracorporeal shockwave lithotripsy (64 patients) or the mini-percutaneous nephrolithotripsy technique (54 patients) were included. Extracorporeal shockwave lithotripsy was carried out by using a Dornier electromagnetic lithotripter. The mini-percutaneous nephrolithotripsy technique was through 14-Fr renal access using a 9.5-Fr semirigid ureteroscope with holmium:yttrium aluminium garnet lithotripsy. The two study groups were compared using Mann-Whitney, χ(2) -test or Fisher's exact test. Stone parameters were similar in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups in all patients, and in the pelvic (39 Miniperc, 52 extracorporeal shockwave lithotripsy) and lower calyceal (15 Miniperc, 12 extracorporeal shockwave lithotripsy) subgroups. Stone-free rates in the mini-percutaneous nephrolithotripsy technique and extracorporeal shockwave lithotripsy groups were 88.9% versus 43.8% (P < 0.001) and 94.4% versus 81.2% (P = 0.032) after first and last sessions, respectively. In the renal pelvis, they were 87.2% versus 50% (P < 0.001) and 94.9% versus 84.6% (P = 0.179), whereas in the lower calyx, they were 93.3% versus 16.7% (P < 0.001) and 93.3% versus 66.7% (P = 0.139) after first and last sessions, respectively. Retreatment rates in the mini-percutaneous nephrolithotripsy technique versus extracorporeal shockwave lithotripsy were 7.4% versus 50% (P < 0.001), 7.7% versus 46.2% (P < 0.001), and 6.7% versus 66.7% (P = 0.003) in all patients, renal pelvic and lower calyceal stones, respectively. No significant difference was found in complications (P = 0.521). Auxiliary procedures were required in 9

  8. Laser induced shockwaves on flexible polymers for treatment of bacterial biofilms.

    PubMed

    Navarro, Artemio; Taylor, Zachary D; Beenhouwer, David; Haake, David A; Gupta, Vijay; Grundfest, Warren S

    2011-01-01

    Bacterial biofilm-related infections are a burden on the healthcare industry. The effect of laser generated shockwaves through polycarbonate, a flexible polymer, is explored for its ability to generate high peak stresses, and also for its ability to conform to complex wound surfaces. Shockwave pulses in Al coated polycarbonate substrates and a resulting peak stress of greater than 60 MPa was measured which should provide sufficient pressure to kill bacteria.

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

    PubMed Central

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

    2016-01-01

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

  10. 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.

  11. Original hypothesis: Extracorporeal shockwaves as a homeostatic autoimmune restorative treatment (HART) for Type 1 diabetes mellitus.

    PubMed

    Craig, Kenneth; d'Agostino, Cristina; Poratt, Daniel; Walker, Marjorie

    2014-09-01

    Mononuclear invasion of Langerhans islet and the ensuing insulitis triggers signal-transduction for the autoimmune mediated pancreatic beta-cell (β-cell) apoptosis that severely disrupts insulin production resulting in hyperglycemia associated with Type-1 diabetes (T1DM). Today extensive global research is being conducted to eliminate the need for insulin, and even prevent or find a cure for T1DM. The multifactorial combination of autoimmune dysfunction, Langerhans islet hypoxia, and bio-chemical disruption are seen to be contributory factors for β-cell destruction and the consequential disruption to insulin production. Regeneration of β-cells back to physiological levels may restore homeostatic insulin levels, reversing T1DM. Evidence suggests that there are still functioning pancreatic β-cells even in long standing T1DM providing the potential for their regeneration. Although the exact mechanism of extracorporeal shockwaves (ESW) is yet to be fully elucidated, it is seen to influence a complex spectrum of bio-chemical, cellular and neuronal functions (i.e. suppression of pro-inflammatory immune response, improved tissue hemodynamics, anti-microbial properties, and the induction of progenitor cell expression including proangiogenic factors and nitric oxide syntheses). The rationale for the use of ESW as a therapeutic modality in this instance is attributed to its restorative properties and safety profile demonstrated in urology, cardiology, chronic wounds, osteogenesis, complex pain syndromes, and tendinopathies. ESW may restore autoimmune homeostasis creating a suitable environment for pancreatic β-cell proliferation which in-turn may significantly increase or normalize endogenous insulin secretion reducing or totally eliminating dependency of exogenous insulin. The devastating complications, morbidity and mortality associated with T1DM warrants the exploration of homeostatic autoimmune restorative treatment (HART) modalities that may partially or fully

  12. How has extracorporeal shock-wave lithotripsy changed the treatment of urinary stones in Quebec?

    PubMed Central

    Levy, A R; McGregor, M

    1995-01-01

    OBJECTIVES: To determine the number of people who underwent treatment of urinary stones in Quebec before and after the introduction of extracorporeal shock-wave lithotripsy (ESWL) and to determine how the introduction of ESWL influenced resource utilization. DESIGN: Before-after study; data were obtained from administrative databases and hospital-based cost estimates. SETTING: The 68 acute care hospitals in Quebec in which treatment of urinary stones is undertaken. PATIENTS: Quebec residents admitted to hospital for treatment of urinary stones between the fiscal years 1984 and 1992. OUTCOME MEASURES: Number of people treated for urinary stones per year, total number of procedures per year (including open surgery, percutaneous procedures, retrograde procedures and ESWL), and annual resources (including number of hospital bed-days and direct costs) for treatment of urinary stones used overall and in hospitals with and without ESWL services. RESULTS: Over the study period the number of people treated for urinary stones increased by 59%. As well, the combined frequency of ESWL and surgery (the two main treatment methods) increased by 107%. These increases were largely due to rates of treatment that grew by 52% among women and by 34% among men. The total number of hospital bed-days decreased by 28%, which reflected shorter hospital stays for ESWL. However, despite this decrease, the total direct annual costs were 7% higher in 1992 than in 1984 because of the increased numbers of people treated and procedures performed. In the three hospitals that offered ESWL the number of hospital bed-days and the direct costs of treating urinary stones increased by 49% and $2.5 million respectively. In the 65 other hospitals these figures decreased by 41% and about $2.9 million respectively. CONCLUSIONS: Because of increased intervention rates the total cost of treating urinary stones has risen since the introduction of ESWL. The introduction of ESWL has also been associated with a

  13. Diagnostic features of relief formations on the nanostructured titanium VT1-0 surface after laser shock-wave treatment

    NASA Astrophysics Data System (ADS)

    Lytvynenko, I. V.; Lupenko, S. A.; Maruschak, P. O.; Panin, S. V.; Hats, Yu I.

    2017-02-01

    A new class of diagnostic features for conducting morphological analysis of relief formations induced by laser shock-wave treatment on the surface of the nanostructured titanium VT1-0 alloy is proposed. They are the coefficients of series expansions of statistical estimates for the orthogonal basis of Chebyshev, Laguerre, Kravchuk discrete polynomials and trigonometric functions. Based on the criterion of the minimum number of the diagnostic features in the above-mentioned bases, the Chebyshev one was selected as the most appropriate to solve this problem.

  14. Osteogenic effects of low-intensity pulsed ultrasound, extracorporeal shockwaves and their combination - an in vitro comparative study on human periosteal cells.

    PubMed

    Tam, Kam-Fai; Cheung, Wing-Hoi; Lee, Kwong-Man; Qin, Ling; Leung, Kwok-Sui

    2008-12-01

    Our previous studies have shown that on human periosteal cells, low-intensity pulsed ultrasound (LIPUS) has an immediate stimulatory effect whereas extracorporeal shockwaves (ESW) have an delayed stimulatory effect. Therefore, we hypothesized that a combined ESW and LIPUS treatment might provide additive or synergistic effects on periosteal cells, by using ESW to trigger a biological activity while using LIPUS to maintain the stimulated activity. Human periosteal cells were subjected to a single session of ESW treatment on day 0 and/or daily LIPUS treatments or no treatment (control). The cell viability, proliferation, and alkaline phosphatase activity on day 6 and day 18 as well as matrix mineralization on day 35 were measured. Results revealed that LIPUS alone had early positive effects on the activities on day 6 only. In contrast, ESW alone had an early destructive effect but exerted delayed stimulatory effects on the cellular activities on day 18. The combined treatment of ESW plus LIPUS produced effects that were comparable to the ESW treatment alone. Although these findings suggest that ESW and LIPUS stimulate the periosteal cells in two different ways and at different times, their additive or synergistic effects could not be proven.

  15. Extracorporeal shock-wave lithotripsy: a comparative study of electrohydraulic and electromagnetic units.

    PubMed

    Matin, S F; Yost, A; Streem, S B

    2001-12-01

    We determined the results of shock wave lithotripsy with a newer electromagnetic lithotriptor and compared them with those in a contemporary series of cases managed by an electrohydraulic lithotriptor using identical treatment and followup criteria at a single center. Between 1995 and 1999, 356 patients (375 renal units, 483 upper urinary tract stones) meeting study inclusion criteria were treated with an MFL 5000 electrohydraulic shock wave lithotripsy unit (Dornier Medical Systems, Inc., Marietta, Georgia). From 1999 to 2000, 173 patients (175 renal units; 218 upper urinary tract stones) meeting identical study inclusion criteria were treated using an electromagnetic Modulith SLX shock wave lithotripsy unit (Karl Storz Lithotripsy, Atlanta, Georgia). In each group stone-free results were determined by plain abdominal x-ray and renal ultrasound 1 month after lithotripsy and efficiency quotients were developed. Baseline patient and stone characteristics were compared by the Wilcoxon rank sum and Fisher exact tests. All variables significant at p <0.05 were included in subsequent outcome analysis using multivariate logistic regression. Baseline characteristics were equivalent, including patient age, gender, stone number and location, although patients treated with the electrohydraulic unit had a significantly larger median stone burden (103 versus 71 mm.2, p = 0.015). Multivariate regression analysis demonstrated a higher stone-free rate in the electrohydraulic group (77% versus 67%, p = 0.01) but also a higher rate of total adjunctive measures (56% versus 47%, p = 0.04). Consequently the efficiency quotients were comparable for the electrohydraulic and electromagnetic lithotripsy units (0.45 and 0.42, respectively, p = 0.43). Electrohydraulic lithotripsy resulted in a higher stone-free rate at 1 month, although it was associated with a higher rate of auxiliary measures. Ultimately the efficiency quotients were equivalent, implying that these 2 contemporary energy

  16. The use of low-energy radial shockwave in the treatment of entrapment neuropathy of the medial calcaneal nerve: a pilot study.

    PubMed

    Barrett, Stephen L; Reese, Matthew M; Tassone, John; Buitrago, Maria

    2008-08-01

    Medial calcaneal nerve entrapment is a well-recognized cause of heel pain. In addition, the development of an amputation neuroma of the medial calcaneal nerve from prior heel surgery via an open incision on the medial aspect of the heel is a serious common postoperative complication and can be extremely difficult to treat. This preliminary pilot study demonstrates that the use of low-energy extracorporeal shockwave is safe and efficacious in the treatment of this disorder without the morbidity associated with denervation surgery, which would be one of the most common methods to treat this complicated situation. Four patients, 2 with bilateral affectation, for a total of 6 medial calcaneal nerves, had a series of treatments with low-energy radial shockwave with the Swiss DolorClast machine. All 4 patients had improvement in their pain scores, to the point that none elected surgical treatment, and there were no complications.

  17. The effect of shockwaves on mature and healing cortical bone.

    PubMed

    Forriol, F; Solchaga, L; Moreno, J L; Canãdell, J

    1994-10-01

    It has been proposed that high energy shockwaves could be used to create microfractures in cortical bone. This quality might be exploited clinically to perform closed osteotomies and promote healing in nonunion (15). However, no study has previously documented the effect of shockwaves on cortical bone "in vivo". We report an investigation designed to demonstrate the effect of shockwaves on mature cortical and healing bone. An osteotomy was performed on the tibiae of 37 lambs; two weeks later the operation site was exposed to shockwaves. Three weeks later the lambs were killed and specimens of the bone examined histologically and radiographically. Shockwaves had no effect on the periosteal surface of mature cortical bone, but on the endosteal surface some new trabecular bone was seen. Healing of bone was delayed by the shockwave therapy. We conclude that there is currently little place for shockwave treatment in clinical orthopaedics.

  18. A feasibility double-blind randomized placebo-controlled trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication.

    PubMed

    Harwood, Amy Elizabeth; Green, Jordan; Cayton, Thomas; Raza, Ali; Wallace, Tom; Carradice, Daniel; Chetter, Ian Clifford; Smith, George Edward

    2017-09-21

    Intermittent claudication is the most common symptom of peripheral arterial disease. Previous research has suggested that extracorporeal shockwave therapy (ESWT) may induce angiogenesis in treated tissue. The objective of this feasibility pilot trial was to assess the safety, tolerability, and efficacy of ESWT as a novel treatment. Patients with unilateral claudication were randomized to receive ESWT or sham treatment to the calf muscle three times per week for 3 weeks. Primary outcomes were pain-free walking distance (PFWD) and maximum walking distance (MWD). Secondary outcomes included safety and tolerability of ESWT treatment, ankle-brachial index before and after exercise, and quality of life assessed using generic (36-Item Short Form Health Survey, EuroQol-5 Dimension 3-Level) and disease-specific (Vascular Quality of Life) instruments. Participants were assessed at baseline and 4, 8, and 12 weeks after treatment. Feasibility outcomes included recruitment and attendance rates for treatment and follow-up. Thirty patients were recruited in total. Statistically significant (P < .05) improvements at all time points were observed in the active treatment group for both MWD and PFWD compared with the sham treatment group. PFWD improved by 276% in the active group and MWD improved by 167% in the active group at 12 weeks after treatment. There were no immediate or delayed treatment safety concerns or documented adverse effects of treatment with ESWT in this trial. ESWT is safe and well tolerated when it is applied to the calf and demonstrated significant improvements in walking distances. Current conservative management of intermittent claudication includes supervised exercise. The early results with ESWT as an alternative, noninvasive treatment option show great potential. The mechanism of action, durability of the clinical effect, and cost-effectiveness of ESWT for claudication require further investigation. Copyright © 2017 Society for Vascular Surgery

  19. [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.

  20. Prognostic variables for shockwave lithotripsy (SWL) treatment success: no impact of body mass index (BMI) using a third generation lithotripter.

    PubMed

    Hatiboglu, Gencay; Popeneciu, Valentin; Kurosch, Martin; Huber, Johannes; Pahernik, Sascha; Pfitzenmaier, Jesco; Haferkamp, Axel; Hohenfellner, Markus

    2011-10-01

    • To investigate the effect of different variables including body mass index (BMI) on therapy outcome in patients with upper urinary tract stones treated with a third generation lithotripter, as BMI has been reported to be an independent predictor for stone-free status after extracorporeal shockwave lithotripsy (SWL) performed with first or second generation lithotripters. • In all, 172 patients with kidney stones with a mean (range) size of 9.2 (3.0-32.0) mm were included in the study. • In all, 91 patients (52.9%) were treated with a ureteric stent in situ. • For SWL therapy a third generation, electromagnetic lithotripter (Siemens Lithoskop™) was used. Stone-free status was reached, when no more treatable stones were present (no stone or stone < 3 mm). • BMI, stone size and localization, age, gender, treatment parameters and ureteric stent in situ were evaluated for their prognostic relevance on therapy success. • The mean (range) BMI of all patients was 27.8 (19.0-58.6) kg/m(2). • Patients were categorized into two groups: A) patients that were stone free after one treatment; B) patients with residual stones. The mean (sd) BMI was 27.4 (4.6) kg/m(2) and 28.4 (6.1) kg/m(2) for A and B, respectively. • Univariate and multivariate analysis for freedom of stones showed that only stone size (P < 0.01) and presence of a ureteric stent (P = 0.01) were independent prognostic variables. • BMI had no significant influence on therapy outcome (P = 0.51). • Using a third generation lithotripter, BMI was not an independent predictor of stone-free rate after SWL therapy of kidney stones. • This effect might be attributed to a greater penetration depth of the shockwave energy. Stone size and a ureteric stent in situ were the only variables with prognostic significance. © 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.

  1. Combined endoscopic and extracorporeal shock-wave treatment in difficult bile duct stones: early and long-term results.

    PubMed

    Testoni, P A; Lella, F; Masci, E; Bagnolo, F; Colombo, E; Tittobello, A

    1994-01-01

    Endoscopic papillosphincterotomy (EPT) has become a well-established therapeutic procedure in the management of common bile duct stones; however, in difficult cases with large stones or anatomic conditions limiting the amplitude of the sphincteric section, the procedure may fail. In these cases, the association with extracorporeal shock-wave lithotripsy (ESWL) has proved to be helpful. Twenty out of 21 patients in whom the endoscopic approach failed because of the presence of large stones in the biliary tree (15 cases) or anatomic conditions (5 cases) underwent ESWL treatment. Stone fragmentation was achieved in 18 of the 20 treated patients (90%), with spontaneous clearing of the fragments in 10 patients after ESWL sessions and in another 2 patients within three months. In 6 cases the residual fragments were extracted by means of endoscopy. The combined procedures were therefore successful in all the 18 cases in which stone fragmentation was obtained. Complications occurred in two cases after ESWL treatment (asymptomatic pancreatic reaction and severe bleeding from the papillary area). Clinical, ultrasound and biochemical evaluations at 6 and 12 months documented a normal condition in all but two treated subjects.

  2. Extracorporeal shockwave lithotripsy in pediatrics.

    PubMed

    D'Addessi, Alessandro; Bongiovanni, Luca; Sasso, Francesco; Gulino, Gaetano; Falabella, Roberto; Bassi, Pierfrancesco

    2008-01-01

    Since its introduction in 1980, extracorporeal shockwave lithotripsy (SWL) has become the first therapeutic option in most cases of upper-tract urolithiasis, and the technique has been used for pediatric renal stones since the first report of success in 1986. Lithotripter effectiveness depends on the power expressed at the focal point. Closely correlated with the power is the pain produced by the shockwaves. By reducing the dimensions of the focus, it becomes possible to treat the patient without anesthesia or analgesia but at the cost of a higher re-treatment rate. Older children often tolerate SWL under intravenous sedation, and minimal anesthesia is applicable for most patients treated with second- and third-generation lithotripters. Ureteral stenting before SWL has been controversial. Current data suggest that preoperative stent placement should be reserved for a few specific cases. Stone-free rates in pediatric SWL exceed 70% at 3 months, with the rate reaching 100% in many series. Even the low-birth-weight infant can be treated with a stone-free as high as 100%. How can one explain the good results? Possible explanations include the lesser length of the child's ureter, which partially compensates for the narrower lumen. Moreover, the pediatric ureter is more elastic and distensible, which facilitates passage of stone fragments and prevents impaction. Another factor is shockwave reproduction in the body: there is a 10% to 20% damping of shockwave energy as it travels through 6 cm of body tissue, so the small body volume of the child allows the shockwaves to be transmitted with little loss of energy. There are several concerns regarding the possible detrimental effect of shockwaves on growing kidneys. Various renal injures have been documented with all type of lithotripters. On the other hand, several studies have not shown adverse effects. In general, SWL is considered to be the method of choice for managing the majority of urinary stones in children of all

  3. [Treatment of lithiasis in horseshoe kidney with extracorporeal shock-wave lithotripsy].

    PubMed

    Torrecilla Ortíz, C; Ponce Campuzano, A; Contreras García, J; Marco Pérez, L M; Colom Feixas, S; Vigués Juliá, F; Serrallach Milá, N

    2001-01-01

    The horseshoe kidney is the most frequent renal anomaly. As a consequence of impaired urinary drainage, urolithiasis is present in 20% of the cases. Indications for extracorporeal shock wave lithotripsy (ESWL) in the treatment of patients with anomalous kidneys is still the subject of controversy. To evaluate ESWL efficacy in the treatment for lithiasis in horseshoe kidney. Between april 1988 and december 1999 a total of 32 symptomatic lithiasis in 30 patients with horseshoe kidneys were managed by 65 sessions with ESWL. Until march 1999 a Dornier HM-4 electrohydraulic lithotripter was used. Posteriorly, two treatments was performed with an electromagnetic Dornier Lithotripter S. These procedures have been performed without anaesthesia or sedation for the Dornier HM-4 equipment. Analgesia with Meperidine was used for the Dornier Lithotripter S. Diuresis was not forced during or after treatment with diuretics or serotherapy. Treatments was conducted in an outpatient clinic in all cases. Treatment/lithiasis rate was 2.03. Following treatment 16 patients (54%) were stone-free by X-ray, 9 patients (30%) had residual fragments and in 5 patients (16%) no sign of stone disintegration was observed. Open surgery was performed in three of this patients. Better results was achieved in stones located in the renal pelvis and stone size is 10 mm or less. Clinical evolution: free of symptoms in 20 patients; chronic vague flank pain in 5 patients and acute renal colic with or without hematuria in 5 patients. No major complication was observed in our compilation. These results suggest that ESWL is the method of primary choice in the treatment for small lithiasis (10 mm or less) in horseshoe kidney.

  4. The efficacy of performing shockwave lithotripsy before retrograde intrarenal surgery in the treatment of multiple or large (≥1.5 cm) nephrolithiasis: A propensity score matched analysis

    PubMed Central

    Shim, Myungsun; Park, Myungchan

    2017-01-01

    Purpose To investigate the effect of performing shockwave lithotripsy (SWL) before retrograde intrarenal surgery (RIRS) on the treatment outcomes of patients with nephrolithiasis. Materials and Methods The data of 189 patients with renal stones who underwent RIRS from July 2007 to July 2014 was reviewed retrospectively. Patients with stones larger than 1.5 cm were recommended to undergo SWL before RIRS. Patients were divided into 2 groups based on whether the preoperative SWL was performed (group 1, n=68) or not (group 2, n=121). The cohorts of the 2 groups cohorts were matched 1:1 using propensity score analysis. Patient, stone characteristics, operative parameters, and stone-free rates were compared. Results Patients in groups 1 and 2 were matched with respect to stone size, number, and location, leaving 57 patients in each group. After matching, no differences were identified between the 2 groups regarding age, body mass index, sex, stone composition, density and multiplicity. Compared to group 2 patients, patients in group 1 had fewer number of procedures performed (1.10 vs. 1.26, p=0.045) and higher stone-free rate (89.4% vs.73.6%, p=0.039). In multivariate analysis, Non lower calyceal location (odd ratio [OR], 8.215; 95% confidence interval [CI], 1.782–21.982; p=0.041), stone size (OR, 6.932; 95% CI, 1.022–18.283; p<0.001), and preoperative SWL (OR, 2.210; 95% CI, 1.058–7.157; p=0.019) were independent factors predicting a stone-free state after RIRS. Conclusions Performing SWL before RIRS may favor stone eliminations during surgery and increase the stone-free rate in selected patients. PMID:28097265

  5. Extracorporeal shockwave application to the distal femur of rabbits diminishes the number of neurons immunoreactive for substance P in dorsal root ganglia L5.

    PubMed

    Hausdorf, Jörg; Lemmens, Marijke A M; Kaplan, Suleyman; Marangoz, Cafer; Milz, Stefan; Odaci, Ersan; Korr, Hubert; Schmitz, Christoph; Maier, Markus

    2008-05-01

    Application of extracorporeal shockwaves to the musculoskeletal system can induce long-term analgesia in the treatment of chronic painful diseases such as calcifying tendonitis of the shoulder, tennis elbow and chronic plantar fasciitis. However, the molecular and cellular mechanisms underlying this phenomenon are largely unknown. Recently it was shown that application of extracorporeal shockwaves to the distal femur of rabbits can lead to reduced concentration of substance P in the shockwaves' focal zone. In the present study we investigated the impact of extracorporeal shockwaves on the production of substance P within dorsal root ganglia in vivo. High-energy shockwaves were applied to the ventral side of the right distal femur of rabbits. After six weeks, the dorsal root ganglia L5 to L7 were investigated with high-precision design-based stereology. The application of extracorporeal shockwaves caused a statistically significant decrease in the mean number of neurons immunoreactive for substance P within the dorsal root ganglion L5 of the treated side compared with the untreated side, without affecting the total number of neurons within this dorsal root ganglion. No effect was observed in the dorsal root ganglia L6 and L7, respectively. These data might further contribute to our understanding of the molecular and cellular mechanisms in the induction of long-term analgesia by extracorporeal shockwave application to the musculoskeletal system.

  6. Effects of extracorporeal shockwaves on the stability of the interface between bone and polymethylmethacrylate: an in vitro study on human femoral segments.

    PubMed

    Braun, W; Claes, L; Rüter, A; Paschke, D

    1992-02-01

    The increasing number of revision procedures for failed total arthroplasty requiring difficult cement removal has led to various developments of new instruments and techniques to facilitate this procedure. In this in vitro study the effect of extracorporeal shockwaves on the bone-cement interface was investigated. At first the pressure reduction caused by the passage of shockwaves through compounds consisting of cortical bone-polymethyl-methacrylate and cancellous bone-polymethylmethacrylate by means of a needle pressure probe was measured. Secondly, the mechanical and morphological effects of extracorporeal shockwaves on the polymethylmethacrylate-bone interface of human femoral segments was tested. Using bone cement, stainless steel rods were implanted into cadaveric femoral segments and the polymethylmethacrylate-bone interface was treated with extracorporeal shockwaves. When comparing the treatment and control groups mechanically, radiologically, and microscopically it was not possible to demonstrate evidence of disruption of the interface caused by extracorporeal shockwaves. Instead it was shown that intravasation of bone marrow can be induced by shockwaves. Considering these facts, shockwaves seems not to be good clinical adjunct in revision surgery of failed arthroplasty.

  7. [Role of electrohydraulic extracorporeal shockwave lithotripsy (Dornier HM 4) in the treatment of caliceal diverticulum lithiasis].

    PubMed

    Torrecilla Ortiz, C; Marco Pérez, L; Contreras García, J; Ponce Campuzano, A; Ruíz-Lluch López, R; Roig Sanz, M; Serrallach Mila, N

    1998-10-01

    Caliceal diverticula may be congenital or acquired malformations of the collecting system, normally asymptomatic and discovered during an IVP. Indications for treatment included chronic vague flank pain, acute renal colic, urinary tract infection and hematuria. We present the results of 29 patients with symptomatic calculi in caliceal diverticula who were managed by ESWL monotherapy. All treatments were performed with electrohydraulic machine (Dornier HM 4) in ambulatory form. The average followup was 42 months. 12 patients (40%) had passed successfully all of the stone fragments, while 2 patients (7%) had passed more than half and 4 (13.5%) had passed less than half of the fragments. 66 per cent of patients had been rendered free of symptoms. The possibility of producing a satisfactory result (66% free of symptoms and 40% stone free by X ray) and the low morbidity of ESWL suggest that this treatment may be appropriate for majority of calculi in calicea diverticula.

  8. Extracorporeal shockwave therapy in musculoskeletal disorders

    PubMed Central

    2012-01-01

    The sources of shockwave generation include electrohydraulic, electromagnetic and piezoelectric principles. Electrohydraulic shockwaves are high-energy acoustic waves generated under water explosion with high voltage electrode. Shockwave in urology (lithotripsy) is primarily used to disintegrate urolithiasis, whereas shockwave in orthopedics (orthotripsy) is not used to disintegrate tissues, rather to induce tissue repair and regeneration. The application of extracorporeal shockwave therapy (ESWT) in musculoskeletal disorders has been around for more than a decade and is primarily used in the treatment of sports related over-use tendinopathies such as proximal plantar fasciitis of the heel, lateral epicondylitis of the elbow, calcific or non-calcific tendonitis of the shoulder and patellar tendinopathy etc. The success rate ranged from 65% to 91%, and the complications were low and negligible. ESWT is also utilized in the treatment of non-union of long bone fracture, avascular necrosis of femoral head, chronic diabetic and non-diabetic ulcers and ischemic heart disease. The vast majority of the published papers showed positive and beneficial effects. FDA (USA) first approved ESWT for the treatment of proximal plantar fasciitis in 2000 and lateral epicondylitis in 2002. ESWT is a novel non-invasive therapeutic modality without surgery or surgical risks, and the clinical application of ESWT steadily increases over the years. This article reviews the current status of ESWT in musculoskeletal disorders. PMID:22433113

  9. [Treatment of renoureteral lithiasis using extracorporeal shockwave lithotripsy. Experience in Cuba].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodríguez, M; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1989-01-01

    Herein we present our experience in 5,000 cases of reno-ureteral lithiasis submitted to treatment at the Extracorporeal Lithotripsy Unit of Hermanos Ameijeiras Hospital in Havana, Cuba, from April 1986 and during a period spanning 30 months. Treatment was exclusively by extracorporeal shock wave lithotripsy (ESWL) in 85.5% of the patients and in combination with other procedures in 14.5% (endoscopic maneuvers in 5.9%, percutaneous nephrostomy 4.4%, open surgery 3.6%, and percutaneous nephrolithotripsy 0.6%). Complications were observed in 7% of the cases: ureteric obstruction (6.4%) with or without infection, perirenal hematoma (0.4%), and obstructive anuria (0.2%); acute urinary infection of different clinical types, some of which were very severe, were observed concomitantly in 2.6% of these patients. Two months following treatment, 86% of the cases were completely stone-free. At 6 months 96.2% were completely stone-free; the remaining 3.8% were classed as residual lithiasis. The pathologic conditions that put patients at high therapeutic risk and the possible complications that could arise were identified. The efficacy of the Dornier HM-3 lithotripter and the health care system that permits its extensive use are highlighted.

  10. [Percutaneous nephrolitholapaxy combined with extracorporeal shockwave lithotripsy in the treatment of staghorn lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Castillo Rodríguez, M; Hernández Silverio, D; Casals Armada, J; Valdés Gómez, C; Báez Hernández, D

    1990-05-01

    From December, 1988 to July, 1989, 41 patients with renal or juxtapyelic ureteral calculi were submitted to percutaneous litholapaxy (PCN) at the Stone Center of the Hermanos Amerijeiras Hospital in Havana. This series comprise our early experience utilizing this procedure. PCN was initially limited to pelvic and juxtapyelic ureteric calculi with dilated renal cavities. It was subsequently used in combination with extracorporeal lithotripsy (ESWL) in the treatment of staghorn stones. The present study analyzed the results achieved with PCN in 30 patients with staghorn calculi; 21 (70%) incomplete staghorns and 9 (30%) complete staghorns. Posteriorly, 6 additional borderline staghorns were completely removed by PCN and are not included in the present study. PCN was performed to reduce stone mass and for placement of a large renal drain to permit subsequent ESWL. At two months following treatment, 86.6% of the patients were completely stone-free. The remaining 13.4% with stone remnants presented anatomic and functional renal conditions that allow us to predict complete elimination within a short period of time. Since 6 months had not elapsed in these cases, these were not considered as residual fragments. One patient presented massive absorption of fluids. This was the only observed major and non-lethal complication. Episodes of fever were observed in 23% post-PCN. No patient presented severe sepsis. In our view, PCN combined with ESWL is one of the currently available therapeutic options in the treatment of staghorn calculi. This approach permits adequate resolution of cases that would have otherwise required surgery.

  11. Shock-wave behavior of structural nitrogen-bearing steel after heat treatment under various conditions

    NASA Astrophysics Data System (ADS)

    Meshcheryakov, Yu. I.; Divakov, A. K.; Zhigacheva, N. I.; Konovalov, G. V.; Barakhtin, B. K.; Kalinin, G. Yu.; Mushnikova, S. Yu.; Fomina, O. V.

    2014-10-01

    04Kh20G11N6M2AFB steel is subjected to shock tests in the following two states: after high-temperature mechanical treatment (HTMT) and after HTMT followed by quenching. The dynamic yield strength, the spall strength, and the structural transition threshold induced by shock loading are determined. It is shown that these parameters weakly depend on the shock loading rate in the steel after HTMT and increase slightly in the steel quenched from a temperature of 1100°C. In both cases, the mass velocity defect at a compression pulse plateau increases sharply beginning from a certain threshold strain rate, which indicates a high energy absorption ability of the steel.

  12. Bacterial biofilm disruption using laser generated shockwaves.

    PubMed

    Taylor, Zachary D; Navarro, Artemio; Kealey, Colin P; Beenhouwer, David; Haake, David A; Grundfest, Warren S; Gupta, Vijay

    2010-01-01

    A system was built to test the efficacy of bacterial biofilm disruption using laser generated shockwaves. The system is based on a Q-switched, ND:YAG pulsed laser operating at a rep rate of 10 Hz with 1500 mJ pulses centered at 1064 nm. The laser pulses were used to create shockwave pulses in Al coated polycarbonate substrates and a resulting peak stress of greater than 50 MPa was measured. These stress pulses were coupled to bacteria grown to confluence on agar plates and cell death as a result of shockwave stress was assessed. The results show a 55% reduction in the number living bacteria between shocked and control samples. This type of biofilm disruption method could prove useful in the treatment of infected wounds where standard treatment methods such as debridement and topical antibiotics have proven to be ineffectual or harmful.

  13. [Percutaneous nephrostomy associated with extracorporeal shockwave lithotripsy in the treatment of renoureteral lithiasis].

    PubMed

    Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L

    1993-01-01

    From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.

  14. 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.

  15. The Chelyabinsk airburst shockwave

    NASA Astrophysics Data System (ADS)

    Popova, O.; Shuvalov, V.; Rybnov, Y.; Jenniskens, P.; Kharlamov, V.; Usoltseva, O.; Glazachev, D.; Podobnaya, E.; Dyagilev, R.; Trubetskaya, I.

    2014-07-01

    The Chelyabinsk airburst of 15 February 2013 was exceptional because of the large kinetic energy of the impacting body and because the airburst that was generated created significant damage and injuries in a densely populated area. The butterfly-shape of the damaged area (Popova et al., 2013) is explained from the fact that the energy was deposited over a range of altitudes. Some uncertainty remains about the source energy of the airburst, because it is not known precisely at what pressure glass is expected to break. Reasonable results were obtained for energies of 300--520 kt TNT and over pressures of 500--1000 Pa, assuming that the time dependence of the energy release followed the meteor lightcurve (Popova et al. 2013). Additional information about the airburst characteristics may be extracted from the arrival times of the shockwave at various locations and from pressure records. Arrival times of the shock wave were derived from video observations. From the analysis of these shock wave arrival times, a range of altitudes of energy deposition was derived (Popova et al. 2013). The observed arrival times were compared with model estimates, taking into account the real wind and atmospheric conditions. Results of the numerical simulations were compared with recorded sound signals, which were often quite complex. Borovicka et al. (2013) suggested that subsequent acoustic arrivals corresponded to separate fragmentation events. This hypothesis is tested. There were no instrumental records of overpressure in the damaged area. However, seismic records exist from locations surrounding a coal mine at Korkino, situated in the damage area close to the meteoroid trajectory, almost immediately below the region of highest energy deposition. Its seismic control system to monitor land slides recorded the blast wave from the meteoroid entry indirectly due to coupling to the ground. This is the only instrumental record of the airburst close to the meteoroid trajectory. An analysis

  16. In-vitro cell treatment with focused shockwaves-influence of the experimental setup on the sound field and biological reaction.

    PubMed

    Dietz-Laursonn, Kristin; Beckmann, Rainer; Ginter, Siegfried; Radermacher, Klaus; de la Fuente, Matías

    2016-01-01

    To improve understanding of shockwave therapy mechanisms, in vitro experiments are conducted and the correlation between cell reaction and shockwave parameters like the maximum pressure or energy density is studied. If the shockwave is not measured in the experimental setup used, it is usually assumed that the device's shockwave parameters (=manufacturer's free field measurements) are valid. But this applies only for in vitro setups which do not modify the shockwave, e.g., by reflection or refraction. We hypothesize that most setups used for in vitro shockwave experiments described in the literature influence the sound field significantly so that correlations between the physical parameters and the biological reaction are not valid. To reveal the components of common shockwave in vitro setups which mainly influence the sound field, 32 publications with 37 setups used for focused shockwave experiments were reviewed and evaluated regarding cavitation, cell container material, focal sound field size relative to cell model size, and distance between treated cells and air. For further evaluation of the severity of those influences, experiments and calculations were conducted. In 37 setups, 17 different combinations of coupling, cell container, and cell model are described. The setup used mainly is a transducer coupled via water to a tube filled with a cell suspension. As changes of the shockwaves' maximum pressure of 11 % can already induce changes of the biological reaction, the sound field and biological reactions are mainly disturbed by use of standard cell containers, use of coupling gel, air within the 5 MPa focal zone, and cell model sizes which are bigger than half the -6 dB focal dimensions. Until now, correct and sufficient information about the shockwave influencing cells in vitro is only provided in 1 of 32 publications. Based on these findings, guidelines for improved in vitro setups are proposed which help minimize the influence of the setup on the sound

  17. Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

    PubMed Central

    Bakoyiannis, Christos; Anastasiou, Ioannis; Koutsoumpelis, Andreas; Fragiadis, Evangelos; Felesaki, Eleni; Kafeza, Marina; Georgopoulos, Sotirios; Tsigris, Christos

    2012-01-01

    The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL. PMID:23304627

  18. Analysis of flexible substrates for clinical translation of laser-generated shockwave therapy

    PubMed Central

    Francis, Nathan C.; Kassam, Imara; Nowroozi, Bryan; Grundfest, Warren S.; Taylor, Zach D.

    2015-01-01

    Bacteria biofilms in chronically infected wounds significantly increase the burden of healthcare costs and resources for patients and clinics. Because biofilms are such an effective barrier to standard antibiotic treatment, new methods of therapy need to be developed to combat these infections. Our group has demonstrated the potential of using Laser Generated Shockwaves as a potential therapy to mechanically disrupt the bacterial biofilms covering the wound. Previous studies have used rigid silica glass as the shockwave propagation medium, which is not compatible with the intended clinical application. This paper describes the exploration of five candidate flexible plastic films to replace the glass substrate. Each material measured 0.254 mm thick and was used to generate shockwaves of varying intensities. Shockwave characterization was performed using a high-speed Michelson displacement interferometer and peak stress values obtained in the flexible substrates were compared to glass using one-way nested Analysis of Variance and Tukey HSD post-hoc analysis. Results demonstrate statistically significant differences between substrate material and indicate that polycarbonate achieves the highest peak stress for a given laser fluence suggesting that it is optimal for clinical applications. PMID:25798307

  19. Analysis of flexible substrates for clinical translation of laser-generated shockwave therapy.

    PubMed

    Francis, Nathan C; Kassam, Imara; Nowroozi, Bryan; Grundfest, Warren S; Taylor, Zach D

    2015-03-01

    Bacteria biofilms in chronically infected wounds significantly increase the burden of healthcare costs and resources for patients and clinics. Because biofilms are such an effective barrier to standard antibiotic treatment, new methods of therapy need to be developed to combat these infections. Our group has demonstrated the potential of using Laser Generated Shockwaves as a potential therapy to mechanically disrupt the bacterial biofilms covering the wound. Previous studies have used rigid silica glass as the shockwave propagation medium, which is not compatible with the intended clinical application. This paper describes the exploration of five candidate flexible plastic films to replace the glass substrate. Each material measured 0.254 mm thick and was used to generate shockwaves of varying intensities. Shockwave characterization was performed using a high-speed Michelson displacement interferometer and peak stress values obtained in the flexible substrates were compared to glass using one-way nested Analysis of Variance and Tukey HSD post-hoc analysis. Results demonstrate statistically significant differences between substrate material and indicate that polycarbonate achieves the highest peak stress for a given laser fluence suggesting that it is optimal for clinical applications.

  20. Low-Energy Shockwave Therapy Improves Ischemic Kidney Microcirculation.

    PubMed

    Zhang, Xin; Krier, James D; Amador Carrascal, Carolina; Greenleaf, James F; Ebrahimi, Behzad; Hedayat, Ahmad F; Textor, Stephen C; Lerman, Amir; Lerman, Lilach O

    2016-12-01

    Microvascular rarefaction distal to renal artery stenosis is linked to renal dysfunction and poor outcomes. Low-energy shockwave therapy stimulates angiogenesis, but the effect on the kidney microvasculature is unknown. We hypothesized that low-energy shockwave therapy would restore the microcirculation and alleviate renal dysfunction in renovascular disease. Normal pigs and pigs subjected to 3 weeks of renal artery stenosis were treated with six sessions of low-energy shockwave (biweekly for 3 consecutive weeks) or left untreated. We assessed BP, urinary protein, stenotic renal blood flow, GFR, microvascular structure, and oxygenation in vivo 4 weeks after completion of treatment, and then, we assessed expression of angiogenic factors and mechanotransducers (focal adhesion kinase and β1-integrin) ex vivo A 3-week low-energy shockwave regimen attenuated renovascular hypertension, normalized stenotic kidney microvascular density and oxygenation, stabilized function, and alleviated fibrosis in pigs subjected to renal artery stenosis. These effects associated with elevated renal expression of angiogenic factors and mechanotransducers, particularly in proximal tubular cells. In additional pigs with prolonged (6 weeks) renal artery stenosis, shockwave therapy also decreased BP and improved GFR, microvascular density, and oxygenation in the stenotic kidney. This shockwave regimen did not cause detectable kidney injury in normal pigs. In conclusion, low-energy shockwave therapy improves stenotic kidney function, likely in part by mechanotransduction-mediated expression of angiogenic factors in proximal tubular cells, and it may ameliorate renovascular hypertension. Low-energy shockwave therapy may serve as a novel noninvasive intervention in the management of renovascular disease. Copyright © 2016 by the American Society of Nephrology.

  1. Current concepts of shockwave therapy in stress fractures.

    PubMed

    Leal, Carlos; D'Agostino, Cristina; Gomez Garcia, Santiago; Fernandez, Arnold

    2015-12-01

    Stress fractures are common painful conditions in athletes, usually associated to biomechanical overloads. Low risk stress fractures usually respond well to conservative treatments, but up to one third of the athletes may not respond, and evolve into high-risk stress fractures. Surgical stabilization may be the final treatment, but it is a highly invasive procedure with known complications. Shockwave treatments (ESWT), based upon the stimulation of bone turnover, osteoblast stimulation and neovascularization by mechanotransduction, have been successfully used to treat delayed unions and avascular necrosis. Since 1999 it has also been proposed in the treatment of stress fractures with excellent results and no complications. We have used focused shockwave treatments in professional athletes and military personnel with a high rate of recovery, return to competition and pain control. We present the current concepts of shockwave treatments for stress fractures, and recommend it as the primary standard of care in low risk patients with poor response to conventional treatments.

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

    PubMed

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

    2013-12-01

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

  3. Comparison of the effectiveness and safety of MPL 9000 and Lithostar Modularis shockwave lithotriptors: treatment results of 263 children.

    PubMed

    Aksoy, Yilmaz; Ziypak, Tevfik; Yapanoglu, Turgut

    2009-04-01

    In this study, we aimed to compare the treatment results of two different shock wave lithotripsy (SWL) machines used in the management of pediatric urolithiasis. Between January 1993 and October 2004, Dornier MPL 9000 (electrohydraulic) had been used, and since then Siemens Lithostar Modularis (electromagnetic) has been used. The last evaluation was done 3 months after SWL treatment in terms of the success rate, use of anesthesia and complications. A total of 263 children (171 boys and 92 girls), with an age range of 9 months-14 years (mean age 8.1 +/- 3.8 years) were included in this study. Of the patients treated with the Dornier MPL 9000, 60.1% (173/104) required general anesthesia and 69 needed sedation. In contrast, for all patients treated with the Lithostar Modularis necessitated only sedo-analgesia (90 children). The hospital stay was shorter for Siemens Lithostar Modularis than those of Dornier MPL 9000 (26.2 vs. 35.5 h, P = 0.03). The success rate for the electromagnetic unit (86.5%) was almost identical that achieved with the electrohydraulic unit (85.2%) in the stones for the different location. Success rates were compared for stone burden subsets, the differences were insignificant for both lithotriptors (P > 0.05, for all). The electromagnetic unit had a significantly higher success rate for distal ureteral calculi (86.2 vs. 54.5%, P = 0.034). The efficiency quotients (EQ) for distal ureteral calculi were significantly different in favor of electromagnetic machine (56 vs. 40%). The complication rates for SWL were not significantly different for electrohydraulic and electromagnetic lithotriptors (8.7 and 6.2%, respectively). This study showed that SWL treatment was effective and safe in pediatric urolithiasis using both electrohydraulic and electromagnetic machines. Electromagnetic machine was more effective than electrohydraulic one for distal ureteral calculi. Additionally, the electromagnetic lithotriptor has significant clinical advantages over the

  4. International Shock-Wave Database: Current Status

    NASA Astrophysics Data System (ADS)

    Levashov, Pavel

    2013-06-01

    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.

  5. Some aspects of shock-wave research

    NASA Astrophysics Data System (ADS)

    Glass, I. I.

    1986-01-01

    Examples are given of shock-wave phenomena on Earth and in space. A specific shock-wave research problem, namely, pseudostationary oblique shock-wave reflections in perfect and imperfect gases is presented. Consideration is given to what has been achieved to date by using two- and three-shock theory to predict what type of reflection results when a planar shock wave M sub s, in a shock tube, collides with a sharp compressive wedge of angle, theta sub w. Experimental (interferometric and other optical) data are presented in (M sub s, theta sub w)-plots for argon, nitrogen, oxygen, air carbon-dioxide, Freon 12 and sulfurhexafluoride, in order to check the validity of the analytically predicted regions and transition lines of the four types of reflection (RR, SMR, CMR, DMR). Some disagreements are noted and discussed. Our interferometric isopycnic data are also compared with state-of-the-art computational results from a solution of the inviscid Euler equations using a CRAY I computer. Good agreement was obtained, yet, it would be important to obtain new data by solving the Navier-Stokes equations, as well as the rate equations for imperfect-gas excitations, in order to judge the improvement obtained with real-flow interferograms.

  6. A Supernova's Shockwaves

    NASA Technical Reports Server (NTRS)

    2007-01-01

    Supernovae are the explosive deaths of the universe's most massive stars. In death, these volatile creatures blast tons of energetic waves into the cosmos, destroying much of the dust surrounding them.

    This false-color composite from NASA's Spitzer Space Telescope and NASA's Chandra X-ray Observatory shows the remnant of one such explosion. The remnant, called N132D, is the wispy pink shell of gas at the center of this image. The pinkish color reveals a clash between the explosion's high-energy shockwaves and surrounding dust grains.

    In the background, small organic molecules called polycyclic aromatic hydrocarbons are shown as tints of green. The blue spots represent stars in our galaxy along this line of sight.

    N132D is located 163,000 light-years away in a neighboring galaxy called, the Large Magellanic Cloud.

    In this image, infrared light at 4.5 microns is mapped to blue, 8.0 microns to green and 24 microns to red. Broadband X-ray light is mapped purple. The infrared data were taken by Spitzer's infrared array camera and multiband imaging photometer, while the X-ray data were captured by Chandra.

  7. A Supernova's Shockwaves

    NASA Technical Reports Server (NTRS)

    2007-01-01

    Supernovae are the explosive deaths of the universe's most massive stars. In death, these volatile creatures blast tons of energetic waves into the cosmos, destroying much of the dust surrounding them.

    This false-color composite from NASA's Spitzer Space Telescope and NASA's Chandra X-ray Observatory shows the remnant of one such explosion. The remnant, called N132D, is the wispy pink shell of gas at the center of this image. The pinkish color reveals a clash between the explosion's high-energy shockwaves and surrounding dust grains.

    In the background, small organic molecules called polycyclic aromatic hydrocarbons are shown as tints of green. The blue spots represent stars in our galaxy along this line of sight.

    N132D is located 163,000 light-years away in a neighboring galaxy called, the Large Magellanic Cloud.

    In this image, infrared light at 4.5 microns is mapped to blue, 8.0 microns to green and 24 microns to red. Broadband X-ray light is mapped purple. The infrared data were taken by Spitzer's infrared array camera and multiband imaging photometer, while the X-ray data were captured by Chandra.

  8. 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.

  9. Implicit finite-difference computations of unsteady transonic flows about airfoils, including the treatment of irregular shock-wave motions

    NASA Technical Reports Server (NTRS)

    Ballhaus, W. F.; Goorjian, P. M.

    1977-01-01

    A computer code, LTRAN2, has been constructed that efficiently computes low-frequency unsteady transonic flows about airfoils in motion. The code solves the two-dimensional, nonlinear, low-frequency, small-disturbance equation by an alternating-direction implicit (ADI) algorithm. First, as a check on the code, LTRAN2 is used to solve the linear, low-frequency, small-disturbance equation. The results are compared with known answers from linear theory. Then nonlinear results are presented. Tijdeman's experimental observations of shock wave motions resulting from airfoil flap oscillations are qualitatively reproduced by LTRAN2. These computations compare favorably with those of Magnus and Yoshihara and are obtained in substantially less computer time. Also the underlying theory of the governing equation and the construction of the algorithm are discussed.

  10. 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

  11. Low-Energy Extracorporeal Shock-Wave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy: A Case Series

    PubMed Central

    Pavone, Vito; Di Stefano, Antonio; Testa, Gianluca; Costarella, Luciano; Sessa, Giuseppe

    2016-01-01

    Introduction. We report the results of a series of 40 patients with chronic insertional Achilles tendinopathy treated with low-energy ESWT after the failure of a 3-month program of eccentric exercises alone. Methods and Materials. 40 patients, 28 (70%) males and 12 (30%) females, were treated between January and December 2014. All patients were previously treated with only eccentric exercises for a 3-month period. The treatment protocol included 4 sessions of ESWT with a 2-week interval, from 800 shots in each one (4 Hz, 14 KeV), together with eccentric exercises. Visual Analogue Scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot score were recorded. Results. At the 12-month follow-up, 26 (65.0%) patients did not complain about pain (VAS < 2), 11 (27.5%) patients got back to normal activities despite residual pain (VAS 2–4), and 3 (7.5%) of the patients still complained about pain (VAS > 4). There was no significative improvement in both scores after eccentric exercises alone. Mean VAS improvement was 5.8 ± 1.3 SD points (P < 0.001). Mean AOFAS Hindfoot score improvement was 19.8 ± 5.0 SD points (P < 0.001). Conclusions. ESWT is recommended, in combination with an eccentric exercise program, in patients with chronic Achilles tendinopathy being both insertional and not. PMID:27843949

  12. 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.

  13. Chronic lateral epicondylitis of the elbow: A prospective study of low-energy shockwave therapy and low-energy shockwave therapy plus manual therapy of the cervical spine.

    PubMed

    Rompe, J D; Riedel, C; Betz, U; Fink, C

    2001-05-01

    To compare the effects of extracorporeal shockwave therapy (ESWT) alone with a combination of ESWT and manual therapy of the cervical spine in treating chronic tennis elbow. Prospective, matched single-blind control trial. University hospital clinic. Thirty patients with unilateral chronic tennis elbow, an unsuccessful conservative therapy during the 6 months before referral, and clinical signs of cervical dysfunction (eg, pressure pain at the C4-5 and/or C5-6 level, protraction of the head). Three times at weekly intervals all patients received 1000 shockwave impulses of an energy flux density of.16mJ/mm(2) at the lateral elbow. Additionally, they underwent manual therapy of the cervical spine and the cervicothoracic junction 10 times (group I). For each patient, a control matched by age (3-yr range) and gender at first conservative treatment was drawn at random from 127 patients who had undergone low-energy shockwave therapy in the same unit in the past 3 years (group II). Follow-up examinations took place at 12 weeks and at 12 months. The Roles and Maudsley outcome score at 12 months, defining an excellent or good result with no or only occasional discomfort without limitation of activity and range of motion. Neither group differed statistically before the study, with a poor rating for all patients (p >.05). At 12 months, there was still no significant difference, with the outcome being excellent or good in 56% in group I, and in 60% in group II (p >.05). Each group showed significant improvement compared with the respective prestudy evaluation (p <.0001). ESWT may be an effective conservative treatment method for unilateral chronic tennis elbow. The efficacy of additional cervical manual therapy for lateral epicondylitis remains questionable.

  14. 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)

  15. Variation Coefficient of Stone Density: A Novel Predictor of the Outcome of Extracorporeal Shockwave Lithotripsy.

    PubMed

    Yamashita, Shimpei; Kohjimoto, Yasuo; Iguchi, Takashi; Nishizawa, Satoshi; Iba, Akinori; Kikkawa, Kazuro; Hara, Isao

    2017-04-01

    Although previous studies have indicated that stone heterogeneity can affect extracorporeal shockwave lithotripsy (SWL) outcomes, there is no established measurement of stone heterogeneity on CT imagery. We investigated whether variation coefficient of stone density (VCSD) can predict shockwave success. We conducted a retrospective review of 245 patients with urinary calculi who had undergone SWL. We compared the predictive powers of treatment success between VCSD and other parameters associated with CT attenuation. In addition, we performed logistic regression analysis to identify the factors contributing to treatment success. Treatment success was determined within 3 months after first treatment using noncontrast CT. The treatment success rate was 47.8% (117/245 cases). From receiver operating characteristic curves for treatment success, area under curve of VCSD (0.7181) was larger than that of mean stone density (MSD) (0.6384, p = 0.09) and standard deviation of stone density (0.5412, p < 0.01). Multivariate analysis revealed that MSD (p = 0.028) and VCSD (p < 0.001) independently predicted the outcome. Categorized by stone location, VCSD was the independent significant predictor for SWL outcomes in both kidney (p = 0.047) and ureteral calculi (p < 0.001). We found that VCSD can be a novel predictor of SWL success. The development of nomograms or scoring systems, including VCSD, can assist in the decision process for patients and minimize unnecessary delay in treatment of urolithiasis.

  16. Some aspects of shock-wave research

    NASA Astrophysics Data System (ADS)

    Glass, I. I.

    1986-01-01

    The major portion of the paper is devoted to a specific shock-wave research problem, namely, pseudostationary oblique shock-wave reflections in perfect and imperfect gases. Consideration is given to what has been achieved to date by using two- and three-shock theory to predict what type of reflection results when a planar shock wave M(S), in a shock tube, collides with a sharp compressive wedge of angle, theta(W). Expermental (interferometric and other optical) data are presented in (M(S), theta(W))-plots for argon, nitrogen, oxygen, air, carbon-dioxide, Freon-12 and sulfurhexafluoride, in order to check the validity of the analytically predicted regions and transition lines of the four types of reflection. Some disagreements are noted and discussed. The present interferometric isopycnic data are also compared with state-of-the-art computational results from a solution of the inviscid Euler equations using a CRAY I computer. Good agreement was obtained; it would be important, however, to obtain new data by solving the Navier-Stokes equations, as well as the rate equations for imperfect-gas excitations, in order to judge the improvement obtained with real-flow interferograms.

  17. Delayed stimulatory effect of low-intensity shockwaves on human periosteal cells.

    PubMed

    Tam, Kam-Fai; Cheung, Wing-Hoi; Lee, Kwong-Man; Qin, Ling; Leung, Kwok-Sui

    2005-09-01

    We investigated the effect of shockwaves on cells explanted from normal human periosteum to study the potential mechanisms of their responses and to determine suitable treatment settings. The cells were subjected to one shockwave treatment with systematic combinations of energy intensities (range, 0.05-0.5 mJ/mm) and number of shocks (range, 500-2000) whereas control cells received no treatment. The immediate effect on cell viability and the long-lasting effect on proliferation, viable cell number at Day 18, and mineralization at Day 35 were assessed. We observed an immediate dose-dependent destructive effect of shockwaves. Energy intensity and number of shocks contributed equally to viability. Total energy dose (intensity x number of shocks) was a better reference for determining the shockwave effect. We also found a long-term stimulatory effect on proliferation, viable cell number, and calcium deposition of human periosteal cells. At the same total energy dose, low-intensity shockwaves with more shocks (0.12 mJ/mm at 1250 shocks) were more favorable for enhancing cellular activities than high-intensity waves with fewer shocks (0.5 mJ/mm at 300 shocks). These findings document some of the biochemical changes of periosteal cells during shockwave treatments.

  18. Shock-wave measurement using a calibrated interferometric fiber-tip sensor.

    PubMed

    Koch, C; Molkenstruck, W; Reibold, R

    1997-01-01

    The results of shock-wave measurements using a calibrated fiber-tip sensor based on a Michelson interferometer are presented. A transfer function, obtained by an independent experiment that describes the properties of the sensor system, was used to correct the measured shock-wave data in the Fourier frequency domain. The phase of the transfer function was determined from its amplitude by a fitting procedure using minimum-phase terms. As an example of application, the acoustic output field of an electromagnetic lithotriptor was investigated, and the shock-wave source was reliably characterized. The measured data provide a basis for estimating the hazard to which a patient is exposed during shock-wave treatment and for optimizing a lithotriptor system to produce a sharply localized and effective acoustic field.

  19. 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

  20. Laser-induced shockwave propagation from ablation in a cavity

    SciTech Connect

    Zeng Xianzhong; Mao Xianglei; Mao, Samuel S.; Wen, S.-B.; Greif, Ralph; Russo, Richard E.

    2006-02-06

    The propagation of laser-induced shockwaves from ablation inside of cavities was determined from time-resolved shadowgraph images. The temperature and electron number density of the laser-induced plasma was determined from spectroscopic measurements. These properties were compared to those for laser ablation on the flat surface under the same energy and background gas condition. A theoretical model was proposed to determine the amount of energy and vaporized mass stored in the vapor plume based on these measurements.

  1. Efficacy of Extracorporeal Shockwave Therapy in Frozen Shoulder

    PubMed Central

    Vahdatpour, Babak; Taheri, Parisa; Zade, Abolghasem Zare; Moradian, Saeed

    2014-01-01

    Background: Frozen shoulder has always been considered important because of the impact on the quality-of-life and long period of illness. Therefore, the use of noninvasive and safe techniques that can speed up the healing process of the disease is important. Methods: This study was a randomized clinical trial study on patients suffering from frozen shoulder who were referred to Isfahan University of Medical Sciences hospitals in 2011 and 2012. A total of 36 patients were enrolled in the study. Eligible patients were allocated into two groups. Intervention group received extracorporeal shockwave therapy (ESWT) once a week for 4 weeks. The control group received sham shockwave therapy once a week for 4 weeks. On the follow-up period, changes in individual performance and the amount of pain and disability were assessed by the Shoulder Pain and Disability Index (SPADI) questionnaire and the range of motion changes were assessed by a goniometer. Data obtained were analyzed using SPSS software. Results: Variance analysis revealed a difference in the mean pain and disability score of the SPADI questionnaire, flexion, extension, and abduction, external rotation of involved shoulder between two groups before and after the shockwave therapy (P < 0.05). Improvement was more satisfactory in the intervention group, but the mean internal rotation did not differ significantly in two groups (P > 0.05). Conclusions: The use of ESWT seems to have positive effects on treatment, quicker return to daily activities, and quality-of-life improvement on frozen shoulder. PMID:25104999

  2. Shockwave Engine: Wave Disk Engine

    SciTech Connect

    2010-01-14

    Broad Funding Opportunity Announcement Project: MSU is developing a new engine for use in hybrid automobiles that could significantly reduce fuel waste and improve engine efficiency. In a traditional internal combustion engine, air and fuel are ignited, creating high-temperature and high-pressure gases which expand rapidly. This expansion of gases forces the engine’s pistons to pump and powers the car. MSU’s engine has no pistons. It uses the combustion of air and fuel to build up pressure within the engine, generating a shockwave that blasts hot gas exhaust into the blades of the engine’s rotors causing them to turn, which generates electricity. MSU’s redesigned engine would be the size of a cooking pot and contain fewer moving parts—reducing the weight of the engine by 30%. It would also enable a vehicle that could use 60% of its fuel for propulsion.

  3. Shockwave Interactions with Argon Glow Discharges

    DTIC Science & Technology

    2006-03-01

    grow. Therefore, a stable solution to ne and nm is not possible. This highlights the main features of why two-step ionization in a noble gas discharge...Shockwaves, generated by a spark gap, were launched into a direct current gas discharge in argon. The modification of the positive column structure was...the topic of shockwave interaction with weakly-ionized gas , the jump conditions for the neutral species at a shock front in argon are presented. The

  4. 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

  5. Report on the first 1000 patients treated at St Thomas' Hospital by extracorporeal shockwave lithotripsy.

    PubMed

    Palfrey, E L; Bultitude, M I; Challah, S; Pemberton, J; Shuttleworth, K E

    1986-12-01

    Since March 1985, over 1000 patients have been treated on the lithotripter at St Thomas' Hospital. Since it is the only machine in the country offering treatment to National Health Service patients at no cost to the referring Health Authority, there has been a heavy demand for treatment and 97% of referrals have been accepted. Analysis of the first 1000 patients shows extracorporeal shockwave lithotripsy (ESWL) to be a safe procedure with a low morbidity rate and no mortality. The number of patients who were stone-free 3 months after treatment was low (44.1%) compared with the numbers reported in other series. The most likely reasons for this are the poor follow-up rate (48.9%), the stringent criteria for the diagnosis of "stone-free" and a possible skewed referral and follow-up pattern.

  6. A shockwave approach for web-based clinical motion analysis.

    PubMed

    Lemaire, Edward

    2004-01-01

    Advances in Internet connectivity and personal multimedia computing have created opportunities for integrating simple motion analysis into clinical practice. The Macromedia Shockwave environment provides tools for creating media-rich software that runs within a Web browser. For this project, clinical motion analysis software was created using Shockwave that can load digital video clips of a client's motion, step/shuttle/play through the clip, superimpose a grid over the video image, measure relative joint angles, scale to a linear factor, measure distances, and measure average velocities. After installing the Shockwave and Quicktime video plug-ins, the Motion Analysis Tools-Shockwave program runs directly from a Web page hyperlink. Program testing involved comparing angle measurements, linear distances, stride length, and walking speed among six video clips. The first three clips were of a transtibial prosthesis being carried through the field of view (640 x 480, 320 x 240, 320 x 240 enlarged to 640 x 480). The second set of three clips was of a metal square carried through the field of view. Average root mean square errors were 2.0 degrees for angle measures and 1.2 cm for length measures. Stride length standard deviation was 4.6 cm (mean length = 212.1 cm). Average walking speed standard deviation was 0.015 m/s (mean speed = 1.15 m/s). The test results were consistent with video motion analysis results and within an acceptable range for clinical design-making. This Web-based motion analysis approach provides a useful tool for ubiquitous, quantitative, clinical gait analysis.

  7. Comparing non contrast computerized tomography criteria versus dual X-ray absorptiometry as predictors of radio-opaque upper urinary tract stone fragmentation after electromagnetic shockwave lithotripsy.

    PubMed

    Hameed, Diaa A; Elgammal, Mohammed A; ElGanainy, Ehab O; Hageb, Adel; Mohammed, Khaled; El-Taher, Ahmed Mohamed; Mostafa, Mostafa Mohamed; Ahmed, Abdelfatah Ibrahim

    2013-11-01

    The objective of this study was to assess the value of dual X-ray absorptiometry (DXA) in comparison to non contrast computed tomography (NCCT) density as possible predictors of upper urinary tract stone disintegration by shock wave lithotripsy (SWL). This study included 100 consecutive patients, with solitary renal stone 0.5-2 cm or upper ureteral stone up to 1 cm. DXA to calculate stone mineral density (SMD) and stone mineral content (SMC) was done. NCCT was performed to measure Hounsfield units (HU). SWL was performed with an electromagnetic lithotripsy, plain X-ray documented disintegration after SWL. Successful treatment was defined as stone free or complete fragmentation after 1 or 2 sessions of SWL. The impact of patients age, sex, body mass index, stone laterality, location, volume, length, mean SMC and SMD, HU and Hounsfield density (HD), skin to stone distance (SSD) and number of shock waves were evaluated by univariate and multivariate analysis. Only 76 patients were available for follow-up. Success of disintegration was observed in 50 out of 76 patients (65.8 %). On multivariate analysis, SMC and number of shock wave were the significant independent factors affecting SWL outcome (p = 0.04 and p = 0.000, respectively). SMC as detected by DXA is a significant predictor of success of stone disintegration by SWL. SMC measured by DXA is more accurate than HU measured by CT. Patients with high stone mineral content (SMC greater than 0.65 g) should be directly offered another treatment option.

  8. Renal Vasoconstriction Occurs Early During Shockwave Lithotripsy in Humans.

    PubMed

    Lee, Franklin C; Hsi, Ryan S; Sorensen, Mathew D; Paun, Marla; Dunmire, Barbrina; Liu, Ziyue; Bailey, Michael; Harper, Jonathan D

    2015-12-01

    In animal models, pretreatment with low-energy shock waves and a pause decreased renal injury from shockwave lithotripsy (SWL). This is associated with an increase in perioperative renal resistive index (RI). A perioperative rise is not seen without the protective protocol, which suggests that renal vasoconstriction during SWL plays a role in protecting the kidney from injury. The purpose of our study was to investigate whether there is an increase in renal RI during SWL in humans. Subjects were prospectively recruited from two hospitals. All subjects received an initial 250 shocks at low setting, followed by a 2-minute pause. Treatment power was then increased. Measurements of the renal RI were taken before start of procedure, at 250, after 750, after 1500 shocks, and at the end of the procedure. A linear mixed-effects model was used to compare RIs at the different time points. Fifteen patients were enrolled. Average treatment time was 46 ± 8 minutes. Average RI at pretreatment, after 250, after 750, after 1500 shocks, and post-treatment was 0.67 ± 0.06, 0.69 ± 0.08, 0.71 ± 0.07, 0.73 ± 0.07, and 0.74 ± 0.06, respectively. In adjusted analyses, RI was significantly increased after 750 shocks compared with pretreatment (p = 0.05). Renal RI increases early during SWL in humans with the protective protocol. Monitoring for a rise in RI during SWL is feasible and may provide real-time feedback as to when the kidney is protected.

  9. Renal Vasoconstriction Occurs Early During Shockwave Lithotripsy in Humans

    PubMed Central

    Hsi, Ryan S.; Sorensen, Mathew D.; Paun, Marla; Dunmire, Barbrina; Liu, Ziyue; Bailey, Michael; Harper, Jonathan D.

    2015-01-01

    Abstract Introduction: In animal models, pretreatment with low-energy shock waves and a pause decreased renal injury from shockwave lithotripsy (SWL). This is associated with an increase in perioperative renal resistive index (RI). A perioperative rise is not seen without the protective protocol, which suggests that renal vasoconstriction during SWL plays a role in protecting the kidney from injury. The purpose of our study was to investigate whether there is an increase in renal RI during SWL in humans. Materials and Methods: Subjects were prospectively recruited from two hospitals. All subjects received an initial 250 shocks at low setting, followed by a 2-minute pause. Treatment power was then increased. Measurements of the renal RI were taken before start of procedure, at 250, after 750, after 1500 shocks, and at the end of the procedure. A linear mixed-effects model was used to compare RIs at the different time points. Results: Fifteen patients were enrolled. Average treatment time was 46 ± 8 minutes. Average RI at pretreatment, after 250, after 750, after 1500 shocks, and post-treatment was 0.67 ± 0.06, 0.69 ± 0.08, 0.71 ± 0.07, 0.73 ± 0.07, and 0.74 ± 0.06, respectively. In adjusted analyses, RI was significantly increased after 750 shocks compared with pretreatment (p = 0.05). Conclusion: Renal RI increases early during SWL in humans with the protective protocol. Monitoring for a rise in RI during SWL is feasible and may provide real-time feedback as to when the kidney is protected. PMID:26239232

  10. Blood clot disruption in vitro using shockwaves delivered by an extracorporeal generator after pre-exposure to lytic agent.

    PubMed

    Goldenstedt, Cedric; Birer, Alain; Cathignol, Dominique; Lafon, Cyril

    2009-06-01

    The standard methods for recanalyzing thrombosed vessels are vascular stenting or administration of thrombolytic drugs. However, these methods suffer from uncertain success rate and side-effects. Therefore, minimally-invasive ultrasound methods have been investigated. In this article, we propose to use shockwaves after pre-exposure to fibrinolytic agent for disrupting thrombus. Shockwaves were delivered by an extracorporeal piezocomposite generator (120 mm in diameter, focused at 97 mm, pulse length = 1.4 micros). In vitro blood clots, made from human blood, were placed at the focal point of the generator. The clots were exposed to shockwaves either with or without prior immersion in a solution of streptokinase. The percentage of lysed clot was determined by weighing the clot before and after treatment. The proportion of lysed clot increased with the pressure at the focus and with the number of shocks. A mean clot reduction of 91% was obtained for 42 MPa in 4-min treatment duration only, without using streptokinase. For a treatment of 2 min at 29 MPa, the clot reduction increased significantly (p < 0.01) from 47% without streptokinase to 82% when streptokinase was used prior to shockwaves. These results also showed no significant damage to streptokinase due to exposure to shockwaves. This study suggests that extracorporeal shockwaves combined with streptokinase is a promising pharmaco-mechanical method for treating occlusive thrombus, and should be confirmed by in vivo trials. Additional studies must also be conducted with other fibrinolytic agents, whose abilities to penetrate clots are different.

  11. 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.

  12. 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.

  13. 1D GAS-DYNAMIC SIMULATION OF SHOCK-WAVE PROCESSES VIA INTERNET

    SciTech Connect

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

    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 stainless steel plates are presented in comparison with experimental data from Shakhray et al.(2005).

  14. D Gas-Dynamic Simulation of Shock-Wave Processes via Internet

    NASA Astrophysics Data System (ADS)

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

    2009-12-01

    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 stainless steel plates are presented in comparison with experimental data from Shakhray et al. (2005).

  15. 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.

  16. Superconductivity of Al/Al2O3 interface formed under shock-wave conditions

    NASA Astrophysics Data System (ADS)

    Shakhray, D. V.; Avdonin, V. V.; Palnichenko, A. V.; Vyaselev, O. M.

    2015-11-01

    A mixture of powdered Al and Al2O3 has been subjected to a shock-wave pressure of ≈ 170 kbar, followed by vacuum-encapsulating and quenching of the product to liquid nitrogen. The ac magnetic susceptibility measurements of the samples have revealed metastable superconductivity with Tc ≈ 37 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 interfacial granular layer formed between metallic Al and its oxide due to the shock-wave treatment.

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

    NASA Astrophysics Data System (ADS)

    Palnichenko, A. V.; Sidorov, N. S.; Shakhrai, D. V.; Avdonin, V. V.; Vyaselev, O. M.; Khasanov, S. S.

    2014-03-01

    A mixture of powdered Cu and CuO has been subjected to a 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≈19.5 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.

  18. Extracorporeal shockwave therapy for peyronie disease.

    PubMed

    Groth, T; Monga, M

    2003-01-01

    While surgery is the mainstay of therapy for Peyronie disease requiring correction of angulation, interest has grown in the application of extracorporeal shockwave therapy (ESWT) as a minimally invasive approach. This article reviews the current literature reporting the use of ESWT for Peyronie disease.

  19. Shockwaves induce osteogenic differentiation of human mesenchymal stem cells through ATP release and activation of P2X7 receptors.

    PubMed

    Sun, Dahui; Junger, Wolfgang G; Yuan, Changji; Zhang, Wenyan; Bao, Yi; Qin, Daming; Wang, Chengxue; Tan, Lei; Qi, Baochang; Zhu, Dong; Zhang, Xizheng; Yu, Tiecheng

    2013-06-01

    Shockwave treatment promotes bone healing of nonunion fractures. In this study, we investigated whether this effect could be due to adenosine 5'-triphosphate (ATP) release-induced differentiation of human mesenchymal stem cells (hMSCs) into osteoprogenitor cells. Cultured bone marrow-derived hMSCs were subjected to shockwave treatment and ATP release was assessed. Osteogenic differentiation and mineralization of hMSCs were evaluated by examining alkaline phosphatase activity, osteocalcin production, and calcium nodule formation. Expression of P2X7 receptors and c-fos and c-jun mRNA was determined with real-time reverse transcription polymerase chain reaction and Western blotting. P2X7-siRNA, apyrase, P2 receptor antagonists, and p38 MAPK inhibitors were used to evaluate the roles of ATP release, P2X7 receptors, and p38 MAPK signaling in shockwave-induced osteogenic hMSCs differentiation. Shockwave treatment released significant amounts (≈ 7 μM) of ATP from hMSCs. Shockwaves and exogenous ATP induced c-fos and c-jun mRNA transcription, p38 MAPK activation, and hMSC differentiation. Removal of ATP with apyrase, targeting of P2X7 receptors with P2X7-siRNA or selective antagonists, or blockade of p38 MAPK with SB203580 prevented osteogenic differentiation of hMSCs. Our findings indicate that shockwaves release cellular ATP that activates P2X7 receptors and downstream signaling events that caused osteogenic differentiation of hMSCs. We conclude that shockwave therapy promotes bone healing through P2X7 receptor signaling, which contributes to hMSC differentiation.

  20. Extracorporeal shockwave lithotripsy of gallstones. Possibilities and limitations.

    PubMed Central

    Vergunst, H; Terpstra, O T; Brakel, K; Laméris, J S; van Blankenstein, M; Schröder, F H

    1989-01-01

    Recently extracorporeal shockwave lithotripsy (ESWL) has been introduced as a nonoperative treatment for gallstone disease. Except for lung damage, no significant adverse effects of ESWL of gallbladder stones have been observed in animals. In clinical use ESWL of gallbladder stones is now confined to 15% to 30% of symptomatic patients. To achieve complete stone clearance, ESWL of gallbladder stones must be supplemented by an adjuvant therapy. ESWL of bile duct stones is highly effective and can be considered in patients in whom primary endoscopic or surgical stone removal fails. Second generation lithotriptors allow anesthesia-free (outpatient) treatments, but the clinical experience with most of these ESWL devices is still limited. The likelihood of gallbladder stone recurrence is a major disadvantage of ESWL treatment, which raises the issue of cost-effectiveness. ESWL for cholelithiasis is a promising treatment modality with good short-term and unknown long-term results. PMID:2684058

  1. Use of shock-wave heating for faster and safer ablation of tissue volumes in high intensity focused ultrasound therapy

    NASA Astrophysics Data System (ADS)

    Khokhlova, V.; Yuldashev, P.; Sinilshchikov, I.; Partanen, A.; Khokhlova, T.; Farr, N.; Kreider, W.; Maxwell, A.; Sapozhnikov, O.

    2015-10-01

    Simulation of enhanced heating of clinically relevant tissue volumes using nonlinear ultrasound waves generated by a multi-element HIFU phased array were conducted based on the combined Westervelt and bio-heat equations. A spatial spectral approach using the fast Fourier transform algorithm and a corresponding analytic solution to the bioheat equation were used to optimize temperature modeling in tissue. Localized shock-wave heating within a much larger treated tissue volume and short, single HIFU pulses within a much longer overall exposure time were accounted for in the algorithm. Separation of processes with different time and spatial scales made the calculations faster and more accurate. With the proposed method it was shown that for the same time-average power, the use of high peak power pulsing schemes that produce high-amplitude shocks at the focus result in faster tissue heating compared to harmonic, continuous-wave sonications. Nonlinear effects can significantly accelerate volumetric heating while also permitting greater spatial control to reduce the impact on surrounding tissues. Such studies can be further used to test and optimize various steering trajectories of shock-wave sonications for faster and more controlled treatment of tissue volumes.

  2. Comparative Effectiveness of Nonoperative Treatments for Chronic Calcific Tendinitis of the Shoulder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

    PubMed

    Wu, Yi-Cheng; Tsai, Wen-Chung; Tu, Yu-Kung; Yu, Tung-Yang

    2017-08-01

    To investigate the effectiveness of various nonoperative treatments for chronic calcific tendinitis of the shoulder, a systematic review and network meta-analysis of randomized trials was performed to evaluate changes in pain reduction, functional improvements in patients with calcific tendinitis, and the ratio of complete resolution of calcific deposition. Studies were comprehensively searched, without language restrictions, on PubMed, Embase, Cochrane Controlled Trials Register, the Cochrane, and other databases. The reference lists of articles and reviews were cross-checked for possible studies. Randomized controlled trials from before August 2016 were included. Study selection was conducted by 2 reviewers independently. The quality of studies was assessed and data extracted by 2 independent reviewers. Disagreements were settled by consulting a third reviewer to reach a consensus. Fourteen studies with 1105 participants were included in the network meta-analysis that used a random-effect model to investigate the mean difference of pooled effect sizes of the visual analog scale, Constant-Murley score, and the ratio of complete resolution of calcific deposition on native radiographs. The present network meta-analysis demonstrates that ultrasound-guided needling (UGN), radial extracorporeal shockwave therapy (RSW), and high-energy focused extracorporeal shockwave therapy (H-FSW) alleviate pain and achieve complete resolution of calcium deposition. Compared with low-energy focused extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and ultrasound therapy, H-FSW is the best therapy for providing functional recovery. Physicians should consider UGN, RSW, and H-FSW as alternative effective therapies for chronic calcific tendinitis of the shoulder when initial conservative treatment fails. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  3. [The characteristics or urolithiasis in flight personnel and the treatment results using a method of extracorporeal shockwave lithotripsy on the Russian lithotripter Urat-P2].

    PubMed

    Garilevich, B A; Avdeĭchuk, Iu I

    1995-01-01

    Urolithiasis occurs more frequently in the pilots than in the ground-service personnel. To decrease a damaging effect of the focused shock waves on the renal tissue while using remote lithotripsy technique, a new domestic-certified lithotriptor "URAT-P2" which shows a significantly low energy of shock wave with sufficient effectiveness of crushing the renal stones, is devised. Urolithiasis in the pilots is apparent at the early stages of its development and its complicated forms are less common than in the subjects of other professions. The stones are predominantly located in the renal calyces (73,3% of cases), in the left kidney and urethra in 63,3% of cases and there were urate stones in 40% of cases. The clinical use of the URAT-P2 complex in 30 pilots indicated that it holds advantages over the production domestic-certified lithotriptor. The stones are crushed in all the patients but the complications associated with a negative effect of the focused shock waves on the renal tissue are absent. The use of the new lithotriptor for treating urolithiasis in the pilots will allow one to improve the treatment response and to maintain professional worthiness of the pilots for a long time.

  4. Update, comparing different plate treatments and design

    NASA Technical Reports Server (NTRS)

    Baer, D.

    1980-01-01

    Eight electrochemical cells were tested for precycling capacity and compared. The cell design variables included teflon treatment, silver treatment, light loading, and a polypropylene separator. Data are presented in tabular form.

  5. Three lectures: NEMD, SPAM, and shockwaves

    NASA Astrophysics Data System (ADS)

    Hoover, Wm. G.; Hoover, Carol G.

    2011-03-01

    We discuss three related subjects well suited to graduate research. The first, Nonequilibrium molecular dynamics or "NEMD", makes possible the simulation of atomistic systems driven by external fields, subject to dynamic constraints, and thermostated so as to yield stationary nonequilibrium states. The second subject, Smooth Particle Applied Mechanics or "SPAM", provides a particle method, resembling molecular dynamics, but designed to solve continuum problems. The numerical work is simplified because the SPAM particles obey ordinary, rather than partial, differential equations. The interpolation method used with SPAM is a powerful interpretive tool converting point particle variables to twice-differentiable field variables. This interpolation method is vital to the study and understanding of the third research topic we discuss, strong shockwaves in dense fluids. Such shockwaves exhibit stationary far-from-equilibrium states obtained with purely reversible Hamiltonian mechanics. The SPAM interpolation method, applied to this molecular dynamics problem, clearly demonstrates both the tensor character of kinetic temperature and the time-delayed response of stress and heat flux to the strain rate and temperature gradients. The dynamic Lyapunov instability of the shockwave problem can be analyzed in a variety of ways, both with and without symmetry in time. These three subjects suggest many topics suitable for graduate research in nonlinear nonequilibrium problems.

  6. Causality violation, gravitational shockwaves and UV completion

    NASA Astrophysics Data System (ADS)

    Hollowood, Timothy J.; Shore, Graham M.

    2016-03-01

    The effective actions describing the low-energy dynamics of QFTs involving gravity generically exhibit causality violations. These may take the form of superluminal propagation or Shapiro time advances and allow the construction of "time machines", i.e. spacetimes admitting closed non-spacelike curves. Here, we discuss critically whether such causality violations may be used as a criterion to identify unphysical effective actions or whether, and how, causality problems may be resolved by embedding the action in a fundamental, UV complete QFT. We study in detail the case of photon scattering in an Aichelburg-Sexl gravitational shockwave background and calculate the phase shifts in QED for all energies, demonstrating their smooth interpolation from the causality-violating effective action values at low-energy to their manifestly causal high-energy limits. At low energies, these phase shifts may be interpreted as backwards-in-time coordinate jumps as the photon encounters the shock wavefront, and we illustrate how the resulting causality problems emerge and are resolved in a two-shockwave time machine scenario. The implications of our results for ultra-high (Planck) energy scattering, in which graviton exchange is modelled by the shockwave background, are highlighted.

  7. Comparing extracorporeal shock wave lithotripsy and ureteroscopy for treatment of proximal ureteric calculi: a cost-effectiveness study.

    PubMed

    Izamin, I; Aniza, I; Rizal, A M; Aljunid, S M

    2009-03-01

    Extracorporeal shockwave lithotripsy (ESWL) and ureteroscopy (URS) are two main methods of treating proximal ureteric stones. Success rates and cost-effectiveness of the two methods were compared. A total of 67 patients who underwent treatment between January 2007 and July 2007 at a state general hospital were included in the study. The success rate for ESWL group was 81.8% and for URS group was 84.6%. ESWL technique produced a significant higher overall cost per patient than URS (RM930.02 versus RM621.95 respectively). There was no significant difference in quality of patient's life. Cost-effectiveness ratio was lower for URS. The analysis suggested that URS was more cost-effective than ESWL.

  8. Shockwave-induced deformation of organic particles during laser shockwave cleaning

    NASA Astrophysics Data System (ADS)

    Hoon Kim, Tae; Cho, Hanchul; Busnaina, Ahmed; Park, Jin-Goo; Kim, Dongsik

    2013-08-01

    Although the laser shockwave cleaning process offers a promising alternative to conventional dry-cleaning processes for nanoscale particle removal, its difficulty in removing organic particles has been an unexplained problem. This work elucidates the physics underlying the ineffectiveness of removing organic particles using laser shock cleaning utilizing polystyrene latex particles on silicon substrates. It is found that the shockwave pressure is high enough to deform the particles, increasing the contact radius and consequently the particle adhesion force. The particle deformation has been verified by high-angle scanning electron microscopy. The Maugis-Pollock theory has been applied to predict the contact radius, showing good agreement with the experiment.

  9. High-energy extracorporeal shockwave therapy in a patellar tendon animal model: a vascularization-focused study

    PubMed Central

    Penteado, Fernando Travaglini; Faloppa, Flávio; Giusti, Guilherme; Moraes, Vinícius Ynoe; Belloti, João Carlos; dos Santos, João Baptista Gomes

    2011-01-01

    OBJECTIVE: The aim of this study was to analyze the effect of high-energy extracorporeal shockwave therapy on tendon angiogenesis in the patellar tendons of rabbits. We sought to investigate whether different voltage and number pulses modify the angiogenesis pattern. INTRODUCTION: High-energy extracorporeal shockwave therapy is an option in the treatment of orthopedic diseases such as chronic tendonitis. Despite its potential clinical applicability, there have been few studies on this technique that examine both its clinical effectiveness and its effect on angiogenesis. METHODS: High-energy extracorporeal shockwave therapy was applied at the tibial insertion of the left patellar ligament in 30 rabbits that were separated into six groups that differed in terms of the voltage and number of pulses that were applied by high-energy extracorporeal shockwave therapy. The tibial insertion in the right legs of the animals was used as the control. After six weeks, we performed histological analysis on the region and quantified the number of blood vessels. RESULTS: No significant differences in the number of blood vessels between the left and right patellar tendons were found within groups. Additionally, no significant differences in the number of blood vessels in the left patellar tendons were found between groups. CONCLUSIONS: The application of high-energy extracorporeal shockwave therapy did not cause a change in vascularization in the patellar tendon in rabbits. PMID:22179168

  10. Failure after shockwave lithotripsy: is outcome machine dependent?

    PubMed

    Argyropoulos, A N; Tolley, D A

    2009-10-01

    To investigate the issue of shockwave lithotripsy failure by studying the effect of machine crossover to the Technomed Sonolith Vision (TSV) lithotriptor in patients with previously unsuccessfully treated renal stones with the Dornier Compact Delta (DCD). Records were examined for the period between 1998 and 2006. Parameters analysed were: size, multiple/single stones, location, treatments/stone. Seventy-six patients fulfilled the inclusion criteria. Following lithotripsy with the TSV, the stone-free rate (SFR) at 3 months was 56.7%, and the success rate (stone-free and fragments < or = 4 mm, SR) 86.7%. Twenty-two patients had multiple stones and the majority of the stones were located in the lower calyx (59.2%). Mean size was 8.9 mm prior to treatment with the TSV machine (10.2 mm for DCD). Further analysis followed in a subgroup of 42 patients of the same stone size (+/-2 mm) before and after DCD sessions. Mean stone size was 7 mm. The SFR was 61.9% (62.9% vs. 40.9% for single and multiple stones), and the SR was 88.1%. No difference in SFR was found for single or multiple stones in any of the two groups. The term 'extracorporeal shockwave lithotripsy (ESWL)-resistant stones' needs to be re-examined, as treatment with a different lithotriptor was successful in a group of stones where another machine had failed. Lithotripters with different shock wave characteristics may result in difference in the results of ESWL. Future research in ESWL should focus on stone characteristics and development of machines with the ability to adapt to specific stone features.

  11. Extracorporeal shockwaves induce the expression of ATF3 and GAP-43 in rat dorsal root ganglion neurons.

    PubMed

    Murata, Ryo; Ohtori, Seiji; Ochiai, Nobuyasu; Takahashi, Norimasa; Saisu, Takashi; Moriya, Hideshige; Takahashi, Kazuhisa; Wada, Yuichi

    2006-07-30

    Although extracorporeal shockwave has been applied in the treatment of various diseases, the biological basis for its analgesic effect remains unclear. Therefore, we investigated the dorsal root ganglion neurons of rats following shockwave exposure to the footpad to elucidate its effect on the peripheral nervous system. We used activating transcription factor 3 (ATF3) and growth-associated phosphoprotein (GAP-43) as markers for nerve injury and axonal regeneration, respectively. The average number of neurons immunoreactive for ATF3 increased significantly in the treated rats at all experimental time points, with 78.3% of those neurons also exhibiting immunoreactivity for GAP-43. Shockwave exposure induced injury of the sensory nerve fibers within the exposed area. This phenomenon may be linked to the desensitization of the exposure area, not the cause of pain, considering clinical research with a particular absence of painful adverse effect. Subsequent active axonal regeneration may account for the reinnervation of exposed area and the amelioration of the desensitization.

  12. Extracorporeal shockwave: mechanisms of action and physiological aspects for cellulite, body shaping, and localized fat-Systematic review.

    PubMed

    Modena, Débora A Oliveira; da Silva, Caroline Nogueira; Grecco, Clovis; Guidi, Renata Michelini; Moreira, Renata Gomes; Coelho, Andresa A; Sant'Ana, Estela; de Souza, José Ricardo

    2017-10-01

    Extracorporeal Shockwave Therapy (ESWT) has had a wide use in rehabilitation, and has presented positive effects in the treatment of unaesthetic affections. The objective of the present study was to search, in the literature, the mechanisms of action and the physiological aspects of shockwaves acting on the biological tissue to improve the condition of cellulite and localized fat. The systematic review of the literature was carried out in the period of September 2016 to February 2017 based on the bibliographic databases such as Lilacs, Medline, PubMed, and SciELO. Fifteen articles were identified in that systematic review, three of which were excluded as they did not make the complete access to the article available or the theme investigated did not encompass the objective of the study. The revision demonstrated that extracorporeal shockwaves present relevant effects on the biological tissue, which leads to the restructuring of skin properties and subcutaneous tissue, thus clinically improving the aspects of cellulite and localized fat.

  13. Shockwaves increase T-cell proliferation and IL-2 expression through ATP release, P2X7 receptors, and FAK activation.

    PubMed

    Yu, Tiecheng; Junger, Wolfgang G; Yuan, Changji; Jin, An; Zhao, Yi; Zheng, Xueqing; Zeng, Yanjun; Liu, Jianguo

    2010-03-01

    Shockwaves elicited by transient pressure disturbances are used to treat musculoskeletal disorders. Previous research has shown that shockwave treatment affects T-cell function, enhancing T-cell proliferation and IL-2 expression by activating p38 mitogen-activated protein kinase (MAPK) signaling. Here we investigated the signaling pathway by which shockwaves mediate p38 MAPK phosphorylation. We found that shockwaves at an intensity of 0.18 mJ/mm(2) induce the release of extracellular ATP from human Jurkat T-cells at least in part by affecting cell viability. ATP released into the extracellular space stimulates P2X7-type purinergic receptors that induce the activation of p38 MAPK and of focal adhesion kinase (FAK) by phosphorylation on residues Tyr397 and Tyr576/577. Elimination of released ATP with apyrase or inhibition of P2X7 receptors with the antagonists KN-62 or suramin significantly weakens FAK phosphorylation, p38 MAPK activation, IL-2 expression, and T-cell proliferation. Conversely, addition of exogenous ATP causes phosphorylation of FAK and p38 MAPK. Silencing of FAK expression also reduces these cell responses to shockwave treatment. We conclude that shockwaves enhance p38 MAPK activation, IL-2 expression, and T-cell proliferation via the release of cellular ATP and feedback mechanisms that involve P2X7 receptor activation and FAK phosphorylation.

  14. Radial extracorporeal shock-wave therapy in rotator cuff calcific tendinosis

    PubMed Central

    Mangone, Giuseppe; Veliaj, Altin; Postiglione, Marco; Viliani, Tamara; Pasquetti, Pietro

    2010-01-01

    The objective of the study is to evaluate the effectiveness of Radial Extracorporeal Shock-wave Therapy (RESWT) compared with High Power LASER Therapy (HPLT) for the treatment of patients with Rotator Cuff Calcific Tendinosis (RCCT). RCCT is widely diffused, it is painful and invalidating. It is an important public health problem with social and economic implications. The most common therapeutic approach is a physiotherapic one. Both HPLT and RESWT give positive results. There is a debate on which is to be preferred. Therefore there is need to obtain scientific evidence to support either case. An observational study was carried out in the period between October 2008 and September 2009 in our outpatient clinic with 62 patients, divided into 3 groups: group A 36 patients treated only with RESWT, group B 26 patients treated only with HPLT and group C 16 patients with only short term improvement with HPLT retreated with RESWT. Patients were evaluated with Constant-Murley scale before and after treatment (immediately, 1 month and 3 months) for mean constant score, pain and range of movement. Data were examined statistically with SPSS. Criteria for inclusion and exclusion were defined. Patients treated with HPLT have shown good clinical results but have returned to original syndrome 1 month after treatment. RESWT has given improvement after treatment extended in time (3 months) in terms of pain and recover of functionality with a limited number of applications. The evidence collected indicates that RESWT is the method of choice. PMID:22460011

  15. Reynolds number effects on shock-wave turbulent boundary-layer interactions - A comparison of numerical and experimental results

    NASA Technical Reports Server (NTRS)

    Horstman, C. C.; Settles, G. S.; Vas, I. E.; Bogdonoff, S. M.; Hung, C. M.

    1977-01-01

    An experiment is described that tests and guides computations of a shock-wave turbulent boundary-layer interaction flow over a 20-deg compression corner at Mach 2.85. Numerical solutions of the time-averaged Navier-Stokes equations for the entire flow field, employing various turbulence models, are compared with the data. Each model is critically evaluated by comparisons with the details of the experimental data. Experimental results for the extent of upstream pressure influence and separation location are compared with numerical predictions for a wide range of Reynolds numbers and shock-wave strengths.

  16. Acute and chronic bioeffects of single and multiple doses of piezoelectric shockwaves (EDAP LT.01).

    PubMed

    Ryan, P C; Jones, B J; Kay, E W; Nowlan, P; Kiely, E A; Gaffney, E F; Butler, M R

    1991-02-01

    Piezoelectric second generation lithotriptors are an established means of administering extracorporeal shockwave lithotripsy (ESWL) enabling treatment to be performed without anaesthesia or analgesia, but higher shockwave doses and multiple or staged treatment are frequently required. The bioeffects of this modality of ESWL, therefore, require further assessment. Seven experimental groups of adult male rabbits were treated using the EDAP LT.01 in order to determine the acute and chronic bioeffects of clinical dose, excess dose, divided excess dose, high frequency and multiple treatment (X10) piezoelectric shockwaves (PSW). Renal function was measured before and after treatment using mercaptoacetyltriglycine (MAG 3) scans. Gross and histological morphological changes were assessed at one and 30 days following application of PSW. Application of single clinical dose PSW was not associated with any significant functional or morphological renal injury. Excess dose PSW caused transient gross renal contusion, which resolved in the majority of animals with no persistent microscopic abnormality. Divided excess dose PSW resulted in no gross or microscopic damage. High frequency PSW was associated with mild histological abnormality. Multiple PSW treatments caused small discrete fibrotic lesions in all cases, without any change in renal function.

  17. 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.

  18. Experimental Results on Shock-Wave Interaction on Compression Ramps

    NASA Astrophysics Data System (ADS)

    Passaro, A.; Fantoni, G.; Biagioni, L.; Cardone, G.

    2005-02-01

    A set of new experimental tests was carried out with intrusive and non-intrusive measurements related to Shock-Wave Boundary-Layer Interaction (SWBLI) on a 15 deg compression ramp model in a Mach 6 flow with total enthalpy of 1.8-2.5 MJ/kg. The facility was the modified High Enthalpy Arc-heated Tunnel at Alta, Pisa, Italy, with improved performance and diagnostics, in order to provide good control on the actual properties of the tunnel flow. The model shape and test conditions were the same of the previous test campaign carried out during the FESTIP programme. The new results confirmed a good agreement between intrusive and non-intrusive measurements and were also compared with success with numerical predictions, eventually explaining the discrepancy on wall heat flux that was found on the previous test campaign.

  19. Spall fracture of beryllium under shockwave loading

    NASA Astrophysics Data System (ADS)

    Skokov, Viktor; Arinin, Vladimir; Kryuchkov, Dmitry; Ogorodnikov, Vladimir; Raevsky, Viktor; Panov, Konstantin; Peshkov, Viktor; Tyupanova, Olga

    2012-03-01

    We present investigations of beryllium spall fracture with samples of dimensions ø 65×7 mm, which were made via vacuum hot pressing. Samples were loaded at normal incidence by a detonation wave of the explosive charge of TG 5/5 composition, 7, 14 and 30 mm in thickness, which gave shockwave stresses of 21-25 GPa within the sample. Spall fractures formed as the sample unloading at an air gap. A velocity profile was measured at the free boundary using VISAR laser interferometer, a spall layer thickness was measured with two-frame impulse X-ray radiography, and the shockwave profile was measured via a manganin-based gauge in a fluoroplastic base in the course of deceleration of a spall layer and of a basic part of beryllium. Hugoniot dynamic yield strength (YHE) and spall strength (σP) were measure as 0.69-0.73 GPa and 0.85±0.03 GPa, respectively, at a strain rate of ɛ ~104 s-1 in the unloading part of the incident pulse. A weak dependence between the spall layer thickness and HE layer thickness was recorded in tests. The weak dependence is not described through existing damage models and points to the need to develop more sophisticated models.

  20. Developing A Laser Shockwave Model For Characterizing Diffusion Bonded Interfaces

    SciTech Connect

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

    2014-07-01

    12. Other advances in QNDE and related topics: Preferred Session Laser-ultrasonics Developing A Laser Shockwave Model For Characterizing Diffusion Bonded Interfaces 41st Annual Review of Progress in Quantitative Nondestructive Evaluation Conference QNDE Conference July 20-25, 2014 Boise Centre 850 West Front Street Boise, Idaho 83702 James A. Smith, Jeffrey M. Lacy, Barry H. Rabin, Idaho National Laboratory, Idaho Falls, ID ABSTRACT: The US National Nuclear Security Agency has a Global Threat Reduction Initiative (GTRI) which is assigned with 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. The new LEU fuel is based on a monolithic fuel made from a U-Mo alloy foil encapsulated in Al-6061 cladding. In order to complete the fuel qualification process, the laser shock technique is being developed to characterize the clad-clad and fuel-clad interface strengths in fresh and irradiated fuel plates. The Laser Shockwave Technique (LST) is being investigated to characterize interface strength in fuel plates. LST is a non-contact method that uses lasers for the generation and detection of large amplitude acoustic waves to characterize interfaces in nuclear fuel plates. However the deposition of laser energy into the containment layer on specimen’s surface is intractably complex. The shock wave energy is inferred from the velocity on the backside and the depth of the impression left on the surface from the high pressure plasma pulse created by the shock laser. To help quantify the stresses and strengths at the interface, a finite element model is being developed and validated by comparing numerical and experimental results for back face velocities and front face depressions with experimental results. This paper will report on initial efforts to develop a finite element model for laser

  1. New developments in shockwave technology intended for meat tenderization: Opportunities and challenges. A review.

    PubMed

    Bolumar, Tomas; Enneking, Mathias; Toepfl, Stefan; Heinz, Volker

    2013-12-01

    Meat tenderness is an important quality parameter determining consumer acceptance and price. Meat tenderness is difficult to ensure in the global meat chain because the production systems are not always aiming at this purpose (ex.: cattle derived from milk production) and by the existence within the carcass of "tough" primals. Different methods can be used by the meat industry to improve meat tenderness each with its advantages and drawbacks. The application of hydrodynamic pressure or shockwaves has showed outstanding improvements by reducing the Warner Bratzler Shear Force by 25% or more. However, the technology has not penetrated into the market as first systems were based on the use of explosives and further developments seemed to lack the robustness to fulfill industrial requirements. The present paper describes the main challenges to construct a prototype for the continuous treatment of meat by shockwaves based on electrical discharges under water. Finally, improvements on the tenderness of meat by using the novel prototype are presented.

  2. Impact of ureteric stent on outcome of extracorporeal shockwave lithotripsy: A propensity score analysis

    PubMed Central

    Gołąb, Adam; Słojewski, Marcin

    2016-01-01

    Introduction Extracorporeal shockwave lithotripsy (SWL) is one of the most frequently performed procedures in patients with urolithiasis. For ureter-localized stones, SWL is often preceded by a double J stent insertion. However, fear of serious complications, including sepsis associated with stents, is often expressed. The following study assessed the impact of stent insertions on the results of SWL in patients with ureteric stones. Material and methods The study group consisted of 411 ureteric stone patients who were treated with SWL from January 2010 to December 2014. In 60 cases, treatment was preceded by ureteric stent insertion. A propensity scoring system was used to pair non-stented patients with the stented group. Success rates were assessed and compared using the chi-squared test. Multivariate logistic regression analysis was used to evaluate the influence of particular variables on the stone-free rate. Results The overall success rate was 82.2%. After matching, the success rate of the stented group was not significantly different from the control group (85.0% vs. 83.3% respectively, p = 0.80). The mean number of sessions was higher in the stented group (1.88 per patient). Stones located in the lower part of the ureter have the greatest chance of being successfully treated. Conclusions The double J stent has no influence on the outcome of SWL treatment. In view of the greater likelihood of having additional sessions, this approach should be reserved for selected cases. PMID:27551556

  3. [The history of extracorporeal shockwave lithotripsy in Spain].

    PubMed

    Ruíz Marcellán, Francisco Javier; Ibarz Servio, Luis

    2007-10-01

    We give a historical outline of urinary lithiasis with emphasis in the alternative therapeutic options to surgery. We expose the previous steps that led to the birth of extracorporeal shockwave lithotripsy and its implementation in our country.

  4. Detecting cavitation in vivo from shock-wave therapy devices

    NASA Astrophysics Data System (ADS)

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

    2005-04-01

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

  5. [A 10-month experience with extracorporeal shockwave therapy of urolithiasis].

    PubMed

    García Sisamón, F; Ferrer Roda, J; Tudela Bañuls, O; Ferrer Bosch, L

    1990-01-01

    From November 1987 treatment of urinary lithiasis regardless location was initiated in our Service of extracorporal renal lithofragmentation using shockwaves. Up until August 1988 (10 months), 411 patients have been treated representing a total of 590 lithiasis and 699 sessions on which the present communication is based; treatment included calculus of various chemical composition, as well as different sizes and locations. Also the relationship between sex, age, number of waves, use of analgesia, hospital stay, etc, has been considered. Results obtained after a 2.5 months follow-up are: 60.34% fragments-free and 39.41% in expulsion stage. Monotherapy was chosen in 98% cases and multiple drug therapy in the remaining 2%. There has been no case of complementary open surgical therapy. Thus, we consider extracorporal renal lithofragmentation as the ideal treatment for urinary lithiasis, as long as the indication is correct. And we believe it to be the ideal treatment since it is a simple procedure, highly effective and with few complications.

  6. Influence of shockwave profile on ejecta

    SciTech Connect

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

    2009-01-01

    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. Assay foils, optical shadowgraphy, and x-ray attenuation.

  7. Does extracorporeal shockwave lithotripsy cause hypertension?

    PubMed

    Montgomery, B S; Cole, R S; Palfrey, E L; Shuttleworth, K E

    1989-12-01

    Several series have suggested that the incidence of hypertension following extracorporeal shockwave lithotripsy (ESWL) may be as high as 8%. In this study, changes in blood pressure and the incidence of hypertension have been observed in 733 patients 12 to 44 months after renal ESWL on the Dornier HM3. The incidence of hypertension following ESWL was 8.1%. In patients with a pre-ESWL diastolic pressure less than 90 mmHg, the incidence of those with a diastolic greater than or equal to 100 mm Hg post-operatively was significantly greater than that predicted by historical data. There was no overall change in the mean blood pressure of the group. The hypertensive risk of ESWL remains unclear. However, blood pressure surveillance should be performed following ESWL and a prospective study is required.

  8. Comparing two treatments by decision theory.

    PubMed

    Longford, Nicholas T

    2016-09-01

    Decision theory is applied to the general problem of comparing two treatments in an experiment with subjects assigned to the treatments at random. The inferential agenda covers collection of evidence about superiority, non-inferiority and average bioequivalence of the treatments. The proposed approach requires defining the terms 'small' and 'large' to qualify the magnitude of the treatment effect and specifying the losses (or loss functions) that quantify the consequences of the incorrect conclusions. We argue that any analysis that ignores these two inputs is deficient, and so is any ad hoc way of taking them into account. Sample size calculation for studies intended to be analysed by this approach is also discussed. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  9. Extracorporeal shockwave lithotripsy for renal stones in pediatric patients: a multivariate analysis model for estimating the stone-free probability.

    PubMed

    El-Nahas, Ahmed R; El-Assmy, Ahmed M; Awad, Bassam A; Elhalwagy, Samer M; Elshal, Ahmed M; Sheir, Khaled Z

    2013-12-01

    To define factors affecting the stone-free rate of extracorporeal shockwave lithotripsy in the treatment of pediatric renal calculi, and to establish a regression model for pretreatment prediction of stone-free probability. From January 1999 through February 2012, 207 children with mean age 6.4 ± 3.8 years underwent shockwave lithotripsy with Dornier Lithotripter S for treatment of renal stones. The stone-free rate was evaluated 3 months after the last shockwave lithotripsy session with non-contrast computed tomography. Treatment success was defined as complete clearance of the stones with no residual fragments. Multivariate logistic regression analysis was used to identify independent risk factors and to predict the probability of being stone free. The mean length of the stone was 11.6 ± 4 mm. The stone-free rate was 71%. Independent factors that adversely affect stone-free rate were increasing stone length and calyceal site of the stone. Relative risks for not being free of stones were 1.123 for stone length, 2.673 for stones in the upper or middle calyx and 4.208 for lower calyx stones. Stone length and location are prognostic factors determining stone-free rate after shockwave lithotripsy for renal calculi in pediatric patients. Based on our analysis, shockwave lithotripsy should be recommended for renal pelvis stones up to 24 mm, upper or middle calyceal stones up to 15 mm and lower calyceal stones up to 11 mm. © 2013 The Japanese Urological Association.

  10. Extracorporeal shockwave therapy and therapeutic exercise for supraspinatus and biceps tendinopathies in 29 dogs.

    PubMed

    Leeman, J J; Shaw, K K; Mison, M B; Perry, J A; Carr, A; Shultz, R

    2016-10-15

    Supraspinatus tendinopathy (ST) and biceps tendinopathy (BT) are common causes of forelimb lameness in large-breed dogs and have historically been treated with conservative management or surgery. Extracorporeal shockwave therapy (ESWT) and therapeutic exercise (TE) are thought to be treatment options for these conditions. The objectives of this study were to report the clinical presentations of dogs treated with ESWT for shoulder tendinopathies, to determine the association between shoulder lesion severity identified on ultrasonography or MRI and outcome, and to compare the outcomes of dogs treated with ESWT with and without TE. Medical records of 29 dogs diagnosed with shoulder tendinopathies and treated with ESWT were reviewed, and 24 dogs were diagnosed with either unilateral BT or BT and ST. None were found to have unilateral ST. Five dogs were diagnosed with bilateral disease. Eighty-five per cent of dogs had good or excellent outcomes determined by owner assessment 11-220 weeks after therapy. Outcomes were found to be better as tendon lesion severity increased (P=0.0497), regardless if ESWT was performed with or without TE (P=0.92). ESWT should be considered a safe primary therapeutic option for canine shoulder tendinopathies. Larger controlled prospective studies are needed to adequately assess these findings.

  11. Functional and histologic alterations in growing solitary rat kidney as result of extracorporeal shockwaves.

    PubMed

    Ferreira, U; Claro, J de A; Rodrigues Netto, N; Denardi, F; Figueiredo, J F; Riccetto, C L

    1995-02-01

    The long-term effects of extracorporeal shockwave lithotripsy (SWL) on children treated for renal calculi are unclear. To study the effects on the immature animal, we evaluated 31 Wistar white rats that underwent right nephrectomy at 30 days of age. At 40 days of age they were divided into three groups: a control group of 10 rats that received no shockwaves; Group I (9 rats) that received 1000 shockwaves at 16.0 kV, and Group II (12 animals) that received 1000 shock waves at 17.2 kV. Six months later at maturity (7 months and 10 days of age), the following parameters were measured: (1) body and renal weight; (2) blood lithium, sodium, potassium, and creatinine; (3) fractional lithium, sodium, and potassium excretion; and (4) clearances of lithium and creatinine. The kidneys were studied grossly and histologically. We found no significant changes in overall animal and renal growth between the post-SWL and control groups. However, there were significant changes in renal function. The animals in Groups I and II presented significant increases in blood potassium compared with the control group. Furthermore, the 1000 x 17.2 kV group showed permanent histologic renal changes, including red cells in Bowman's capsule and glomerular congestion. The disorders caused by SWL are compatible with hyporeninemic hypoaldosteronism, inappropriately low plasma renin activity, and aldosterone deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Extracorporeal shockwave lithotripsy without radiation: Ultrasound localization is as effective as fluoroscopy

    PubMed Central

    Smith, Hazel Elizabeth; Bryant, David Alistair; KooNg, Jenny; Chapman, Richard Alexander; Lewis, Gareth

    2016-01-01

    Context: Extracorporeal shockwave lithotripsy (SWL) is the first-line treatment for renal calculi in most cases. Recent technology has allowed lithotriptor machines to localize stones using fluoroscopy or ultrasound (US). Aim: The aim of this study is to compare stone free rates (SFR) using two techniques. Methods: This is a single center retrospective cohort study. We have studied 95 patients with renal calculi undergoing first SWL treatment with localization using US (48 pts) and fluoroscopy (47 pts). SFR was defined as fragments ≤2 m at 4 weeks post procedure on x-ray or US. Patient records were reviewed. Results: Stone size and location, age and body mass index were comparable between groups. Stones ≤7 mm had better SFR with US 86% (18/21) compared to fluoroscopy 59% (10/17) P= 0.08. Overall the US group had similar SFR to the fluoroscopy group for stones of all sizes and locations with 60% (29/48) compared to 45% (21/47)P= 0.18. Radiation exposure was the biggest difference between techniques with a mean radiation dose (mGy/cm2) in the US group of 103 (0–233) and 2113 (241–7821) in the fluoroscopy group. Radiation use in the US group was due to the use of a single shot pre- and post-procedure, this could be reduced to zero. Conclusions: Our data show equivalent outcomes using US compared to the traditional fluoroscopy localization technique. We would encourage departments to develop the use of US localization to reduce radiation exposure to patients. PMID:28057991

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

    PubMed

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

    2012-06-01

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

  14. Comparative Analysis of Treatment Costs in EUROHOPE.

    PubMed

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

    2015-12-01

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

  15. Impact of extracorporeal shockwave therapy on tooth mobility in adult orthodontic patients: a randomized single-center placebo-controlled clinical trial.

    PubMed

    Falkensammer, Frank; Rausch-Fan, Xiaohui; Schaden, Wolfgang; Kivaranovic, Danijel; Freudenthaler, Josef

    2015-03-01

    This RCT investigated the effect of non-invasive extracorporeal shockwaves on tooth mobility in orthodontic patients after active treatment. Seventy-two adult patients were included in the study. Immediately after active orthodontic treatment, patients were assigned to a treatment or a placebo group based on block randomization. The orthodontic patients were required to be otherwise healthy. The region of interest was the anterior portion of the mandible. The treatment group received a single shockwave treatment with 1000 impulses while the placebo group was treated with an acoustic sham. Tooth mobility was evaluated over a period of 6 months using a Periotest and manual testing. Pocket probing depths, bleeding on probing and the irregularity index were also assessed. Tooth mobility reduced significantly over 6 months in both groups, but shockwaves achieved significantly more rapid reduction on manual testing. Probing depth was significantly reduced while the irregularity index remained stable. Bleeding on probing was significantly reduced in the treatment group. No anti-inflammatory effect could be derived due to possible initial group differences. The mobility of teeth aligned by orthodontic treatment reduces over time. Shockwave treatment appeared to reduce tooth mobility more rapidly. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Clearance of refractory bile duct stones with extracorporeal shockwave lithotripsy

    PubMed Central

    Ellis, R; Jenkins, A; Thompson, R; Ede, R

    2000-01-01

    BACKGROUND—Extracorporeal shockwave lithotripsy (ESWL) has been used since the mid-1980s to fragment bile duct stones which cannot be removed endoscopically. Early machines required general anaesthesia and immersion in a waterbath.
AIMS—To investigate the effectiveness of the third generation Storz Modulith SL20 lithotriptor in fragmenting bile duct stones that could not be cleared by mechanical lithotripsy.
METHODS—Eighty three patients with retained bile duct stones were treated. All patients received intravenous benzodiazepine sedation and pethidine analgesia. Stones were targeted by fluoroscopy following injection of contrast via a nasobiliary drain or T tube. Residual fragments were cleared at endoscopic retrograde cholangiopancreatography.
RESULTS—Complete stone clearance was achieved in 69 (83%) patients and in 18 of 24 patients (75%) who required more than one ESWL treatment. Stone clearance was achieved in all nine patients (100%) with intrahepatic stones and also in nine patients (100%) referred following surgical exploration of the bile duct. Complications included six cases of cholangitis and one perinephric haematoma which resolved spontaneously.
CONCLUSION—Using the Storz Modulith, 83% of refractory bile duct calculi were cleared with a low rate of complications. These results confirm that ESWL is an excellent alternative to surgery in those patients in whom endoscopic techniques have failed.


Keywords: lithotripsy; bile duct calculi; extracorporeal lithotripsy PMID:11034593

  17. Time Resolved Shadowgraph Images of Silicon during Laser Ablation:Shockwaves and Particle Generation

    SciTech Connect

    Liu, C.Y.; Mao, X.L.; Greif, R.; Russo, R.E.

    2006-05-06

    Time resolved shadowgraph images were recorded of shockwaves and particle ejection from silicon during laser ablation. Particle ejection and expansion were correlated to an internal shockwave resonating between the shockwave front and the target surface. The number of particles ablated increased with laser energy and was related to the crater volume.

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

    SciTech Connect

    Sawada, H.; Regan, S.P.; Radha, P.B.; Epstein, R.; Li, D.; Goncharov, V.N.; Hu, S.X.; Meyerhofer, D.D.; Delettrez, J.A.; Jaanimagi, P.A.; Smalyuk, V.A.; Boehly, T.R.; Sangster, T.C.; Yaakobi, B.; Mancini, R.C.

    2009-05-19

    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 were 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.

  19. Shock-wave boundary layer interactions

    NASA Technical Reports Server (NTRS)

    Delery, J.; Marvin, J. G.; Reshotko, E.

    1986-01-01

    Presented is a comprehensive, up-to-date review of the shock-wave boundary-layer interaction problem. A detailed physical description of the phenomena for transonic and supersonic speed regimes is given based on experimental observations, correlations, and theoretical concepts. Approaches for solving the problem are then reviewed in depth. Specifically, these include: global methods developed to predict sudden changes in boundary-layer properties; integral or finite-difference methods developed to predict the continuous evolution of a boundary-layer encountering a pressure field induced by a shock wave; coupling methods to predict entire flow fields; analytical methods such as multi-deck techniques; and finite-difference methods for solving the time-dependent Reynolds-averaged Navier-Stokes equations used to predict the development of entire flow fields. Examples are presented to illustrate the status of the various methods and some discussion is devoted to delineating their advantages and shortcomings. Reference citations for the wide variety of subject material are provided for readers interested in further study.

  20. Cloud cavitation effects in shockwave lithotripsy

    NASA Astrophysics Data System (ADS)

    Colonius, Tim; Tanguay, Michel

    2003-10-01

    Cavitation has already been identified as an important damage mechanism in the comminution of kidney stones in shockwave lithotripsy (SWL). However, the precise conditions that maximize the damage caused by the collapsing bubbles are still unknown. Numerical simulations are used to investigate shock propagation and the consequent growth and collapse of a bubble cloud in the focal region of a lithotripter. In the simulations, a continuum two-phase flow model for the ensemble-averaged macroscale is coupled to a Gilmore model for individual spherical bubble dynamics at the microscale. The simulations show agreement with experimental pressure measurements and high-speed photography of the bubble cloud. At void fractions commensurate with experiments, it is found that the collective collapse of the bubble cloud provides a significant increase to the energy available for comminution (beyond what a single bubble would produce). Relatively small increases in the pressure at the center of the cloud in advance of collapse (two orders of magnitude smaller than the initial shock) can more than double the energy of the collapsing bubble.

  1. Cost-effectiveness comparison of ureteral calculi treated with ureteroscopic laser lithotripsy versus shockwave lithotripsy.

    PubMed

    Cone, Eugene B; Pareek, Gyan; Ursiny, Michal; Eisner, Brian

    2017-01-01

    To evaluate the cost-effectiveness of shockwave lithotripsy (SWL) versus ureteroscopic lithotripsy (URS) for patients with ureteral stones less than 1.5 cm in diameter. Patient age, stone diameter, stone location, and stone-free status were recorded for patients treated with SWL or URS for ureteral stones under 1.5 cm over a 1 year period. Institutional charges were obtained from in-house billing. A decision analysis model was constructed to compare the cost-effectiveness of SWL and URS using our results and success rates for modeling. Three separate models were created to reflect differing practice patterns. A total of 113 patients were included-51 underwent SWL and 62 underwent URS as primary treatment. Single procedure stone-free rates for SWL and URS were 47.1 and 88.7 %, respectively (p < 0.002). Decision analysis modeling demonstrated cost-effectiveness of SWL when SWL single procedure stone-free rates (SFR) were greater than or equal to 60-64 % or when URS single procedure SFRs were less than or equal to 57-76 %, depending on practice patterns. This retrospective study revealed superior SFR for ureteral stones less than 1.5 cm treated with URS compared to SWL. Our decision analysis model demonstrated that when SFR for SWL is less than 60-64 % or is greater than 57-76 % for URS, SWL is not a cost-effective treatment option. Based on these findings, careful stratification and selection of stone patients may enable surgeons to increase the cost-effectiveness of SWL.

  2. Improved interval estimation of comparative treatment effects

    NASA Astrophysics Data System (ADS)

    Van Krevelen, Ryne Christian

    Comparative experiments, in which subjects are randomized to one of two treatments, are performed often. There is no shortage of papers testing whether a treatment effect exists and providing confidence intervals for the magnitude of this effect. While it is well understood that the object and scope of inference for an experiment will depend on what assumptions are made, these entities are not always clearly presented. We have proposed one possible method, which is based on the ideas of Jerzy Neyman, that can be used for constructing confidence intervals in a comparative experiment. The resulting intervals, referred to as Neyman-type confidence intervals, can be applied in a wide range of cases. Special care is taken to note which assumptions are made and what object and scope of inference are being investigated. We have presented a notation that highlights which parts of a problem are being treated as random. This helps ensure the focus on the appropriate scope of inference. The Neyman-type confidence intervals are compared to possible alternatives in two different inference settings: one in which inference is made about the units in the sample and one in which inference is made about units in a fixed population. A third inference setting, one in which inference is made about a process distribution, is also discussed. It is stressed that certain assumptions underlying this third type of inference are unverifiable. When these assumptions are not met, the resulting confidence intervals may cover their intended target well below the desired rate. Through simulation, we demonstrate that the Neyman-type intervals have good coverage properties when inference is being made about a sample or a population. In some cases the alternative intervals are much wider than necessary on average. Therefore, we recommend that researchers consider using our Neyman-type confidence intervals when carrying out inference about a sample or a population as it may provide them with more

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

    PubMed

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

    2014-04-15

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

  4. High-efficiency shock-wave generator for extracorporeal lithotripsy.

    PubMed

    Broyer, P; Cathignol, D; Theillère, Y; Mestas, J L

    1996-09-01

    In extracorporeal lithotripsy, the electro-acoustic efficiency of electrohydraulic generators is limited by the inductance of the electrical discharge circuit. A new shock-wave generator is described that uses a coaxial discharge line enabling electro-acoustic efficiency to be greatly increased. The line is built using a para-electric ceramic with a relative dielectric constant of 1700, manufactured for use in high-voltage impulse mode. A coaxial spark gap, with minimal inductance, has been developed to obtain the triggered breakdown of the discharge line. Shock waves are created with a coaxial electrode plugged directly into the spark gap and immersed in an electrolyte of degassed saline. Electrode gap and electrolyte resistivity are adjusted to match the resistivity of the electrolyte volume between the underwater electrodes to the characteristic impedance of the line. The discharge line generates in the medium a rectangular current pulse with an amplitude of about 6000 A and a rise time of 50 ns. Compared with conventional generators, measurements of the expansive peak pressure pulse show an increase of 105% at 10 kV, 86.5% at 12 kV and 34.5% at 14 kV charging voltage. Electro-acoustic efficiency is found to be 11% instead of 5.5% for a conventional discharge circuit.

  5. Shockwave Absorption using Network-forming Ionic glass

    NASA Astrophysics Data System (ADS)

    Lee, Jaejun; Yang, Ke; Moore, Jeffrey; Sottos, Nancy; MURI SWED Collaboration

    2015-06-01

    Network-forming ionic glasses composed of di-ammonium cations and citrate anions exhibit significant potential for dissipation of shock wave energy. The long alkyl side chains in the di-ammonium cation form a soft matrix, while the negatively charged heads of anions segregate into hard nanophase domains. Similar to polyurea, which has microphase separation of soft and hard domains, we hypothesize that shock wave dissipation of the ionic glass occurs by bond breaking in the hard domains and/or pressure-induced phase transition. By employing size-tunable alkyl side chains in the cations, we examine the effect of the relative soft domain size on energy dissipation. A series of thin film (ca. 50 μm) ionic glass specimens are subjected to laser-induced compressive stress waves and the transmitted response measured interferometrically. Structural changes of the ionic glass due to shock wave impact are characterized by x-ray diffraction. When compared directly to polyurea films of identical thickness and geometry, the ionic glass showed superior shock-wave mitigating performance. ONR MURI program.

  6. Developing a laser shockwave model for characterizing diffusion bonded interfaces

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  7. 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.

    2016-10-01

    The creation of an electrostatic shock wave and ensuing ion acceleration is studied on the OMEGA EP Laser System at the Laboratory for Laser Energetics. Previous work using a 10- μm CO2 laser in a H2 gas jet shows promising results for obtaining narrow spectral features in the accelerated proton spectra. Scaling the shock-wave acceleration mechanism to the 1- μm-wavelength drive laser makes it possible to use petawatt-scale laser systems such as OMEGA-EP, but involves tailoring of the plasma profile. To accomplish the necessitated sharp rise to near-critical plasma density and a long exponential fall, an 1- μm-thick CH foil is illuminated on the back side by thermal x rays produced from an irradiated gold foil. The plasma density is measured using the fourth-harmonic probe system, the accelerating fields are probed using an orthogonal proton source, and the accelerated protons and ions are detected with a Thomson parabola. These results will be presented and compared with particle-in-cell simulations. This material is based upon work supported by the Department of Energy National Nuclear Security Administration under Award Number DE-NA0001944 and LLNL's Laboratory Directed Research and Development program under project 15-LW-095.

  8. Shock-wave dynamics during oil-filled transformer explosions

    NASA Astrophysics Data System (ADS)

    Efremov, V. P.; Ivanov, M. F.; Kiverin, A. D.; Utkin, A. V.

    2016-08-01

    This paper presents a numerical and experimental study of the shock-wave processes evolving inside a closed vessel filled with mineral oil. Obtained experimental Hugoniot data for oil are compared with the corresponding data for water. It is found that compression of mineral oil and water can be described by approximately the same Hugoniot over a wide pressure range. Such similarity allows the use of water instead of mineral oil in the transformer explosion experiments and to describe the compression processes in both liquids using similar equations of state. The Kuznetsov equation of state for water is adopted for a numerical study of mineral oil compression. The features of the evolution of shock waves within mineral oil are analyzed using two-dimensional numerical simulations. Numerical results show that different energy sources may cause different scenarios of loading on the shell. The principal point is the phase transition taking place at relatively high temperatures for the case of high-power energy sources. In this case, a vapor-gaseous bubble emerges that qualitatively changes the dynamics of compression waves and the pattern of loads induced on the shell. Taking into account the features of the process together with the concept of water-oil similarity, the present work presents a new approach for experimental modeling of transformer shell destruction using an explosion with given characteristics in a water-filled shell.

  9. The effect of shockwave profile shape on dynamic brittle failure

    NASA Astrophysics Data System (ADS)

    Brown, E. N.; Escobedo, J. P.; Trujillo, C. P.; Gray, G. T.

    2012-08-01

    The role of shock wave loading profile is investigated for the failure processes in a brittle material. The dynamic damage response of ductile metals has been demonstrated to be critically dependent on the shockwave profile and the stress-state of the shock. Changing from a square to triangular (Taylor) profile with an identical peak compressive stress has been reported to increase the "spall strength" by over a factor of two and suppress damage mechanisms. The spall strength of tungsten heavy alloy (WHA) based on plate impact square-wave loading has been extensively reported in the literature. Here a triangular wave loading profile is achieved with a composite flyer plate of graded density in contrast to the square-wave loading. Counter to the strong dependence in wave profile in ductile metals, for WHA, both square and triangle wave profiles the failure is by brittle cleavage fracture with additional energy dissipation through crack branching in the more brittle tungsten particles, largely indistinguishable between wave profiles. The time for crack nucleation is negligible compared to the duration of the experiment and the crack propagation rate is limited to the sound speed as defined by the shock velocity.

  10. Developing a laser shockwave model for characterizing diffusion bonded interfaces

    SciTech Connect

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

    2015-03-31

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

  11. Shock-wave dynamics during oil-filled transformer explosions

    NASA Astrophysics Data System (ADS)

    Efremov, V. P.; Ivanov, M. F.; Kiverin, A. D.; Utkin, A. V.

    2017-05-01

    This paper presents a numerical and experimental study of the shock-wave processes evolving inside a closed vessel filled with mineral oil. Obtained experimental Hugoniot data for oil are compared with the corresponding data for water. It is found that compression of mineral oil and water can be described by approximately the same Hugoniot over a wide pressure range. Such similarity allows the use of water instead of mineral oil in the transformer explosion experiments and to describe the compression processes in both liquids using similar equations of state. The Kuznetsov equation of state for water is adopted for a numerical study of mineral oil compression. The features of the evolution of shock waves within mineral oil are analyzed using two-dimensional numerical simulations. Numerical results show that different energy sources may cause different scenarios of loading on the shell. The principal point is the phase transition taking place at relatively high temperatures for the case of high-power energy sources. In this case, a vapor-gaseous bubble emerges that qualitatively changes the dynamics of compression waves and the pattern of loads induced on the shell. Taking into account the features of the process together with the concept of water-oil similarity, the present work presents a new approach for experimental modeling of transformer shell destruction using an explosion with given characteristics in a water-filled shell.

  12. Unsteady relativistic shock-wave diffraction by cylinders and spheres.

    PubMed

    Tsai, I-Nan; Huang, Juan-Chen; Tsai, Shang-Shi; Yang, J Y

    2012-02-01

    The unsteady relativistic shock-wave diffraction patterns generated by a relativistic blast wave impinging on a circular cylinder and a sphere are numerically simulated using some high-resolution relativistic kinetic beam schemes in a general coordinate system for solving the relativistic Euler equations of gas dynamics. The diffraction patterns are followed through about 6 radii of travel of the incident shock past the body. The complete diffraction patterns, including regular reflection, transition from regular to Mach reflection, slip lines, and the complex shock-on-shock interaction at the wake region resulting from the Mach shocks collision behind the body are reported in detail. Computational results of several incident shock Mach numbers covering the near ultrarelativistic limit are studied. Various contours of flow properties including the Lorentz factor and velocity streamline plots are also presented to add a better understanding of the complex diffraction phenomena. The three-dimensional relieving effects of the sphere cases are evident and can be quantitatively evaluated as compared with the corresponding cylinder cases.

  13. Sonoporation of erythrocytes by lithotripter shockwaves in vitro.

    PubMed

    Miller, D L; Williams, A R; Morris, J E; Chrisler, W B

    1998-08-01

    Sonoporation of red blood cells was examined in relation to cavitation-induced hemolysis. FITC-dextran at 580,000 MW was added to suspensions of canine erythrocytes and the mixture was exposed to lithotripter shockwaves. Exposure at 5% or 50% hematocrit in PBS or 50% in plasma yielded not only hemolysis but also FITC-dextran uptake in surviving cells. Hemolysis increased with increasing numbers of shockwaves. The numbers of cells with fluorescent dextran uptake remained roughly constant for 250-1000 shockwaves, but this represented an increasing percentage of the surviving cells. In addition, fluorescent microspheres formed spontaneously in samples with hemolysis. An air bubble was needed in the chamber to obtain substantial effects, implicating the cavitation mechanism. The exposure-response trends could be modeled by simple theory for random interaction of the cells with bubbles.

  14. Healing of Achilles tendon partial tear following focused shockwave: a case report and literature review

    PubMed Central

    Hsu, Yu-Chun; Wu, Wei-Ting; Chang, Ke-Vin; Han, Der-Sheng; Chou, Li-Wei

    2017-01-01

    Achilles tendinopathy is a common cause of posterior heel pain and can progress to partial tendon tear without adequate treatment. Effects of traditional treatments vary, and many recent reports focus on the use of extracorporeal shockwave therapy (ESWT) for Achilles tendinopathy but not for Achilles tendon partial tear. Here, we report the case of a 64-year-old female suffering from severe left heel pain for half a year. All treatment and rehabilitation were less effective until ESWT was applied. Each course of focused shockwave therapy included 2500 shots with energy flux density from 0.142 mJ/mm2 to 0.341 mJ/mm2. The visual analog scale decreased from nine to one degree. High-resolution musculoskeletal ultrasonography was performed before and 1 month after the treatment, which revealed healing of the torn region and decrease in inflammation. ESWT had shown to be an alternative treatment for Achilles tendon partial tear under safety procedure and ultrasound observation. PMID:28579818

  15. Evaluation of long-term side effects after shock-wave lithotripsy for renal calculi using a third generation electromagnetic lithotripter.

    PubMed

    Pirola, Giacomo Maria; Micali, Salvatore; Sighinolfi, Maria Chiara; Martorana, Eugenio; Territo, Angelo; Puliatti, Stefano; Bianchi, Giampaolo

    2016-10-01

    To assess the incidence of long-term side effects after shock-wave lithotripsy treatment performed with an electromagnetic Dornier Lithotripter S device. A specific follow-up was undertaken on a cohort of 100 selected patients that underwent SWL for a single renal stone in our center from 2002 to 2004. Previous and current data were compared using the Student t test. Factors associated with the incidence of hypertension and diabetes mellitus were determined. Ten years after treatment, mean serum creatinine level and glomerular filtration rate remained similar to previous values (serum creatinine level: 0.96 ± 0.22 vs. 0.92 ± 0.19 mg/dL; glomerular filtration rate: 92.8 ± 17.8 vs. 88.1 ± 21.7 mL/min). There were marked increases in blood cholesterol, blood pressure, and blood glucose levels, while smoking decreased. Age, glomerular filtration rate, body mass index, blood glucose and blood pressure at the time of treatment were significantly associated with the presence of hypertension and diabetes mellitus at follow-up; blood cholesterol was associated with diabetes mellitus development. After 10 years, overall renal function appeared to have been unaffected by shock-wave lithotripsy treatment. The increased rate of hypertension and diabetes mellitus were consistent with the incidence in the global population. This is the first report on the long-term safety of a third generation electromagnetic lithotripter, and indicates that there are no long-term sequelae.

  16. Use of internal polyethylene ureteral stents in extracorporeal shock-wave lithotripsy of staghorn calculi.

    PubMed

    Pode, D; Shapiro, A; Verstandig, A; Pfau, A

    1987-01-01

    Ureteral stenting during extracorporeal shock-wave lithotripsy (ESWL) of complete staghorn calculi, using an internal polyethylene pigtail catheter, was found to be an efficient prophylactic measure against the high rate of complications in these cases. In the presence of a ureteral stent the stone fragments passed more easily into the bladder, accumulation of obstructing stone streets was prevented, and internal drainage of the urine was guaranteed. The need for auxiliary measures such as percutaneous nephrostomy, ureteroscopy or ureteral meatotomy was prevented in most cases. This prophylactic measure may turn ESWL to become the primary treatment of large staghorn calculi.

  17. Numerical Simulation of Low-Density Shock-Wave Interactions

    NASA Technical Reports Server (NTRS)

    Glass, Christopher E.

    1999-01-01

    Computational Fluid Dynamics (CFD) numerical simulations of low-density shock-wave interactions for an incident shock impinging on a cylinder have been performed. Flow-field density gradient and surface pressure and heating define the type of interference pattern and corresponding perturbations. The maximum pressure and heat transfer level and location for various interaction types (i.e., shock-wave incidence with respect to the cylinder) are presented. A time-accurate solution of the Type IV interference is employed to demonstrate the establishment and the steadiness of the low-density flow interaction.

  18. 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.

  19. Is Extracorporeal Shockwave Therapy Combined With Isokinetic Exercise More Effective Than Extracorporeal Shockwave Therapy Alone for Subacromial Impingement Syndrome? A Randomized Clinical Trial.

    PubMed

    Santamato, Andrea; Panza, Francesco; Notarnicola, Angela; Cassatella, Gennaro; Fortunato, Francesca; de Sanctis, Jula Laura; Valeno, Giovanni; Kehoe, Patrick G; Seripa, Davide; Logroscino, Giancarlo; Fiore, Pietro; Ranieri, Maurizio

    2016-09-01

    Study Design Single-blind randomized trial. Background Extracorporeal shockwave therapy (ESWT) has been shown to produce good results in the treatment of subacromial impingement syndrome (SAIS). The efficacy of a combined administration of ESWT and isokinetic exercise (IE) has not yet been studied. Objectives To evaluate the efficacy of focused ESWT combined with IE for the rotator cuff versus focused ESWT alone in the treatment of SAIS. The secondary objective was to assess the isokinetic torque recovery (external rotation at 210°/s, 180°/s, and 120°/s). Methods Thirty participants with SAIS were randomly assigned to a focused-ESWT group or focused ESWT-plus-IE group. Subjects of both groups received 3 treatment sessions of focused ESWT over a period of 10 days. Participants in the second group also received IE for 10 therapy sessions. Outcome measures were the Constant-Murley score (CMS), the visual analog scale (VAS), and isokinetic parameters (peak torque and total work calculated from 5 repetitions) measured with the isokinetic test. Subjects were assessed at baseline, 10 days after the last treatment session with focused ESWT, and after 2 months of follow-up. Results At 2 months posttreatment, participants in the focused ESWT-plus-IE group showed significantly less pain (focused-ESWT VAS, 3.4 ± 0.8 versus focused ESWT-plus-IE VAS, 1.5 ± 0.5; P<.001) and greater improvement in functionality (focused-ESWT CMS, 75.9 ± 6.7 versus focused ESWT-plus-IE CMS, 92.1 ± 6.3; P<.001) and muscle endurance than the subjects in the focused-ESWT group. Conclusion In subjects with SAIS, combined administration of focused ESWT and IE for the rotator cuff resulted in greater reduction of pain, as well as superior functional recovery and muscle endurance in the short to medium term, compared with ESWT alone. Level of evidence Therapy, 2b. unregistered 2011 trial. J Orthop Sports Phys Ther 2016;46(9):714-725. Epub 5 Aug 2016. doi:10.2519/jospt.2016.4629.

  20. 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.

  1. Extracorporeal shockwave therapy in osteonecrosis of femoral head

    PubMed Central

    Zhang, Qingyu; Liu, Lihua; Sun, Wei; Gao, Fuqiang; Cheng, Liming; Li, Zirong

    2017-01-01

    Abstract Background: Osteonecrosis is an incapacitating disorder with high morbidity. Though extracorporeal shockwave therapy (ESWT) provides a noninvasive treatment option, controversial subjects still exist about its effectiveness, indications, and mechanism of action. Methods: An electronic databases search was performed using PubMed, Embase, and the Cochrane library to collect clinical trials, case reports, and cases series on this topic and then useful data were extracted and appraised by experienced clinicians. We evaluated the quality of included evidences by using the Oxford Centre for evidence-based medicine (EBM) Levels of Evidence. Results: A total of 17 articles including 2 case reports, 9 open label trials, 2 cohorts, and 6 randomized controlled trials were considered to be eligible for this systematic review. Visual analog scale (VAS), Harris hip scores, and the imaging results were the frequently-used outcome estimates of included studies. Conclusion: By systematically analyzing these evidences, we could conclude that ESWT could act as a safe and effective method to improve the motor function and relieve the pain of patients with osteonecrosis of femoral hip, especially those at early stage. Imaging revealed that bone marrow edema was significantly relieved, but the necrotic bone could not be reversed after ESWT. This technique could slow or even block the progression of ONFH and therefore reduce the demand for surgery. Collaboration with other conservative modalities would not improve the curative benefits of ESWT. Meanwhile, ONFH with various risk factors showed similar reaction to this noninvasive treatment method. However, these conclusions should be interpreted carefully for the low-quality of included publications and further studies are requisite to validate the effect of ESWT in ONFH. PMID:28121934

  2. Shockwave therapy in patients with peripheral artery disease.

    PubMed

    Ciccone, Marco Matteo; Notarnicola, Angela; Scicchitano, Pietro; Sassara, Marco; Carbonara, Santa; Maiorano, Mariagrazia; Moretti, Biagio

    2012-08-01

    Previous studies support the fact that extracorporeal shockwave (SW) induces angiogenesis and improves symptoms in patients affected by limb ischemia. The aim of this study was to evaluate the effects of SW therapy in patients with peripheral artery disease (PAD). Twenty-two patients were enrolled in this study and were randomly assigned into two groups: SW treatment (12 patients, 67 ± 9 years) and control (10 patients, 68 ± 12 years). The inclusion criteria were the following: age over 40 years, PAD diagnosis, optimal medical therapy, and ankle-brachial index less than 0.9. SW therapy was administered using the Minilith® SL1 litotriptor with an ultrasound guide able to detect the target area using a B-mode technique and a 7.5 MHz convex probe emitting 2,000 impulses with an energy flux density of 0.03 mJ/mm(2). The variation in the degree of stenosis before and after treatment was statistically significant between the groups (-9% ± -10% vs. 0% ± 0%; P = 0.001). In addition, a significantly higher number of treated patients than controls showed a reduction in the Fontaine stage (12 [63%] vs. 0 [0%]; P < 0.001). This result was confirmed by analyzing the difference in patients' pain-free walking distance before and after SW therapy (76 ± 46 m vs. 0 ± 0 m for treated patients vs. controls; P < 0.001) and the difference in pain severity (measured on a pain scale; -1.4 ± 0.5 in the treated patients vs. -0.2 ± 0.4 in the controls; P < 0.001). On the basis of these results the authors hypothesized a direct effect of SW on the ultrastructural composition of the vessel walls, inducing a reduction in artery stenosis. These data support the application of SW therapy as a new medical tool to improve the natural clinical course of PAD.

  3. Computation of sharp-fin-induced shockwave/turbulent boundary layer interactions

    NASA Technical Reports Server (NTRS)

    Horstman, C. C.

    1986-01-01

    Solutions of the Reynolds-averaged Navier-Stokes equations are presented and are compared with a family of experimental results for the three-dimensional interaction of a sharp-fin-induced shock wave with a turbulent boundary layer. The solutions predict most of the essential features of the flow fields for various shock-wave strengths. However, some features of the measured flow fields, such as secondary separation and size of the largest separated zones were not accurately computed. The computed flow fields, aided by particle tracing techniques, display a prominent vortical structure which can be correlated with the observed surface phenomena.

  4. Handbook of Comparative Treatments for Adult Disorders.

    ERIC Educational Resources Information Center

    Janzen, Troy; Janzen, Henry L.

    1994-01-01

    Describes and evaluates text providing background, conceptual understanding, and treatment options for major adult disorders. Strengths include comprehensiveness, treatment comparisons, and a process emphasis. Weaknesses center on biases toward psychoanalytic, behavioral, and pharmacological treatments while neglecting cognitive and "cutting edge"…

  5. The value of extracorporeal shock-wave lithotripsy in the management of bile duct stones.

    PubMed

    Lee, S H; Fache, J S; Burhenne, H J

    1990-10-01

    We evaluated the role of biliary extracorporeal shock-wave lithotripsy in treating 70 symptomatic patients with bile duct stones in whom endoscopic or percutaneous radiologic attempts at basket extraction had failed. Forty-four patients had common bile and/or common hepatic duct stones, 21 patients had cystic duct stones, and five patients had intrahepatic duct stones. A total of 43 patients (61%) had complete elimination of stone fragments during the initial treatment period. If patients in whom stones were successfully fragmented yet not totally eliminated on initial hospital treatment but who were asymptomatic at follow-up times of 8-22 months are included, the overall successful treatment rate was 83%. Stones were cleared in 26 of 44 common bile/hepatic duct stone patients, spontaneously in seven patients and after endoscopic or percutaneous radiologic intervention in 19 patients. Fifteen (71%) of 21 patients had cystic duct stones successfully cleared. The fragments in two of five patients with intrahepatic duct stones also were cleared. Five patients (7%) had minor side effects. Seven (10%) of 70 patients went on to have surgery. Complications after 30 days occurred in five patients (7%); two required repeated endoscopy with fragment extraction, two required placement of an endoprosthesis, and one died. We conclude that biliary extracorporeal shock-wave lithotripsy is valuable as an adjuvant to standard interventional techniques for removing bile duct stones.

  6. [Biliary extracorporeal shock-wave lithotripsy].

    PubMed

    Jakobeit, C; Greiner, L

    1992-07-14

    Since 1985/86, more than 200 patients with problematic intra- and extrahepatic bile duct stones were treated with ESWL. Results are excellent and comparable with ESWL's success-story in urinary stone disease, abandoning widely open surgery for bile duct stones. In gallbladder-stone treatment, ESWL (always combined with bile acid litholysis) is only promising or successful in a carefully selected subset (10 to 15%) of all symptomatic patients (with good gallbladder contractility, limited stone volume and sonolucent stones).

  7. Comparing Treatment Approaches for Obsessive Compulsive Disorder.

    ERIC Educational Resources Information Center

    Gariglietti, Kelli P.; Schemmel, Todd A.

    The current status of research literature relevant to obsessive compulsive disorder (OCD) is reviewed. Models proposing the etiology and maintenance of OCD, empirically established treatments for OCD, and research supporting cognitive approaches to treatment are also included in the review. Until recently, most of the controlled research…

  8. Effects of high-energy shockwaves on normal human fibroblasts in suspension.

    PubMed

    Kaulesar Johannes, E J; Sukul, D M; Bijma, A M; Mulder, P G

    1994-12-01

    To gain insight in the effects of shockwaves on human cells the relationship between the energy density and the number of shockwaves as well as their effect on suspensions of normal cells was studied. At energy densities of 0.37, 0.6, 0.78, and 1.20 mJ/mm2 fibroblasts were subjected to 50, 100, 250, 500, and 1,000 shockwaves. Each test was performed three times and one sample was used as control. A decrease in viability related to the logarithm of both the number (P = 0.0000) and the energy density (P = 0.001) of the shockwaves was statistically demonstrable 1 hr after the shockwave application. The energy density of the shockwaves has less influence on the viability than the number of applied shockwaves. Seeding of viable cells 1 hr after the shockwave application showed that the decrease in the 48-hr growth potential was statistically dependent of the number of applied shockwaves only (P = 0.0007). After 24 hr no difference in the 48-hr growth potential could be demonstrated between viable shockwave-treated cells and control cells. The literature as well as our own investigations in vitro and in vivo indicate that shockwaves have a logarithmic dose-dependent destructive effect on cells in suspension, but they also seem to have a dose-dependent stimulating influence on the healing process in damaged tissues. Due to the logarithmic relationship between the viability and both the number and energy density of the applied shockwaves it might be expected that even excessive numbers of high-energy-density shockwaves don't soon lead to total destruction of all cells in the suspension.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. 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.

  10. Influence of shockwave profile on ejection of micron-scale material from shocked Sn surfaces: an experimental study

    SciTech Connect

    Zellner, Michael B; Byers, Mark E; Hammerberg, James E; Germann, Tim C; Dimonte, Guy; Rigg, Paulo A; Buttler, William T

    2009-01-01

    This effort experimentally investigates the relationship between shock-breakout pressure and the amount of micron-scale fragments ejected (ejecta) upon shock release at the metal/vacuum interface of Sn targets shocked with a supported shockwave. The results are compared with an analogous set derived from HE shocked Sn targets, Taylor shockwave loading. The supported shock-pulse was created by impacting a Sn target with a Ti64 (Ti-6Al-4V) impactor that was accelerated using a powder gun. Ejecta production at the free-surface or back-side of the Sn targets were characterized through use of piezoelectric pins and Asay foils, and heterodyne velocimetry verified the time of shock release and the breakout pressure.

  11. Large-Eddy Simulation of Shock-Wave Boundary Layer Interaction and its Control Using Sparkjet

    NASA Astrophysics Data System (ADS)

    Yang, Guang; Yao, Yufeng; Fang, Jian; Gan, Tian; Lu, Lipeng

    2016-06-01

    Large-eddy simulation (LES) of an oblique shock-wave generated by an 8° sharp wedge impinging onto a spatially-developing Mach 2.3 turbulent boundary layer and their interactions has been carried out in this study. The Reynolds number based on the incoming flow property and the boundary layer displacement thickness at the impinging point without shock-wave is 20,000. The detailed numerical approaches are described and the inflow turbulence is generated using the digital filter method to avoid artificial temporal or streamwise periodicity. Numerical results are compared with the available wind tunnel PIV measurements of the same flow conditions. Further LES study on the control of flow separation due to the strong shock-viscous interaction is also conducted by using an active control actuator “SparkJet” concept. The single-pulsed characteristics of the control device are obtained and compared with the experiments. Instantaneous flowfield shows that the “SparkJet” promotes the flow mixing in the boundary layer and enhances its ability to resist the flow separation. The time and spanwise averaged skin friction coefficient distribution demonstrates that the separation bubble length is reduced by maximum 35% with the control exerted.

  12. Vlasov-Fokker-Planck Simulation of a Collisional Ion-Electron Shockwave

    NASA Astrophysics Data System (ADS)

    Taitano, William; Knoll, Dana; Prinja, Anil

    2012-10-01

    There has been recent increased interest in a range of kinetic plasma physics phenomena which may be important in simulating ICF pellet performance. [1] have numerically demonstrated the limitations of the classic Spitzer, Braginski fluid closures in collisional plasmas for shockwave problems. [1] has shown the importance of modeling kinetic effects for scale lengths of shockwave much larger than the ion collision mean free path. In [1], the ions were modeled kinetically using the Fokker-Planck approximation while the electrons were modeled as a fluid. An investigation of a full kinetic treatment of electron with collision is computationally intractable with standard explicit schemes due to collision CFL limitation that requires resolving the electron-electron collision timescale. [2] has developed a new, fully implicit and discretely consistent moment based accelerator method to solve the full ion-electron kinetic Vlasov-Ampere system. A similar moment based accelerator will be extended to a collisionless shock problem in order to accelerate the Fokker-Planck collision source in the kinetic equations. In the presentation, we provide some preliminary results. [4pt] [1] M. Casanova and O. Larroche, Phys. Rev. Let. 67-(16), 1991. [0pt] [2] W.T. Taitano et al. SISC in review.

  13. 1D Gas-Dynamic Simulation of Shock-Wave Processes via Internet

    NASA Astrophysics Data System (ADS)

    Levashov, Pavel; Povarnitsyn, Mikhail; Khishchenko, Konstantin

    2009-06-01

    We present a web-interface, which allows one to perform a 1-dimensional gas-dynamic simulation of typical shock-wave processes via the Internet using the database on shock-wave experiments and equations of state. In this interface a user can supply initial conditions, control the process of simulation and make a treatment of the results. Up to seven objects can take part in the experiment; for every object a substance, its initial position and velocity, equation of state and destruction pressure should be defined. The simulation itself is based upon the Eulerian second order Godunov approach. To start computations, the user also has to set the final time, grid ``coarseness'' and the number of moments in which the output of necessary parameters will take place, including initial and final. Additionally, the user can define several Lagrangian markers to trace the state of matter at a given initial coordinate. At the end of simulation the user can analyze the profiles of different values at different times or at points with the specified coordinates of Lagrangian markers both as charts and in textual form. The main advantage of this system is the possibility to use in simulation all equations of state available in the database (more than 130). The system is available freely via addresses http://teos.ficp.ac.ru/rusbank/, http://www.ihed.ras.ru/rusbank/.

  14. 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.

  15. Contraction ratio effect on boundary layer separation induced by shockwave boundary layer interactions

    NASA Astrophysics Data System (ADS)

    Im, Seongkyun; di Cristina, Giovanni; Do, Hyungrok

    2016-11-01

    Boundary layer separations induced by shockwave boundary layer interaction at various contraction ratios were investigated at a Mach 4.5 flow. Stagnation pressure and temperature condition of 10 bars and 295 K were used, and a high-speed schlieren system visualized the flow features. A shockwave generator with 12 degree wedge generated an impinging shockwave onto a laminar boundary layer on a flat plate. The contraction ratio of the flow was varied by changing the distance between the shockwave generator and the flat plate. The location of the shockwave impingement was fixed while the contraction ratios were changed. Flow visualization showed that the flow separation and its size were influenced by the contraction ratio although overall flow features were similar. At higher contraction ratio, stronger impinging shockwave and more severe flow separation were observed.

  16. Medial tibial subchondral bone is the key target for extracorporeal shockwave therapy in early osteoarthritis of the knee

    PubMed Central

    Wang, Ching-Jen; Cheng, Jai-Hong; Huang, Chien-Yiu; Hsu, Shan-Ling; Lee, Fan-Yen; Yip, Hon-Kan

    2017-01-01

    Extracorporeal shockwave therapy (ESWT) is a new non-invasive method to induce tissue regeneration and repair the damaged osteoarthritis (OA) of knee. Previous studies suggested subchondral bone as the key target for OA treatment. However, the relationship of the effect and different locations of subchondral bone is unknown. The purpose of the study was to investigate whether the subchondral bone of medial tibia as the target for ESWT in early OA knee treatment and compared with various locations on lateral tibia and femur condyles. Application of ESWT on the medial tibial subchondral bone ameliorated 38% in gross pathological OA changes (compared to OA, P < 0.001), 94 % in OARSI score (compared to OA, P < 0.001) and 45% in cartilage defect (compared to OA, P < 0.001), 17% in bone mineral density (compared to OA, P < 0.001) than lateral tibia and femur. In micro-CT analysis, ESWT on medial tibial subchondral bone increased bone volume (61% vs 44% in tibia and 62% vs 53% in femur, P < 0.05), yield stress (6 MPa vs 4 MPa in tibia and 4 MPa vs 2 MPa in femur, P < 0.05) and decreased bone porosity (38% vs 53% in tibia and 37% vs 46% in femur, P < 0.05) than OA. The TUNEL, PCNA and osteocalcin significantly influenced the levels of molecular expression in different locations of ESWT application. Our results confirm that application of ESWT to the medial tibial subchondral bone has more effective therapy for OA knee than lateral locations of joint knee. PMID:28469777

  17. Shockwave-turbulent boundary layer interaction control using magnetically driven surface discharges

    NASA Astrophysics Data System (ADS)

    Kalra, Chiranjeev S.; Zaidi, Sohail H.; Miles, Richard B.; Macheret, Sergey O.

    2011-03-01

    This study demonstrates the potential for shockwave-turbulent boundary layer interaction control in air using low current DC constricted surface discharges forced by moderate strength magnetic fields. An analytical model describing the physics of magnetic field forced discharge interaction with boundary layer flow is developed and compared to experiments. Experiments are conducted in a Mach 2.6 indraft air tunnel with discharge currents up to 300 mA and magnetic field strengths up to 5 Tesla. Separation- and non-separation-inducing shocks are generated with diamond-shaped shockwave generators located on the wall opposite to the surface electrodes, and flow properties are measured with schlieren imaging, static wall pressure probes and acetone flow visualization. The effect of plasma control on boundary layer separation depends on the direction of the Lorentz force ( j × B). It is observed that by using a Lorentz force that pushes the discharge upstream, separation can be induced or further strengthened even with discharge currents as low as 30 mA in a 3-Tesla magnetic field. If shock-induced separation is present, it is observed that by using Lorentz force that pushes the discharge downstream, separation can be suppressed, but this required higher currents, greater than 80 mA. Acetone planar laser scattering is used to image the flow structure in the test section and the reduction in the size of recirculation bubble and its elimination are observed experimentally as a function of actuation current and magnetic field strength.

  18. Thermodynamic parameters of heterogeneous materials under shock-wave loading in presentation of equilibrium model

    NASA Astrophysics Data System (ADS)

    Maevskii, K. K.; Kinelovskii, S. A.

    2016-11-01

    The results of numerical experiments on modeling of shock wave loading of solid and porous heterogeneous materials on the example of molybdenum and some alloys included molybdenum as a component are presented. A thermodynamically equilibrium model is applied to describe the behavior of solid and porous materials. This model ensures good compliance with the experiment in a wide range of pressures. The gas in pores, which is a component of the medium, is taken into account in this model. The equation of state of the Mie-Grüneisen type with allowance for the dependence of the Grüneisen coefficient on temperature is used for condensed phases. The applied model allows the behavior of the molybdenum with porosity from 1 to 3 to be calculated under shock-wave loading at pressures above 5 GPa in the one-velocity and one-temperature approximations, as well as on the assumption of equal pressures for all the phases. Computational results are compared with the well-known experimental results obtained by different authors. The model permits the shock-wave loading of solid and porous alloys with molybdenum in their composition to be described reliably solely by using species parameters.

  19. Neurodevelopmental treatment after stroke: a comparative study

    PubMed Central

    Hafsteinsdottir, T; Algra, A; Kappelle, L; Grypdonck, M; on, b

    2005-01-01

    Background: Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. Objective: To investigate the effects of NDT on the functional status and quality of life (QoL) of patients with stroke during one year after stroke onset. Methods: 324 consecutive patients with stroke from 12 Dutch hospitals were included in a prospective, non-randomised, parallel group study. In the experimental group (n = 223), nurses and physiotherapists from six neurological wards used the NDT approach, while conventional treatment was used in six control wards (n = 101). Functional status was assessed by the Barthel index. Primary outcome was "poor outcome", defined as Barthel index <12 or death after one year. QoL was assessed with the 30 item version of the sickness impact profile (SA-SIP30) and the visual analogue scale. Results: At 12 months, 59 patients (27%) in the NDT group and 24 (24%) in the non-NDT group had poor outcome (corresponding adjusted odds ratio = 1.7 (95% confidence interval, 0.8 to 3.5)). At discharge the adjusted odds ratio was 0.8 (0.4 to 1.5) and after six months it was 1.6 (0.8 to 3.2). Adjusted mean differences in the two QoL measures showed no significant differences between the study groups at six or 12 months after stroke onset. Conclusions: The NDT approach was not found effective in the care of stroke patients in the hospital setting. Health care professionals need to reconsider the use of this approach. PMID:15897499

  20. Neurodevelopmental treatment after stroke: a comparative study.

    PubMed

    Hafsteinsdóttir, T B; Algra, A; Kappelle, L J; Grypdonck, M H F

    2005-06-01

    Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. To investigate the effects of NDT on the functional status and quality of life (QoL) of patients with stroke during one year after stroke onset. 324 consecutive patients with stroke from 12 Dutch hospitals were included in a prospective, non-randomised, parallel group study. In the experimental group (n = 223), nurses and physiotherapists from six neurological wards used the NDT approach, while conventional treatment was used in six control wards (n = 101). Functional status was assessed by the Barthel index. Primary outcome was "poor outcome", defined as Barthel index <12 or death after one year. QoL was assessed with the 30 item version of the sickness impact profile (SA-SIP30) and the visual analogue scale. At 12 months, 59 patients (27%) in the NDT group and 24 (24%) in the non-NDT group had poor outcome (corresponding adjusted odds ratio = 1.7 (95% confidence interval, 0.8 to 3.5)). At discharge the adjusted odds ratio was 0.8 (0.4 to 1.5) and after six months it was 1.6 (0.8 to 3.2). Adjusted mean differences in the two QoL measures showed no significant differences between the study groups at six or 12 months after stroke onset. The NDT approach was not found effective in the care of stroke patients in the hospital setting. Health care professionals need to reconsider the use of this approach.

  1. 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.

  2. Controlling shockwave dynamics using architecture in periodic porous materials

    NASA Astrophysics Data System (ADS)

    Branch, Brittany; Ionita, Axinte; Clements, Bradford E.; Montgomery, David S.; Jensen, Brian J.; Patterson, Brian; Schmalzer, Andrew; Mueller, Alexander; Dattelbaum, Dana M.

    2017-04-01

    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 control of layer symmetries afforded by additive manufacturing techniques at the micron scale.

  3. [Extracorporeal shockwave lithotripsy of stones in lower calices of kidney].

    PubMed

    Martov, A G; Peniukova, I V; Moskalenko, S A; Peniukov, V G; Peniukov, D V; Balykov, I S

    2013-01-01

    The article presents the results of the study aimed to evaluation of possible relationship between anatomical structure of the renal pelvis of the kidney, the size of the stone and the effectiveness of extracorporeal shockwave lithotripsy (ESWL) of stones in lower calices of kidney, defined as "stone-free state". ESWL was performed in 285 patients. Sizes of stones varied from 5 to 25 mm. With interval distribution of stone sizes, the greatest number of cases was detected with size of 5 to 12 mm. The destruction of stone required one ESWL session in 196 cases, and three sessions only in 12 cases. The total number of pulses per one stone did not exceed 9500, and more than 70% of the stones have been effectively destroyed with less than 3000 pulses. The result of treatment was assessed 3-4 months after the last ESWL session on the basis of ultrasound and X-ray examination using nominal (dichotomous) scale. In addition, for verification of significant (expected and unexpected) correlations, exploratory analysis of the correlation matrices of factors possibly affecting the discharge of stone fragments was performed. Positive treatment outcome was recorded in 212 (74.4%) patients. Residual stone fragments (> or = 5 mm) were identified in 73 (25.6%) patients; in 69 patients fragments corresponded to the initial localization and 4 fragments were located in the pelvis and calices of middle and lower segments of the kidney. Statistical processing found no association between the size of the stone and the number of ESWL sessions required for its destruction (P = 0,4056). The analysis of relationship between the nature of the complications and size of stone revealed differences, but there were no significant differences in median test (p = 0.1067). Based on exploratory analysis and correlations identified, in-depth evaluation was carried out on three factors: the size of the stone, length of lower calices neck, and pyelocaliceal corner. Width of lower calices neck as a

  4. Raman study of the shockwave effect on collagens.

    PubMed

    Cárcamo, José J; Aliaga, Alvaro E; Clavijo, R Ernesto; Brañes, Manuel R; Campos-Vallette, Marcelo M

    2012-02-01

    The Raman spectra (1800-200 cm(-1)) of isolated dried collagen types I and III were recorded at different times after shockwave (SW) application in aqueous media. SWs were applied in a single session. One week after the SW application the vibrational data analysis indicates changes in the conformation of the collagens; orientational changes are also inferred. During the next three weeks collagens tended to recover the conformation and orientation existing before SW application.

  5. 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

  6. International Shock-Wave Database: Systematization of Experimental Data

    NASA Astrophysics Data System (ADS)

    Levashov, Pavel R.; Khishchenko, Konstantin V.; Lomonosov, Igor V.; Minakov, Dmitry V.; Zakharenkov, Alexey S.

    2011-06-01

    In this work, we announce the creation of the International Shock-Wave Database (ISWDB). 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. Our 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 thru the Internet, in an interactive form. The development and operation of the ISWDB will be guided by input from a steering committee. The database will be installed on two mirrored web-servers, one in Russia and the other in USA. The database will provide 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. We believe that the ISWDB will be a useful tool for the shock-wave community.

  7. Shockwave-Gas bubble Interaction in Complex Configurations

    NASA Astrophysics Data System (ADS)

    Li, Fenfang; Arora, Manish; Ohl, Claus-Dieter

    2014-11-01

    Shockwave-gas bubble interaction is relevant in biomedical applications such as shock wave lithotripsy and histotripsy where cell rupture needs to be avoided or is advantageous, as well as in the mining industry for microbubble aerated explosive gels. Here we demonstrate an experimental technique to study this interaction in a well-controlled manner utilizing microfluidics and high-speed photography of up to 2 million frames per second. Micron-size gas bubbles are generated with a continuous wave laser beam modulated with a digital hologram, whereas the shockwave and an expanding cavitation bubble are created with a pulsed laser. Gas bubbles are known to generate fast jets when impacted by shockwaves and we observe jets of 125 m/s and more. Complex interactions are reported for geometric arrangements of up to 6 gas bubbles: cascaded and simultaneous collapse of gas bubbles, back reaction of the gas bubbles on the cavitation bubble, and the deflection of jets for neighbouring bubbles. Besides, we find secondary cavitation within the liquid film below the expanding cavitation bubble, which is likely due to trapped gas exposed to low pressures and high shear, i.e. a regime relevant for cavitation in lubricating films.

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

    PubMed Central

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

    2015-01-01

    Objective To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20–30 mm single renal pelvic stone. Patients and methods The computerised records of patients who underwent PNL or ESWL for a 20–30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged <18 years who had a branched stone, advanced hydronephrosis, a solitary kidney, anatomical renal abnormality, or had a surgical intervention within the past 6 months were excluded. The study included 337 patients with a mean (SD, range) age of 49.3 (12.2, 20–81) years. The patients’ criteria (age, sex, body mass index) and the stone characteristics (side, stone length, surface area, attenuation value and skin-to-stone distance) were compared between the groups. The re-treatment rate, the need for secondary procedures, success rate, complications and the total costs were calculated and compared. Results In all, 167 patients were treated by ESWL and 170 by PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P < 0.001). The success rate was significantly higher in the PNL group (95% vs. 75%, P < 0.001), as was the complication rate (13% vs. 6.6%, P = 0.050). The total costs of primary and secondary procedures were significantly higher for PNL (US$ 1120 vs. 490; P < 0.001). Conclusions PNL was more effective than ESWL for treating a single renal pelvic stone of 20–30 mm. However, ESWL was associated with fewer complications and a lower cost. PMID:26413350

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

    PubMed

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

    2015-09-01

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

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

    SciTech Connect

    Sawada, H.; Regan, S. P.; Radha, P. B.; Epstein, R.; Li, D.; Goncharov, V. N.; Hu, S. X.; Meyerhofer, D. D.; Delettrez, J. A.; Jaanimagi, P. A.; Smalyuk, V. A.; Boehly, T. R.; Sangster, T. C.; Yaakobi, B.; Mancini, R. C.

    2009-05-15

    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 spectra 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.

  11. [Effect of Acupuncture plus Different Frequency Shock-wave Interventions on Pain Reactions and Motor Function in Knee Osteoarthritis Patients].

    PubMed

    Li, Jian-wei; Zheng, Shi-jiang; Zhang, Jing-chun; Huang, Jian-jun; Liu, Xiao-gang

    2015-08-01

    To observe the clinical effect of acupuncture plus shock-wave (SW) intervention for osteoarthritis (WA), so as to explore its practicability in clinical practice. A total of 120 cases of knee OA patients were randomly divided into 4 groups, namely acupuncture (acupunct) + LFSW, acupunct + MFSW, acupunct + HFSW and routine acupunct groups, with 30 cases in each group. Xuehai (SP 10) , Liangqiu (ST 34), Yanglingquan (GB 34), Xiyan (ST 35) and Ashi-point were punctured with filiform needles which were manipulated with uniform reinforcing-reducing techniques for 15-20 min, once every other day for 7 times. In addition, these acupoints were also respectively stimulated with shock waves(10 Hz, 14 Hz and 18 Hz, pressure: 1-4 bar) delivered from a DolorClastEMS therapeutic apparatus for 600 times in 3 acupunct+ SW groups. The patients' pain response changes of the knee-joint were assessed by using visual analog scale (VAS) and the motility was evaluated by using a 0-3 grade scale. RESULTS After 7 times of treatment, the patients' VAS scores and motility scores were significantly decreased in the acupunct+ LFSW, acupunct+ MFSW, acupunct+ HFSW and routine acupunct groups compared with their own basic values before treatment (P < 0.01), and the therapeutic effect of the acupunct+ MFSW group was significantly superior to those of the other 3 groups in reducing both VAS and motility scores (P < 0.05). Correspondingly, the Deqi sensation score of the acupunct+ MFSW group was markedly higher than those of the other 3 groups (P < 0.05). Shock wave acu-puncture treatment is effective in relieving OA patients' knee-joint pain and functional activity, and the therapeutic effect of acu- punct + 14 Hz-SW is better, which is closely with Deqi-sensation.

  12. 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.

  13. Shock-wave therapy for tennis and golfer's elbow--1 year follow-up.

    PubMed

    Krischek, O; Hopf, C; Nafe, B; Rompe, J D

    1999-01-01

    Thirty patients with chronic medial epicondylitis were treated with low-energy shock waves. They received 500 impulses of 0.08 mJ/mm2 three times at weekly intervals. At 1 year follow-up examinations were performed. According to the Verhaar criteria, only seven patients reached excellent or good results. In eight cases a fair outcome was recorded, and in 14 patients the outcome was poor. Only six patients were satisfied with the treatment. The average relief of pain was 32%. These data were significantly worse than for identically treated patients with chronic tennis elbow. Thus, the question arises as to whether extracorporal shock-wave therapy is indicated in medial epicondylitis.

  14. [Ureterorenoscopy combined with extracorporeal shockwave lithotripsy].

    PubMed

    González Cabrera, L A; Oro Ortiz, J

    1989-01-01

    In May 1986, extracorporeal shock wave lithotripsy and endourologic procedures became available in the treatment of lithiasis at the "Hermanos Ameijeiras" Hospital. The present study describes our experience and the results achieved during a 12-month period using endourologic procedures. During this period 65 URS procedures were performed to treat post-ESWL ureteral obstruction, and 22 to push the stone up to the kidney for subsequent ESWL treatment.

  15. Generation of highly symmetric, cylindrically convergent shockwaves in water

    NASA Astrophysics Data System (ADS)

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

    2017-08-01

    We report on pulsed power driven, exploding copper wire array experiments conducted to generate cylindrical convergent shockwaves in water employing μs risetime currents >550 kA in amplitude and with stored energies of >15 kJ—a substantial increase over previous results. The experiments were carried out on the recently constructed Mega-Ampere-Compression-and-Hydrodynamics facility at Imperial College London in collaboration with colleagues of Technion, Israel. 10 mm diameter arrays consisting of 60 × 130 μm wires were utilized, and the current and voltage diagnostics of the load region suggested that ˜8 kJ of energy was deposited in the wires (and the load region close to the wires) during the experiments, resulting in the formation of dense, highly resistive plasmas that rapidly expanded driving the shockwaves in water. Laser-backlit framing images of the shockfront were obtained at radii <0.25 mm for the first time, and there was strong evidence that even at radii <0.1 mm this front remains stable, resulting in a convergence ratio of >50:1. Framing images and streak photographs showed that the velocity of the shockwave reached ˜7.5 km s-1 at 0.1 mm from the axis. 2D hydrodynamic simulations that match the experimentally obtained implosion trajectory suggest that pressures >1 Mbar are produced within 10 μm of the axis along with water densities of 3gcm-3 and temperatures of many 1000 s of Kelvin. Under these conditions, Quotidian Equation of State suggests that a strongly coupled plasma with an ionization fraction of ˜0.7 would be formed. The results represent a "stepping stone" in the application of the technique to drive different material samples into high pressure, warm dense matter regimes with compact, university scale generators, and provide support in scaling the technique to multi-mega ampere currents.

  16. On the use of shockwave models in laser produced plasma expansion

    NASA Astrophysics Data System (ADS)

    de Posada, E.; Arronte, M. A.; Ponce, L.; Rodríguez, E.; Flores, T.; Lunney, J. G.

    2011-01-01

    Interaction of medium to high peak power laser pulses with solid materials produces a plasma that expands supersonically. Expansions of such plasmas have been studied and several models have been proposed to describe it. This work presents a study of the expansion of laser produced plasmas in both vacuum and gas environment by using Langmuir probe and photography. It compares some of the most used models to identify that which better describes the expansion process. In vacuum, such process is properly described by the Anisimov model. However when expanding in a background gas it is found that the Sedov-Taylor model fits properly the position of generated shockwave but overestimates both kinetic energy and pressure of the expanding plasma. Such problem is solved by using a modification of the Freiwald-Axford model. Finally it is demonstrated that after the plasma stopping distance the plasma inters in a diffusive regime.

  17. Bacterial biofilm disruption using laser-generated shockwaves

    NASA Astrophysics Data System (ADS)

    Navarro, Artemio; Taylor, Zachary D.; Matolek, Anthony Z.; Weltman, Ahuva; Ramaprasad, Vidyunmala; Huang, Sean; Beenhouwer, David O.; Haake, David A.; Gupta, Vijay; Grundfest, Warren S.

    2012-03-01

    Bacterial related infections are a burden on the healthcare industry. A system was built to test the efficacy of laser generated shockwaves on S. epidermidis biofilms (RP62A) grown on polystyrene surfaces. The system is based on a Qswitched, ND:YAG pulsed laser with an output wavelength of 1.064 μm that ablates titanium-coated soda-lime glass. Results show that the system is capable of generating stress profiles that can effectively delaminate biofilm structures from polymer surfaces.

  18. Laboratory Simulations of Supernova Shockwave Progagation and ISM Interaction

    SciTech Connect

    Hansen, J F; Edwards, M J; Robey, H F; Miles, A R; Froula, D; Gregori, G; Edens, A; Ditmire, T

    2003-08-29

    High Mach number shockwaves were launched in laboratory plasmas to simulate supernova shockwave propagation. The experiments were carried out at inertial fusion facilities using large lasers. Spherical shocks were created by focusing laser pulses onto the tip of a solid pin surrounded by ambient gas. Ablated material from the pin would rapidly expand and launch a shock through the surrounding gas. Planar shocks were created by ablating material from one end of a cylindrical shocktube. Laser pulses were typically 1 ns in duration with ablative energies ranging from <1 J to >4 kJ. Shocks were propagated through various plasmas, and observed at spatial scales of up to 5 cm using optical and x-ray cameras. Interferometry techniques were used to deduce densities, and emission spectroscopy data were obtained to infer electron temperatures. Experimental results confirm that spherical shocks are Taylor-Sedov, and that radiative shocks stall sooner than non-radiative shocks. Unexpected results include the birth of a second shock ahead of the original, stalling shock, at the edge of the radiatively preheated region. We have begun experiments to simulate the interaction between shocks and interstellar material (ISM), and the subsequent turbulent mixing. Comparisons between experimental data and numerical simulations of shock evolution, stall, second shock birth, and interstellar material (ISM) interaction will be presented.

  19. Mesoscale simulations of shockwave energy dissipation via chemical reactions

    NASA Astrophysics Data System (ADS)

    Antillon, Edwin; Strachan, Alejandro

    2015-06-01

    We use a particle-based mesoscale model that incorporates chemical reactions at a coarse-grained level to study the response of materials under shockwave-loading conditions. An additional implicit variable (the particle size) is used to describe volume-reducing chemical reactions using an intra-molecular potential inspired by Transition State Theory, while the dynamics of the center-of-mass motion evolves according to inter-particle forces. The equations of motion are derived from a Hamiltonian and the model captures both: total energy conservation and Galilean invariance. We demonstrate that this model captures complex thermo-mechanical-chemical processes, and we use these features to explore materials with the capabilities to dissipate shocks-wave energy due to ballistic impacts. Our results characterize how the parameters of the chemical model affect shock-wave attenuation, and we elucidate on how the coupling between the different energy-transferring mechanisms influences nucleation of chemistry for conditions away from equilibrium.

  20. [Lithotripsy of gallbladder calculi with extracorporeal shockwaves].

    PubMed

    Nogueira, C E; Martins, F P; Dani, R

    1991-01-01

    Two hundred and sixty two patients with gallbladder stones were prospectively evaluated at the Biliary Lithiasis Treatment Unit of the Mater Dei Hospital, Belo Horizonte, MG., and 45 (17.5%) were selected for extracorporal shock wave lithotripsy (ECSWL). From these, 32 were submitted to the procedure. One stone was present in 30 patients, 2 stones in another and 1 patient had 3 stones. The mean diameter was 14.7 mm ranging from 8 to 28 mm. ECSWL was preceded by 1 week course of ursodeoxycholic acid (8 to 10 mg/dk/day) and this medication was continued after the procedure. ECSWL was done with the Lithosthar-Plus apparatus (Siemens). Meperidine (up to 100 mg) IM and pirazolene IV was given when necessary. The intensity of the shock waves was gradually increased to a maximum (9 bar) whenever tolerated. The treatment was well succeeded in 22 cases (71%) with pulverization in 12 (38.7%). In 9 patients (29%) remaining fragments were greater than 4 mm. From these, 3 were submitted to a second session of ECSWL. In 1 patient the stone could not be properly positioned for lithotripsy. The mean number of shock waves was 2,591, ranging from 801 to 4,411. The mean duration of the sessions was 80 min, ranging from 45 to 150 min. In 3 patients, a complete disappearance of fragments was observed in intervals of 1 to 6 months after the procedure. One patient had severe pain during ECSWL and developed acute cholecystitis. One patient had sinus bradycardia. One patient with total stone pulverization, become jaundiced 1 month after ECSWL and a gallbladder carcinoma was found at surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Treatment of Standardized Fractures by Extracorporeal Shockwave Therapy (ESWT)

    DTIC Science & Technology

    2001-10-25

    Shock Wave Therapy (ESWT) makes use of shock waves , which are produced by electrohydraulic, electromagnetic and piezoelectric means and focused on the...experimental experiences - Abstract tape of the symposium to the shock wave therapy , Kassel-Germany, 11-12 April 1997, pp. 40–45, Hamburg, Dr...body by use of concave reflectors. Studies on the effects of shock waves on living tissues, blood vessels, nerves, renal tissue [1] and bony

  2. Direct numerical simulation of shockwave and turbulent boundary layer interactions

    NASA Astrophysics Data System (ADS)

    Wu, Minwei

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

  3. Shockwave Propagation in Nonequilibrium Air Plasma

    DTIC Science & Technology

    2006-07-01

    V cm-1), the observed B3Πg – A3Σu+ intensity jumps by at least 20% compared to the steady state in 2 μs. This requires a rate of change of the...S.E.Ponomareva, V.M.Shibkov, High Temp. 29, 468 (1990) 5. Y.Z. Ionikh, N. V . Chernysheva, A . V . Meshchanov, A . P. Yalin and R.B. Miles, Phys. Lett. A 259...Cathode Anode 15 Figure 2a -15 -10 -5 0 m V 1.51.00.50.0 mS 20 15 10 5 m

  4. Shock-wave heating model for chondrule formation: Hydrodynamic simulation of molten droplets exposed to gas flows

    NASA Astrophysics Data System (ADS)

    Miura, Hitoshi; Nakamoto, Taishi

    2007-05-01

    Millimeter-sized, spherical silicate grains abundant in chondritic meteorites, which are called as chondrules, are considered to be a strong evidence of the melting event of the dust particles in the protoplanetary disk. One of the most plausible scenarios is that the chondrule precursor dust particles are heated and melt in the high-velocity gas flow (shock-wave heating model). We developed the non-linear, time-dependent, and three-dimensional hydrodynamic simulation code for analyzing the dynamics of molten droplets exposed to the gas flow. We confirmed that our simulation results showed a good agreement in a linear regime with the linear solution analytically derived by Sekyia et al. [Sekyia, M., Uesugi, M., Nakamoto, T., 2003. Prog. Theor. Phys. 109, 717-728]. We found that the non-linear terms in the hydrodynamical equations neglected by Sekiya et al. [Sekiya, M., Uesugi, M., Nakamoto, T., 2003. Prog. Theor. Phys. 109, 717-728] can cause the cavitation by producing negative pressure in the droplets. We discussed that the fragmentation through the cavitation is a new mechanism to determine the upper limit of chondrule sizes. We also succeeded to reproduce the fragmentation of droplets when the gas ram pressure is stronger than the effect of the surface tension. Finally, we compared the deformation of droplets in the shock-wave heating with the measured data of chondrules and suggested the importance of other effects to deform droplets, for example, the rotation of droplets. We believe that our new code is a very powerful tool to investigate the hydrodynamics of molten droplets in the framework of the shock-wave heating model and has many potentials to be applied to various problems.

  5. Effects of extracorporeal shockwave therapy on patients with chronic low back pain and their dynamic balance ability.

    PubMed

    Lee, Sangyong; Lee, Daehee; Park, Jungseo

    2014-01-01

    [Purpose] The purpose of the present study was to examine the effects of extracorporeal shockwave therapy (ESWT) for patients with chronic low back pain and their dynamic balance ability. [Subjects] Twenty-eight patients with chronic low back were divided into an extracorporeal shockwave therapy group (ESWTG: n=13) and a conservative physical therapy group (CPTG, n=15). [Methods] An exercise program that included Williams' exercises and McKenzie's exercises was performed by both groups. The program was implemented twice a week for six weeks. The visual analog scale (VAS) was used to measure the chronic low back pain of the patients. Their dynamic balance ability was measured with BioRescue. [Results] The within-group comparison of the VAS of the ESWTG and the CPTG showed significant improvements after the intervention. In the VAS comparison between the groups after the treatment, the ESWTG showed a significantly larger improvement. In the within-group comparison of dynamic balance ability, the ESWTG showed significant improvements after the intervention in SAPLS, SAPRS, SAPFS, SAPBS, and TSA, and the CPTG showed significant improvements in SAPLS and SAPBS. In the between-group comparison of the dynamic balance ability after the treatment, the ESWTG showed significantly larger improvements in their SAPLS, SAPRS, SAPFS, and TSA. [Conclusion] The exercise program combined with the ESWT relieved chronic back pain more than the exercise program combined with the CPT. The former was also more effective at improving the patients' dynamic balance ability in terms of SAPLS, SAPRS, SAPFS, and TSA.

  6. Comparing Burned and Mowed Treatments in Mountain Big Sagebrush Steppe

    NASA Astrophysics Data System (ADS)

    Davies, K. W.; Bates, J. D.; Nafus, A. M.

    2012-09-01

    Fires in mountain big sagebrush [ Artemisia tridentata spp. vaseyana (Rydb.) Beetle] plant communities historically shifted dominance from woody to herbaceous vegetation. However, fire return intervals have lengthened with European settlement, and sagebrush dominance has increased at the expense of herbaceous vegetation in some plant communities. Management actions may be needed to decrease sagebrush in dense sagebrush stands to increase herbaceous vegetation. Prescribed fire is often used to remove sagebrush; however, mechanical treatments, such as mowing, are increasingly used because they are more controllable and do not pose an inherent risk of escape compared with fire. However, information on the effects of burned and mowed treatments on herbaceous vegetation and whether fire and mowed applications elicit similar vegetation responses are limited. We evaluated the effects of prescribed burning and mowing for 3 years after treatment in mountain big sagebrush plant communities. The burned and mowed treatments generally increased herbaceous cover, density, and production compared with untreated controls ( P < 0.05). However, neither treatment induced a response in native perennial forb cover, density, or biomass ( P > 0.05). In contrast, annual forb (predominately natives) cover, density, and biomass increased with mowing and burning ( P < 0.05). Vegetation generally responded similarly in burned and mowed treatments; however, the burned treatment had less sagebrush, greater herbaceous vegetation production, and more bare ground than the mowed treatment ( P < 0.05). These differences should be considered when selecting treatments to decrease sagebrush.

  7. Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

    ERIC Educational Resources Information Center

    Robst, John; Armstrong, Mary; Dollard, Norin

    2011-01-01

    This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were…

  8. Comparing Outcomes for Youth Served in Treatment Foster Care and Treatment Group Care

    ERIC Educational Resources Information Center

    Robst, John; Armstrong, Mary; Dollard, Norin

    2011-01-01

    This study compared youth in the Florida Medicaid system prior to entry into treatment foster care or treatment group care, and compared outcomes in the 6 months after treatment. Florida Medicaid data from FY2003/04 through 2006/2007 along with Department of Juvenile Justice, Department of Law Enforcement, and involuntary examination data were…

  9. Laser Shockwave Technique For Characterization Of Nuclear Fuel Plate Interfaces

    SciTech Connect

    James A. Smith; Barry H. Rabin; Mathieu Perton; Daniel Lévesque; Jean-Pierre Monchalin; Martin Lord

    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. 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.

  10. Shock-Wave Consolidation of Nanostructured Bismuth Telluride Powders

    NASA Astrophysics Data System (ADS)

    Beck, Jan; Alvarado, Manuel; Nemir, David; Nowell, Mathew; Murr, Lawrence; Prasad, Narasimha

    2012-06-01

    Nanostructured thermoelectric powders can be produced using a variety of techniques. However, it is very challenging to build a bulk material from these nanopowders without losing the nanostructure. In the present work, nanostructured powders of the bismuth telluride alloy system are obtained in kilogram quantities via a gas atomization process. These powders are characterized using a variety of methods including scanning electron microscopy, transition electron microscopy, and x-ray diffraction analysis. Then the powders are consolidated into a dense bulk material using a shock-wave consolidation technique whereby a nanopowder-containing tube is surrounded by explosives and then detonated. The resulting shock wave causes rapid fusing of the powders without the melt and subsequent grain growth of other techniques. We describe the test setup and consolidation results.

  11. Laser shockwave technique for characterization of nuclear fuel plate interfaces

    SciTech Connect

    Perton, M.; Levesque, D.; Monchalin, J.-P.; Lord, M.; Smith, J. A.; Rabin, B. H.

    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. 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.

  12. Thermal loading of laser induced plasma shockwaves on thin films in nanoparticle removal

    SciTech Connect

    Varghese, Ivin; Zhou Dong; Peri, M. D. Murthy; Cetinkaya, Cetin

    2007-06-01

    Damage concerns, such as substrate/film material alterations, damage, and delamination of thin films, have become a central problem in sub-100 nm particle removal applications. In the laser induced plasma (LIP) removal technique both LIP shockwave and radiation heating are potential sources of thermomechanical damage. The specific objective of current study is to conduct a computational investigation of the LIP shockwave effect on the thermoelastic response of a thin chromium (Cr) film deposited on a quartz substrate and to identify the conditions leading to the onset of plastic film deformations. The experimentally characterized shockwave pressure and temperature (approximated from gas dynamic relations) were prescribed as boundary conditions in the computational analysis. From the shockwave arrival times for different travel distances, the shockwave radius as well as the velocity were obtained as a function of the shockwave propagation time. Radial (and circumferential) stresses, caused by thermal expansion of the Cr film, were most dominant and, hence, of damage concern. It is determined that the resultant temperature rise utilizing a 1064 nm Nd:yttrium-aluminum-garnet (YAG) laser (450 mJ) due to the film-shockwave interactions was not sufficiently high to initiate film and/or substrate damage. No material alteration/damage of the Cr film is predicted due to the temperature and pressure of LIP shockwaves at the firing distance of 2 mm, with a high strain rate gain factor of two (minimum), though damage was observed experimentally for 1064 nm Nd:YAG laser at the pulse energy of 370 mJ. Reported results indicate that the leading cause of observed thin film damage during nanoparticle removal is almost certainly radiation heating from the LIP core.

  13. A comparative analysis of outpatient costs in HIV treatment programs.

    PubMed

    Sarti, Flavia Mori; Nishijima, Marislei; Campino, Antonio Carlos Coelho; Cyrillo, Denise Cavallini

    2012-01-01

    To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems. A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars. Annual cost of HIV outpatient treatment for the Brazilian national public program was US$ 2,572.92 in 2006 in São Paulo, ranging from US$ 1,726.19 for patients with CD4 cell count > 500 to US$ 3,693.28 for patients with 51 < CD4 cell count < 200. Antiretrovirals (ARVs) represented approximately 62.0% of annual HIV outpatient costs. Comparing among different health systems during the same period, HIV outpatient treatment presented higher costs in countries where HIV treatment is provided by the private sector. The main cost drivers of HIV outpatient treatment in different health systems were: ARVs, other medications, health professional services, and diagnostic exams. Nevertheless, the magnitude of cost drivers varied among HIV outpatient treatment programs due to health system efficiency. The data presented may be a valuable tool for public policy evaluation of HIV treatment programs worldwide.

  14. Endoscopic-assisted electrohydraulic shockwave lithotripsy in standing sedated horses.

    PubMed

    Röcken, Michael; Fürst, Anton; Kummer, Martin; Mosel, Gesine; Tschanz, Theo; Lischer, Christoph J

    2012-07-01

    To report use of transendoscopic electrohydraulic shockwave lithotripsy for fragmentation of urinary calculi in horses. Case series. Male horses (n = 21). Fragmentation of cystic calculi (median, 6 cm diameter; range, 4-11 cm diameter) was achieved by transurethral endoscopy in standing sedated horses using an electrohydraulic shockwave fiber introduced through the biopsy channel of an endoscope. The fiber was advanced until it contacted the calculus. Repeated activation of the fiber was used to disrupt the calculus into fragments <1 cm diameter. Visibility within the bladder was maintained by repeated lavage with saline solution. Complete calculus removal was achieved in 20 horses (95%) with mean total surgical time of 168.6 minutes (range, 45-450). In the 20 horses with single calculi, 1-6 sessions were required to completely fragment the calculus. Except for 1 horse, in which perineal urethrotomy was eventually performed for complete fragment removal, fragments calculi were excreted via the urethra. Postoperative complications included hematuria because of severe mucosal erosion (n = 2), dysuria because of a trapped urethral fragment (2), small amount of urinary debris (1). One horse was euthanatized because of bladder rupture. Complete clearance of calculi and urinary debris was confirmed endoscopically 20 (3-45) days after the last session. Telephone follow-up (mean, 18.8 months; range, 7-24 months) revealed that horses had returned to previous activity levels without recurrence of clinical signs. Transendoscopic electrohydraulic lithotripsy appears to be an effective method for fragmentation of low-density calcium carbonate cystic calculi in male horses. Copyright 2012 by The American College of Veterinary Surgeons.

  15. Development of a new diagnostic sensor for extra-corporeal shock-wave lithotripsy

    NASA Astrophysics Data System (ADS)

    Fedele, F.; Coleman, A. J.; Leighton, T. G.; White, P. R.; Hurrell, A. M.

    2004-01-01

    Extracorporeal shock-wave lithotripsy is the leading technique used in urology for the non-invasive treatment of kidney and ureteric stones. The stone is comminuted by thousands of ultrasound shocks, into fragments small enough to be naturally passed. Since the technique was introduced in the 1980 different generations of lithotripters have been developed. Nevertheless the alignment systems (x-ray, ultrasound) still have some limitations (indeed, the tighter focusing of newer lithotripter reduces the tolerance for misalignment) and there is no capability for on-line monitoring of the degree of fragmentation of the stone. There is 50% incidence of re-treatments, possibly due to these deficiencies. The objective of this research is to design a new passive acoustic sensor, exploiting the secondary acoustic emission generated during the treatment, which could be used as a diagnostic device for lithotripsy. With a passive cylindrical cavitation detector, developed by the National Physical Laboratory, it was possible to detect these emissions in a laboratory lithotripter, and it was shown that they contain information on the degree of stone fragmentation and stone location. This information could be used to perform the desired monitoring and to improve the stone targeting. In collaboration with Precision Acoustic Ltd, some clinical prototypes were developed and tested to verify the relevance of these preliminary results. Clinical results are presented.

  16. Waste battery treatment options: comparing their environmental performance.

    PubMed

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

    2009-08-01

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

  17. Comparative effectiveness of Clostridium difficile treatments: a systematic review.

    PubMed

    Drekonja, Dimitri M; Butler, Mary; MacDonald, Roderick; Bliss, Donna; Filice, Gregory A; Rector, Thomas S; Wilt, Timothy J

    2011-12-20

    Clostridium difficile infection is increasing in incidence and severity. The optimal treatment is unknown. To determine whether, among adults with C. difficile infection, treatment with certain antibiotics compared with others results in differences in initial cure, recurrence, and harms. MEDLINE, AMED, ClinicalTrials.gov, and Cochrane databases (search dates: inception through August 2011, limited to English-language reports); bibliography review. Randomized, controlled trials of adults with C. difficile infection, independent of outcomes, who were treated with medications available in the United States. Observational studies reporting strain were included. Study design, inclusion and exclusion criteria, quality and strength of evidence as assessed by 2 reviewers, study definitions, and duration of treatment and follow-up. Outcomes included initial cure, recurrence, and treatment harms. 11 trials that included 1463 participants were identified. Three trials compared metronidazole with vancomycin; 8 compared metronidazole or vancomycin with another agent, combined agents, or placebo. Strain was analyzed in 1 trial and 2 cohort studies. No study comparing 2 antimicrobial agents demonstrated a statistically significant difference for initial cure; all comparisons were of low to moderate strength of evidence. Moderate-strength evidence from 1 study demonstrated that recurrence was decreased with fidaxomicin versus vancomycin (15% vs. 25%; difference, -10 percentage points [95% CI, -17 to -3 percentage points]; P=0.005). Subgroup analysis of a single study comparing metronidazole with vancomycin for patients who have severe C. difficile infection showed no difference by intention-to-treat analysis; this was rated as insufficient-strength evidence. Harms, when reported, did not differ between treatments in any study. Definitions of diarrhea, C. difficile infection, initial cure, and relapse varied. Some studies reported insufficient detail to allow assessment of all

  18. Treatment satisfaction and recovery in Saami and Norwegian patients following psychiatric hospital treatment: a comparative study.

    PubMed

    Sørlie, Tore; Nergård, Jens-Ivar

    2005-06-01

    Treatment, treatment satisfaction and recovery in Saami and Norwegian patients treated in a psychiatric hospital were compared. Although half of the Saami patients preferred to speak Saami with their therapists, only one patient did. The extensive use of traditional helpers was only partly recognized. Despite no differences in type and amount of treatment or symptom-change during the hospital stay, the Saami patients showed less satisfaction with all investigated treatment parameters including contact with staff, treatment alliance, information and global treatment satisfaction. There was less agreement between the ratings of the therapists and the Saami patients. Suggestions for improvements are made.

  19. Renal morphology and function immediately after extracorporeal shock-wave lithotripsy

    SciTech Connect

    Kaude, J.V.; Williams, C.M.; Millner, M.R.; Scott, K.N.; Finlayson, B.

    1985-08-01

    The acute effects of extracorporeal shock-wave lithotripsy (ESWL) on morphology and function of the kidney were evaluated by excretory urography, quantitative radionuclide renography (QRR), and magnetic resonance imaging (MRI) in 33 consecutive patients. Excretory urograms demonstrated an enlarged kidney in seven (18%) of 41 treatments and partial or complete obstruction of the ureter by stone fragments after 15 (37%) of 41 treatments. Total effective renal plasma flow (ERPF) was not changed after ESWL, but the percentage ERPF of the treated kidney was decreased by more than 5% in 10 (30%) of 33 cases. QRR images showed partial parenchymal obstruction in 10 (25%) of 41 teated kidneys and total parenchymal obstruction in 9 (22%). MRI disclosed one or more abnormalities in 24 (63%) of 38 treated kidneys. Treated kidneys were normal by all three imaging methods in 26% and abnormal by one or more tests in 74% of cases. The morphologic and functional changes are attributed to renal contusion resulting in edema and extravasation of urine and blood into the interstitial, subcapsular, and perirenal spaces.

  20. Comparing a stratified treatment strategy with the standard treatment in randomized clinical trials.

    PubMed

    Sun, Hong; Bretz, Frank; Gerke, Oke; Vach, Werner

    2016-12-20

    The increasing emergence of predictive markers for different treatments in the same patient population allows us to define stratified treatment strategies. We consider randomized clinical trials that compare a standard treatment with a new stratified treatment strategy that divides the study population into subgroups receiving different treatments. Because the new strategy may not be beneficial in all subgroups, we consider in this paper an intermediate approach that establishes a treatment effect in a subset of patients built by joining several subgroups. The approach is based on the simple idea of selecting the subset with minimal p-value when testing the subset-specific treatment effects. We present a framework to compare this approach with other approaches to select subsets by introducing three performance measures. The results of a comprehensive simulation study are presented, and the relative merits of the various approaches are discussed. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  1. The effect of autologous endothelial progenitor cell transplantation combined with extracorporeal shock-wave therapy on ischemic skin flaps in rats.

    PubMed

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

    2014-08-01

    Endothelial progenitor cells (EPCs) have been used to revascularize ischemic tissues, but only limited effect can be achieved. Extracorporeal shock-wave therapy (ESWT) is a promising angiogenic strategy. We hypothesized that EPC transplantation combined with ESWT would greatly benefit the survival of ischemic skin flaps. Sixty-four male Sprague-Dawley rats were divided into 4 groups (n = 16 in each group): group 1 (serving as sham control), group 2 (treated with subcutaneous EPC implantation, 1.0 × 10(6) cells), group 3 (treated with ESWT, 300 impulses at 0.10 mJ/mm(2)) and group 4 (treated with EPCs implantation combined with ESWT). Ischemic skin flaps were made on the backs of rats and treated accordingly. Blood flow of skin flaps was measured periodically after operation, and flap survival rates were compared. Tissue samples were harvested at 2 weeks postoperatively from each group. The survival rate of skin flaps in group 4 was 87.5 ± 10.23%, which was statistically significantly higher than other groups. Histologic examination showed that the capillary density was higher in the dual-treatment group than in the two single-treatment groups. Compared with groups 2 and 3, blood perfusion increased significantly in group 4. A drastic increase of vWF+ cells was observed in the ischemic skin flaps on immunofluorescence staining in group 4. The expressions of chemotactic factors and angiogenic factors were higher in group 4. Combined treatment with EPCs and ESWT is superior to either EPCs or ESWT alone in improving the survival of ischemic skin flaps in rats. Copyright © 2014 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

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

    PubMed

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

    2017-09-27

    To evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT). Systematic review. Randomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated. Moderate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting. Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK).

    PubMed

    Panah, A; Patel, S; Bourdoumis, A; Kachrilas, S; Buchholz, N; Masood, J

    2013-10-01

    Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.

  4. Comparative Review of the Treatment Methodologies of Carotid Stenosis

    PubMed Central

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

    2015-01-01

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

  5. 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).

  6. Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

    PubMed

    Tourchi, Ali; Ebadi, Maryam; Hosseinzadeh, Alireza; Shabaninia, Mahsa

    2014-03-01

    Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis.

  7. The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments.

    PubMed

    Budge, Stephanie L; Moore, Jonathan T; Del Re, A C; Wampold, Bruce E; Baardseth, Timothy P; Nienhuis, Jacob B

    2013-12-01

    The purpose of Study 1 was to examine the relative efficacy of evidence-based treatments (EBTs) when compared to treatment-as-usual (TAU) for adults diagnosed with a personality disorder (PD). The purpose of Study 2 was to investigate the strength of the differences between bona fide psychotherapeutic treatments for PDs. Two separate computerized searches were conducted of: (a) studies that directly compared an EBT with a TAU for treatment of PDs, or (b) studies that compared at least two bona fide treatments for PDs. Meta-analytic methods were used to estimate the effectiveness of the treatments when compared to one another and to model how various confounding variables impacted the results of this comparative research. A total of 30 studies (Study 1; N=1662) were included in the meta-analysis comparing EBTs to TAU. A total of 12 studies (Study 2; N=723) were included in the meta-analysis comparing bona fide treatments. Study 1 found that EBTs were superior to TAU, although the TAU conditions were not comparable in many respects (e.g., not psychotherapy, lacking supervision, lacking training, etc.) to the EBT and there was significant heterogeneity in the effects. Study 2 found that some bona fide treatments were superior to others. © 2013.

  8. Comparative analysis of bio fouling microorganisms after treatment with glidarc

    NASA Astrophysics Data System (ADS)

    Hnatiuc, M.; Sabau, A.; Hnatiuc, B.; Ghita, S.

    2015-11-01

    The biofouling of the surfaces immersed in water is one of the most important problems which must be solved in the naval field. This phenomenon is amplified during the harbor operations, when the ships are stationary and there is a high density of microorganisms in the neritic area, developing the biofouling. For this reason, in order to prevent or delay the deposition of the first layers of biofouling, different methods have been used [1]. This paper presents the comparative analysis of microorganisms’ behavior obtained by using GlidArc technology for the treatment of the naval metallic surfaces [2, 3]. The main parameters identified for data processing were: the number of microorganisms shared from the point of view of sensibility to the used technology found on the metallic surfaces, the type of the naval paint and the treatment methods. For analysis it was used the epifluorescence microscopy method with. The comparative analysis follows the data processing which has the same input characteristics. Finally it was observed the microorganism's lifetime after the surface treatment.

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

    SciTech Connect

    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. Furthermore, the formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.

  10. 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

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

    SciTech Connect

    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. Furthermore, the formation and growth of extended asymmetric hot regions on nanosecond timescales has important implications for shock initiation thresholds in energetic materials.

  12. 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.

  13. 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.

  14. Impact of extracorporeal shock-wave therapy on the stability of temporary anchorage devices in adults: a single-center, randomized, placebo-controlled clinical trial.

    PubMed

    Falkensammer, Frank; Rausch-Fan, Xiaohui; Arnhart, Christoph; Krall, Christoph; Schaden, Wolfgang; Freudenthaler, Josef

    2014-10-01

    In this randomized, placebo-controlled clinical trial, we investigated the effect of noninvasive extracorporeal shock waves on the stability of temporary anchorage devices (TADs) under orthodontic loading. Thirty adult orthodontic patients of the Bernhard Gottlieb University Clinic in Vienna, Austria, were enrolled in this clinical trial and allocated by block randomization (size, 4) in a 1:1 ratio to either the treatment or the placebo group. Randomization was performed with software, and the allocations were concealed in sealed envelopes. Eligibility criteria included healthy adult patients with mesially directed orthodontic movement of the mandibular second molar into the extraction site of the mandibular first molar. The fixed orthodontic devices included active superelastic coil springs (200 cN) and TADs in the mandibular alveolar bone. Blinding was performed for the subjects and the outcome assessor. The treatment group received 1 shock-wave application with 1000 impulses at 0.19 to 0.23 mJ per square millimeter in the region of the TADs. The placebo group was treated with a deactivated shock-wave applicator and acoustic sham. The TADs positions were evaluated at placement and after 4 months. The reliability and precision of the impression process of the TADs were evaluated in an in-vitro model. Thirteen participants finished the investigation successfully in the treatment group but only 12 finished in the placebo group because 1 TAD loosened. The difference of the total TAD displacement for the 4-month time period between the placebo and treatment groups was 0.17 ± 0.95 mm (95% CI: -0.96, 0.62). No statistically significant difference between the 2 groups was found when sex was evaluated. Primary stability of the TADs as measured by placement torque, amount of tooth movement, and age of the patients did not influence displacement of the TADs. The reliability and precision of TAD impressions were confirmed. No unintended pernicious effects occurred

  15. Treatment of cricopharyngeal dysfunction: a comparative pilot study.

    PubMed

    Arenaz Búa, Beatriz; Olsson, Rolf; Westin, Ulla; Rydell, Roland; Ekberg, Olle

    2015-07-10

    Cricopharyngeal dysfunction is a narrowing at the level of the upper oesophageal sphincter caused by failed or incomplete sphincter opening as a result of lack of pharyngoesophageal coordination or reduction in the muscular compliance of the upper oesophageal sphincter. Oropharyngeal dysphagia is a typical symptom. Videomanometry allows direct comparison of pressure readings with dynamic anatomy during swallowing. This is a prospective randomized pilot study that compares the effect of balloon dilatation and laser myotomy in cricopharyngeal dysfunction. We used videomanometry as an objective measure and the Swedish version of Sydney Swallowing Questionnaire as patient's self-assessment at baseline and 1 and 6 months after treatment. The UES sagittal diameter increased from 5.6 mm pre-operatively to 8.4 mm 6 months post-operatively with no differences between treatment groups. Preoperative mean Sydney Swallowing Questionnaire score was 770 and 6 months post-operative score 559, with no difference between the treatments in our cohort. Cricopharyngeal dysfunction treatment by either laser myotomy or balloon dilatation improved upper oesophageal sphincter opening during at least 6 months. ISRCTN84905610, date: 081214.

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

    SciTech Connect

    Miloshevsky, Alexander; Harilal, Sivanandan S.; Miloshevsky, Gennady Hassanein, Ahmed

    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 from 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.

  17. Shock-wave initiation of heterogeneous reactive solids

    NASA Astrophysics Data System (ADS)

    Johnson, J. N.; Tang, P. K.; Forest, C. A.

    1985-05-01

    Shock-wave initiation of solid explosives depends on localized regions of high temperature (hot spots) created by heterogeneous deformation in the vicinity of various defects. Current mathematical models of shock initiation tend to fall into two broad categories: (1) thermodynamic-state-dependent reaction-rate models, and (2) the continuum theory of multiphase mixtures. The level of generality possessed by (1) appears to be insufficient for representation of observed initiation phenomena, while that of (2) may exceed necessary requirements based on present measurement capabilities. As a means of bridging the gap between these two models, we present an internal-state-variable theory based on elementary physical principles, relying on specific limiting cases for the determination of functional forms. The appropriate minimum set of internal-state variables are the mass fraction of hot spots μ, their degree of reaction f, and their average creation temperature θ. The overall reaction rate λ˙, then depends on μ, f, and θ in addition to the usual macroscopic thermodynamic variables (current state as well as their history). Two specific forms of this set of equations are applied to time-resolved shock-initiation data on PBX-9404. Numerical solution is achieved by the method of characteristics for rate-dependent chemical reaction. Additional questions such as the effect of thermal equilibrium between phases (solid reactants and gaseous products) on the theoretical results are discussed quantitatively.

  18. Shock-wave cosmology inside a black hole.

    PubMed

    Smoller, Joel; Temple, Blake

    2003-09-30

    We construct a class of global exact solutions of the Einstein equations that extend the Oppeheimer-Snyder model to the case of nonzero pressure, inside the black hole, by incorporating a shock wave at the leading edge of the expansion of the galaxies, arbitrarily far beyond the Hubble length in the Friedmann-Robertson-Walker (FRW) spacetime. Here the expanding FRW universe emerges be-hind a subluminous blast wave that explodes outward from the FRW center at the instant of the big bang. The total mass behind the shock decreases as the shock wave expands, and the entropy condition implies that the shock wave must weaken to the point where it settles down to an Oppenheimer-Snyder interface, (bounding a finite total mass), that eventually emerges from the white hole event horizon of an ambient Schwarzschild spacetime. The entropy condition breaks the time symmetry of the Einstein equations, selecting the explosion over the implosion. These shock-wave solutions indicate a cosmological model in which the big bang arises from a localized explosion occurring inside the black hole of an asymptotically flat Schwarzschild spacetime.

  19. Comparing Biofouling Control Treatments for Use on Aquaculture Nets

    PubMed Central

    Swain, Geoffrey; Shinjo, Nagahiko

    2014-01-01

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

  20. Extracorporeal shock-wave therapy enhanced wound healing via increasing topical blood perfusion and tissue regeneration in a rat model of STZ-induced diabetes.

    PubMed

    Kuo, Yur-Ren; Wang, Chun-Ting; Wang, Feng-Sheng; Chiang, Yuan-Cheng; Wang, Ching-Jen

    2009-01-01

    Extracorporeal shock-wave therapy (ESWT) has a significant positive effect in accelerating chronic wound healing. However, the bio-mechanisms operating during ESWT of wounds remain unclear. This study investigated the effectiveness of ESWT in the enhancement of diabetic wound healing. A dorsal skin defect (area, 6 x 5 cm) in a streptozotocin-induced diabetes rodent model was used. Fifty male Wistar rats were divided into five groups. Group I consisted of nondiabetic control; group II included diabetic control receiving no ESWT; group III included rats that underwent one session of ESWT (ESW-1) on day 3 (800 impulses at 0.09 mJ/mm(2)) postwounding; group IV included rats that underwent two sessions of ESWT (ESW-2) on days 3 and 7; and group V included rats that underwent three sessions of ESWT (ESW-3) on days 3, 7, and 10. The wound healing was assessed clinically. Blood perfusion scan was performed with laser Doppler. The VEGF, eNOS, and PCNA were analyzed with immunohistochemical stain. The results revealed that the wound size was significantly reduced in the ESWT-treated rats, especially in the ESW-2 and ESW-3 groups, as compared with the control (p<0.01). Blood perfusion was significantly increased after ESWT compared with the controls. Histological findings revealed a significant reduction in the topical pro-inflammatory reaction in the ESWT group as compared with the control. In immunohistochemical stain, significant increases in VEGF, eNOS, and PCNA expressions were observed in the ESWT group, especially in the ESW-2 and ESW-3 groups, as compared with the control. In conclusion, treatment with an optimal session of ESWT significantly enhanced diabetic wound healing associated with increased neo-angiogenesis and tissue regeneration, and topical anti-inflammatory response.

  1. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report

    PubMed Central

    Vander Eeckt, Kathy; Ost, Dieter; Van Den Branden, Marcel

    2016-01-01

    Abstract Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available. PMID:28078329

  2. Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report.

    PubMed

    Sermeus, Loic; Vander Eeckt, Kathy; Ost, Dieter; Van Den Branden, Marcel

    2016-01-01

    Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available.

  3. 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.

    2017-09-01

    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.

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

    NASA Astrophysics Data System (ADS)

    Coralic, Vedran; Colonius, Tim

    2014-11-01

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

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

    SciTech Connect

    Yeates, P.; Kennedy, E. T.

    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 profiles 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. A 970 Hounsfield units (HU) threshold of kidney stone density on non-contrast computed tomography (NCCT) improves patients' selection for extracorporeal shockwave lithotripsy (ESWL): evidence from a prospective study.

    PubMed

    Ouzaid, Idir; Al-qahtani, Said; Dominique, Sébastien; Hupertan, Vincent; Fernandez, Pédro; Hermieu, Jean-François; Delmas, Vincent; Ravery, Vincent

    2012-12-01

    What's known on the subject? and What does the study add? Stone density on non-contrast computed tomography (NCCT) is reported to be a prognosis factor for extracorporeal shockwave lithotripsy (ESWL). In this prospective study, we determined that a 970 HU threshold of stone density is a very specific and sensitive threshold beyond which the likelihood to be rendered stone free is poor. Thus, NCCT evaluation of stone density before ESWL may useful to identify which patients should be offered alternative treatment to optimise their outcome. • To evaluate the usefulness of measuring urinary calculi attenuation values by non-contrast computed tomography (NCCT) for predicting the outcome of treatment by extracorporeal shockwave lithotripsy (ESWL). • We prospectively evaluated 50 patients with urinary calculi of 5-22 mm undergoing ESWL. • All patients had NCCT at 120 kV and 100 mA on a spiral CT scanner. Patient age, sex, body mass index, stone laterality, stone size, stone attenuation values (Hounsfield units [HU]), stone location, and presence of JJ stent were studied as potential predictors. • The outcome was evaluated 4 weeks after the ESWL session by NCCT. • ESWL success was defined as patients being stone-free (SF) or with remaining stone fragments of <4 mm, which were considered as clinically insignificant residual fragments (CIRF). • Our survey concluded that 26 patients (52%) were SF, 12 (24%) had CIRF and 12 (24%) had residual fragment on NCCT after a one ESWL treatment. • Stones of patients who became SF or had CIRF had a lower density compared with stones in patients with residual fragments [mean (sd) 715 (260) vs 1196 (171) HU, P < 0.001]. • The Youden Index showed that a stone density of 970 HU represented the most sensitive (100%) and specific (81%) point on the receiver-operating characteristic curve. • The stone-free rate for stones of <970 HU was 96% vs 38% for stones of ≥ 970 HU (P < 0.001). A linear relationship between the

  11. Independent evaluator knowledge of treatment in a multicenter comparative treatment study of panic disorder.

    PubMed

    Roll, David; Ray, Susan E; Marcus, Sue M; Passarelli, Vincent; Money, Roy; Barlow, David H; Woods, Scott W; Shear, M Katherine; Gorman, Jack M

    2004-03-01

    The purpose of this study was to examine independent evaluators' (IEs) blindness to treatment condition during a Multicenter Comparative Treatment Study of Panic Disorder. IEs were 15 doctoral- and masters-level clinicians in psychology, social work, and medicine. They conducted three post-treatment assessments with each patient. Immediately after each assessment interview, IEs completed a form indicating which of the five possible treatments they believed the patient had received and any specific information that provided IEs with information about a patient's treatment condition. These forms were completed for 170 patients. Analyses were conducted to determine the accuracy of guesses about treatment condition by IEs during post-treatment assessments, the relationship between accuracy of IE guessing and actual treatment assignment, the relationship between accurate guessing and outcome ratings, and contributors to the breaking of the blind. A significant relationship was found between IE guesses and actual treatment at all three assessment points, across individual IEs, treatment sites, and IE professional affiliations. IEs were no more accurate in their guessing about patients taking medication than those receiving behavior therapy. Patients and project staff inadvertently provided information to IEs that enhanced the rates of accurate guessing. Implications of these findings on interpretation of the treatment study are discussed, and recommendations are made for improving blindness procedures.

  12. In vitro biomechanical evaluation of single impulse and repetitive mechanical shockwave devices utilized for spinal manipulative therapy.

    PubMed

    Liebschner, Michael A K; Chun, Kwonsoo; Kim, Namhoon; Ehni, Bruce

    2014-12-01

    Mechanical shockwave therapy devices have been in clinical use for almost 40 years. While most often used to treat back pain, our understanding of their biomechanical performance is very limited. From biomechanical studies we know that biological tissue is viscoelastic and preferably excited around its resonance frequency. Targeting these frequencies has been the focus in extracorporeal shock wave lithotripsy, but these concepts are relatively new in orthopedic and rehabilitation therapies. The exact mechanism by which shockwave therapy acts is not known. Knowledge of the performance characteristics of these devices, correlated with clinical outcome studies, may lead to better patient selection, improvement of device functionality, and knowledge of the underlying working principals of therapy. The objectives of this study were to determine the ability of several commercial shockwave devices to achieve a desired thrust profile in a benchtop setting, determine the thrust profile in a clinical analog, and determine the influence of operator experience level on device performance. We conducted two different types of testing: (1) bench testing to evaluate the devices themselves, and (2) clinical equivalent testing to determine the influence of the operator. The results indicated a significant dependence of thrust output on the compliance of the test media. The Activator V-E device matched the ideal half-sine thrust profile to 94%, followed by the Impulse device (84%), the Activator IV/FS (74%), and the Activator II (48%). While most devices deviated from the ideal profile on the return path, the Impulse device exhibited a secondary peak. Moreover, the Activator V-E device provided evidence that the device performs consistently despite operator experience level. This has been a major concern in manual spinal manipulation. Based on our results, a hyper-flexible spine would receive a lower peak thrust force than a hypo-flexible spine at the same power setting. Furthermore

  13. Effects of Extracorporeal Shockwave Therapy on Patients with Chronic Low Back Pain and Their Dynamic Balance Ability

    PubMed Central

    Lee, Sangyong; Lee, Daehee; Park, Jungseo

    2014-01-01

    [Purpose] The purpose of the present study was to examine the effects of extracorporeal shockwave therapy (ESWT) for patients with chronic low back pain and their dynamic balance ability. [Subjects] Twenty-eight patients with chronic low back were divided into an extracorporeal shockwave therapy group (ESWTG: n=13) and a conservative physical therapy group (CPTG, n=15). [Methods] An exercise program that included Williams’ exercises and McKenzie’s exercises was performed by both groups. The program was implemented twice a week for six weeks. The visual analog scale (VAS) was used to measure the chronic low back pain of the patients. Their dynamic balance ability was measured with BioRescue. [Results] The within-group comparison of the VAS of the ESWTG and the CPTG showed significant improvements after the intervention. In the VAS comparison between the groups after the treatment, the ESWTG showed a significantly larger improvement. In the within-group comparison of dynamic balance ability, the ESWTG showed significant improvements after the intervention in SAPLS, SAPRS, SAPFS, SAPBS, and TSA, and the CPTG showed significant improvements in SAPLS and SAPBS. In the between-group comparison of the dynamic balance ability after the treatment, the ESWTG showed significantly larger improvements in their SAPLS, SAPRS, SAPFS, and TSA. [Conclusion] The exercise program combined with the ESWT relieved chronic back pain more than the exercise program combined with the CPT. The former was also more effective at improving the patients’ dynamic balance ability in terms of SAPLS, SAPRS, SAPFS, and TSA. PMID:24567665

  14. Comparative tolerability and efficacy of treatments for impotence.

    PubMed

    Meinhardt, W; Kropman, R F; Vermeij, P

    1999-02-01

    treatment studies are very diverse so efficacy data can only be assessed in comparative studies. However, long term comparison studies have not been performed. Safety demands must be set very high for this type of treatment since the disorders being treated present no threat to the patient's health.

  15. Treatment-Resistant Schizophrenia Patients Show Elevated Anterior Cingulate Cortex Glutamate Compared to Treatment-Responsive.

    PubMed

    Mouchlianitis, Elias; Bloomfield, Michael A P; Law, Vincent; Beck, Katherine; Selvaraj, Sudhakar; Rasquinha, Naresh; Waldman, Adam; Turkheimer, Federico E; Egerton, Alice; Stone, James; Howes, Oliver D

    2016-05-01

    Resistance to antipsychotic treatment is a significant clinical problem in patients with schizophrenia with approximately 1 in 3 showing limited or no response to repeated treatments with antipsychotic medication. The neurobiological basis for treatment resistance is unknown but recent evidence implicates glutamatergic function in the anterior cingulate cortex. We examined glutamate levels of chronically ill treatment-resistant patients directly compared to treatment-responsive patients. We acquired proton magnetic resonance spectroscopy (1H-MRS) at 3 Tesla from 21 treatment-resistant and 20 treatment-responsive patients. All participants had a DSM-IV diagnosis of schizophrenia. Treatment-resistant patients were classified using the modified Kane criteria. The groups were matched for age, sex, smoking status, and illness duration. Glutamate to creatine ratio levels were higher in treatment-resistant patients (Mean [SD] = 1.57 [0.24]) than in treatment-responsive patients (Mean[SD] = 1.38 [0.23]), (T[35] = 2.34, P = .025, 2-tailed), with a large effect size of d = 0.76. A model assuming 2 populations showed a 25% improvement in the fit of the Akaike weights (0.55) over a model assuming 1 population (0.44), producing group values almost identical to actual group means. Increased anterior cingulate glutamate level is associated with treatment-resistant schizophrenia. This appears to be a stable neurobiological trait of treatment-resistant patients. We discuss possible explanations for glutamatergic dysfunction playing a significant role in resistance to conventional antipsychotic treatments, which are all dopamine-2 receptor blockers. Our findings suggest that glutamatergic treatments may be particularly effective in resistant patients and that 1H-MRS glutamate indices can potentially have clinical use. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email

  16. Buprenorphine and naloxone compared with methadone treatment in pregnancy.

    PubMed

    Wiegand, Samantha L; Stringer, Elizabeth M; Stuebe, Alison M; Jones, Hendree; Seashore, Carl; Thorp, John

    2015-02-01

    To compare neonatal abstinence syndrome prevalence and characteristics among neonates born to women prescribed buprenorphine and naloxone compared with methadone during pregnancy. Retrospective cohort analysis of mother-neonate dyads treated with either buprenorphine and naloxone or methadone during pregnancy. Primary neonatal outcomes included diagnosis of neonatal abstinence syndrome, neonatal abstinence syndrome peak scores, total amount of morphine used to treat neonatal abstinence syndrome (mg), and duration of treatment for neonatal abstinence syndrome (days). Secondary outcomes included head circumference, birth weight, length, preterm birth, neonatal intensive care unit admission, Apgar scores, and overall length of hospitalization. From January 1, 2011, to November 30, 2013, we identified 62 mother-neonate dyads, 31 treated with methadone and 31 treated with buprenorphine and naloxone. Sixteen neonates (51.6%) in the methadone group were diagnosed with neonatal abstinence syndrome compared with eight (25.1%) in the buprenorphine and naloxone group (adjusted odds ratio 2.55, 95% confidence interval [CI] 1.31-4.98, P = .01). The buprenorphine and naloxone-exposed neonates had lower peak neonatal abstinence syndrome scores (9.0 ± 4.4 compared with 10.7 ± 3.7, multivariate-adjusted mean difference = -2.77, 95% CI -4.99 to -0.56, P = .02) and shorter overall hospitalization (5.6 ± 5.0 compared with 9.8 ± 7.4 days, multivariate-adjusted mean difference = -3.90, 95% CI, -7.13 to -0.67, P = .02). We found no other differences in primary or secondary outcomes. In a cohort of pregnant patients treated with either methadone or buprenorphine and naloxone in pregnancy, newborns exposed to maternal buprenorphine and naloxone had less frequent neonatal abstinence syndrome. Additionally, neonates exposed to buprenorphine and naloxone had shorter overall hospitalization lengths.

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

    PubMed Central

    2016-01-01

    Objective To evaluate the effects of extracorporeal shockwave therapy (ESWT) on pain, function, and ultrasonographic features of chronic stroke patients with knee osteoarthritis (OA). Methods A total of 18 chronic stroke patients (33 knee joints) with unilateral or bilateral knee OA (Kellgren-Lawrence grade ≥1) were enrolled in this study. The patients were randomly allocated to an experimental group receiving ESWT (n=9) or a control group receiving sham ESWT (n=9). For the ESWT group, patients received 1,000 pulses weekly for 3 weeks, totaling to an energy dose of 0.05 mJ/mm2 on the proximal medial tibia of the affected knee. The assessments were performed before the treatment, immediately after the first treatment, and 1 week after the last treatment using the following: the visual analog scale (VAS) for pain; patient perception of the clinical severity of OA; the Korean version of Modified Barthel Index (ambulation and chair/bed transfer); the Functional Independence Measure scale (FIM; bed/chair/wheelchair transfer, toilet transfer, walking, and stairs); and ultrasonographic features (articular cartilage thickness, Doppler activity, and joint effusion height). Results The experimental group showed a significant improvement in VAS score (4.50±1.87 to 2.71±1.38) and patient perception of the clinical severity of OA (1.87±0.83 to 2.75±0.46). The bed/chair/wheelchair transfer components of the FIM score also improved significantly (4.12±1.55 to 4.62±1.30). In terms of the ultrasonographic features, increased Doppler activity was observed in the medial knee in the experimental group immediately following ESWT. Conclusion It is suggested that ESWT may reduce pain and improve function in chronic stroke patients with OA, and may increase vascular activity at the target site. PMID:27847716

  18. Kidney stone size and hounsfield units predict successful shockwave lithotripsy in children.

    PubMed

    El-Assmy, Ahmed; El-Nahas, Ahmed R; Abou-El-Ghar, Mohamed E; Awad, Bassam A; Sheir, Khaled Z

    2013-04-01

    To define the preoperative kidney and stones characteristics on noncontrast-enhanced computed tomography that affect the success of extracorporeal shockwave lithotripsy (SWL) for treatment of renal calculi in pediatric patients. From 2005 to 2011, 57 children (age <16 years) with documented preoperative noncontrast-enhanced computed tomography scans underwent SWL for treatment of renal stones and were included in the present study. Stone size, site, multiplicity, average skin-to-stone distance, stone attenuation value, and kidney morphology were determined from the preoperative noncontrast-enhanced computed tomography scans. Success was defined as radiographically stone-free status at the 3-month follow-up examination after a single lithotripsy session without the need for additional sessions or ancillary procedures. After a single session of SWL, 24 children (42.1%) were stone free on the 3-month follow-up imaging study without the need for additional SWL sessions. Treatment failed in 33 patients (57.9), with residual fragments in 30 children, of whom 29 required repeat SWL, and 3 with stones that were considered unchanged and were finally treated with percutaneous nephrolithotomy. Logistic regression analysis revealed that stone attenuation in Hounsfield units (HU) and stone length were the only significant predictors of success. When the HU were stratified into 2 groups of ≤600 and >600 HU, the SWL success rate was 82.1% and 20%, respectively (P = .023). When length was stratified as ≤12 mm and >12 mm, the stone-free rate was 58.6% and 25.1%, respectively (P = .016). Stone attenuation ≤600 HU and stone length ≤12 mm were significant independent predictors of SWL success in children. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. [THE BONE DEFECT HEALING UNDER THE INFLUENCE OF RADIAL EXTRACORPOREAL SHOCK-WAVE THERAPY IN EXPERIMENT].

    PubMed

    Gertsen, G I; Se-Fey; Ostapchuk, R M; Lesovoy, A V; Zherebchuk, V V

    2016-03-01

    In experiment on 24 rabbits the processes of reparative osteogenesis in perforated defect of proximal tibial metaphysis under the influence of extracorporeal shock-wave therapy were studied. In accordance to data of clinical, roentgenological and morphological investiagations, conducted in terms 5, 15, 30 and 45 days of observation, there was established, that under the influence of extracorporeal shock-wave therapy in the bone marrow in the traumatic region a vasodilatation, as well as the blood cells exit from capillaries and sinusoid vessels with creation of massive regions of osseous endostal regenerate, guaranteeing the tibial integrity restoration, occurs.

  20. Cost-effectiveness of trachoma control measures: comparing targeted household treatment and mass treatment of children.

    PubMed Central

    Frick, K. D.; Lietman, T. M.; Holm, S. O.; Jha, H. C.; Chaudhary, J. S.; Bhatta, R. C.

    2001-01-01

    OBJECTIVE: The present study compares the cost-effectiveness of targeted household treatment and mass treatment of children in the most westerly part of Nepal. METHODS: Effectiveness was measured as the percentage point change in the prevalence of trachoma. Resource measures included personnel time required for treatment, transportation, the time that study subjects had to wait to receive treatment, and the quantity of azithromycin used. The costs of the programme were calculated from the perspectives of the public health programme sponsor, the study subjects, and the society as a whole. FINDINGS: Previous studies have indicated no statistically significant differences in effectiveness, and the present work showed no significant differences in total personnel and transportation costs per child aged 1-10 years, the total time that adults spent waiting, or the quantity of azithromycin per child. However, the mass treatment of children was slightly more effective and used less of each resource per child aged 1-10 years than the targeted treatment of households. CONCLUSION: From all perspectives, the mass treatment of children is at least as effective and no more expensive than targeted household treatment, notwithstanding the absence of statistically significant differences. Less expensive targeting methods are required in order to make targeted household treatment more cost-effective. PMID:11285663

  1. Experimental studies of hypersonic shock-wave boundary-layer interactions

    NASA Technical Reports Server (NTRS)

    Lu, Frank K.

    1992-01-01

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

  2. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season: a randomized clinical trial.

    PubMed

    Zwerver, Johannes; Hartgens, Fred; Verhagen, Evert; van der Worp, Henk; van den Akker-Scheek, Inge; Diercks, Ron L

    2011-06-01

    Patellar tendinopathy is a common overuse injury among jumping athletes. No evidence-based treatment guidelines exist. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment but its effectiveness has not been studied in athletes with patellar tendinopathy who have symptoms for 3 to 12 months and are still playing. The TOPGAME study was created to determine the effectiveness of ESWT on pain, symptoms, and function in athletes with early symptomatic patellar tendinopathy who are still in training and competition. Randomized controlled trial; Level of evidence, 1. Athletes playing volleyball, basketball, or handball with patellar tendinopathy for 3 to 12 months were randomized into the ESWT or placebo group during the first half of the season. The ESWT group received 3 ESWT treatments while the placebo group received sham ESWT. In-season follow-up measurements were 1, 12, and 22 weeks after treatment. The primary outcome was severity of patellar tendinopathy determined with the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire. Secondary outcome measures were pain during activities of daily living and sports and after functional knee-loading tests rated on a visual analog scale and subjective improvement. Multilevel analyses were performed to determine differences between groups over time. Of the 127 symptomatic athletes invited to participate, 62 were eligible, gave consent, and were randomized into the ESWT (n = 31) or placebo group (n = 31). Mean VISA-P scores before and 1, 12, and 22 weeks after treatment were 59.4 (±11.7), 66.8 (±16.2), 66.7 (±17.5), and 70.5 (±18.9) for the ESWT group and 62.4 (±13.4), 66.3 (±19.0), 68.9 (±20.3), and 72.7 (±18.0) for the placebo group. For the VISA-P, there was a significant effect for time (P < .01) but no treatment × time interaction effect (P = .82). The same pattern was seen in visual analog scale pain scores. One week after final treatment, significantly more athletes in

  3. Treatment Options for Patellar Tendinopathy: A Systematic Review.

    PubMed

    Everhart, Joshua S; Cole, Devon; Sojka, John H; Higgins, John D; Magnussen, Robert A; Schmitt, Laura C; Flanigan, David C

    2017-04-01

    To compare the efficacy of common invasive and noninvasive patellar tendinopathy (PT) treatment strategies. A systematic search was performed in PubMed, Google Scholar, CINAHL, UptoDate, Cochrane Reviews, and SPORTDiscus. Fifteen studies met the following inclusion criteria: (1) therapeutic outcome trial for PT, and (2) Victorian Institute of Sports Assessment was used to assess symptom severity at follow-up. Methodological quality and reporting bias were evaluated with a modified Coleman score and Begg's and Egger's tests of bias, respectively. A total of 15 studies were included. Reporting quality was high (mean Coleman score 86.0, standard deviation 9.7), and there was no systematic evidence of reporting bias. Increased duration of symptoms resulted in poorer outcomes regardless of treatment (0.9% decrease in improvement per additional month of symptoms; P = .004). Eccentric training with or without core stabilization or stretching improved symptoms (61% improvement in the Victorian Institute of Sports Assessment score, 95% confidence interval [CI] 53% to 69%). Surgery in patients refractory to nonoperative treatment also improved symptoms (57%, 95% CI 52% to 62%) with similar outcomes among arthroscopic and open approaches. Results from shockwave (54%, 95% CI 22% to 87%) and platelet-rich plasma (PRP) studies (55%, 95% CI 5% to 105%) varied widely though PRP may accelerate early recovery. Finally, steroid injection provided no benefit (20%, 95% CI -20% to 60%). Initial treatment of PT can consist of eccentric squat-based therapy, shockwave, or PRP as monotherapy or an adjunct to accelerate recovery. Surgery or shockwave can be considered for patients who fail to improve after 6 months of conservative treatment. Corticosteroid therapy should not be used in the treatment of PT. Level IV, systematic review of Level II-IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods.

    PubMed

    Gray, R J; Quayle, A A; Hall, C A; Schofield, M A

    1994-04-09

    Temporomandibular joint pain dysfunction syndrome (TMJPDS) comprises of a constellation of signs and symptoms including joint tenderness and pain on function, restricted jaw movement, clicking, jaw locking and tenderness in the muscles of mastication. Headache may also be a feature. Physiotherapy is commonly employed in the treatment of this condition but there is little published material reporting the relative efficacy of the different types of treatment currently available. Further, no attempt seems to have been made to compare the costs of physiotherapy with other forms of treatment of this disorder such as occlusal splint therapy. This paper reports a comparative evaluation of four different physiotherapy treatments and placebo in the management of TMJPDS and comments on their cost benefit aspects compared with that of splint therapy. The four methods of physiotherapy tested were short-wave diathermy, megapulse, ultrasound and soft laser. There was no statistically significant difference in success rate between any of the four tested (range 70.4-77.7%) although each individually was significantly better than placebo treatment. The time of improvement appeared to vary between the four methods.

  5. 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

  6. The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial.

    PubMed

    Zwerver, Johannes; Verhagen, Evert; Hartgens, Fred; van den Akker-Scheek, Inge; Diercks, Ron L

    2010-02-08

    Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative and surgical treatments remain suboptimal, new diagnostic and therapeutic strategies have to be developed and evaluated. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment in patients with chronic patellar tendinopathy. ESWT is most often applied after the known conservative treatments have failed. However, its effectiveness as primary therapy has not been studied in athletes who keep playing sports despite having patellar tendon pain. The aim of this study is to determine the effectiveness of ESWT in athletes with patellar tendinopathy who are still in training and competition. The TOPGAME-study (Tendinopathy of Patella Groningen Amsterdam Maastricht ESWT) is a multicentre two-armed randomised controlled trial with blinded participants and outcome assessors, in which the effectiveness of patient-guided focussed ESWT treatment (compared to placebo ESWT) on pain reduction and recovery of function in athletes with patellar tendinopathy will be investigated. Participants are volleyball, handball and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months who are still able to train and compete. The intervention group receives three patient-guided focussed medium-energy density ESWT treatments without local anaesthesia at a weekly interval in the first half of the competition. The control group receives placebo treatment. The follow-up measurements take place 1, 12 and 22 weeks after the final ESWT or placebo treatment, when athletes are still in competition. Primary outcome measure is the VISA-P (Victorian Institute of Sport Assessment - patella) score. Data with regard to pain during function tests (jump

  7. The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial

    PubMed Central

    2010-01-01

    Background Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative and surgical treatments remain suboptimal, new diagnostic and therapeutic strategies have to be developed and evaluated. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment in patients with chronic patellar tendinopathy. ESWT is most often applied after the known conservative treatments have failed. However, its effectiveness as primary therapy has not been studied in athletes who keep playing sports despite having patellar tendon pain. The aim of this study is to determine the effectiveness of ESWT in athletes with patellar tendinopathy who are still in training and competition. Methods/design The TOPGAME-study (Tendinopathy of Patella Groningen Amsterdam Maastricht ESWT) is a multicentre two-armed randomised controlled trial with blinded participants and outcome assessors, in which the effectiveness of patient-guided focussed ESWT treatment (compared to placebo ESWT) on pain reduction and recovery of function in athletes with patellar tendinopathy will be investigated. Participants are volleyball, handball and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months who are still able to train and compete. The intervention group receives three patient-guided focussed medium-energy density ESWT treatments without local anaesthesia at a weekly interval in the first half of the competition. The control group receives placebo treatment. The follow-up measurements take place 1, 12 and 22 weeks after the final ESWT or placebo treatment, when athletes are still in competition. Primary outcome measure is the VISA-P (Victorian Institute of Sport Assessment - patella) score. Data with regard to pain

  8. Comparative study of novel endovascular treatment techniques for intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Cantón, Gádor; Lasheras, Juan C.; Levy, David I.; Sparks, Steven R.

    2002-11-01

    Intracranial aneurysms are life-threatening vascular lesions, which are potentially treatable to avoid the consequences of their rupture. Current treatments, either surgical or endovascular, are all guided to reduce the hemodynamic forces acting on the aneurysm wall in an effort to minimize the risk of rupture. Surgical clipping is still the most used technique to treat this type of aneurysm but there is a continued demand for less invasive approaches. This has led to the development of several endovascular techniques. We report here a comparative study of the reduction in the hemodynamic stresses and the modification of the flow in the parent vessel resulting from the use of three different techniques. The first one consists of endosaccular packing with platinum coils (GDC, Target Therapeutics), which is already widely used but its long-term efficacy has not yet been determined. The second one consists of the embolization of the aneurismal sac with Onyx, a polymer which hardens when in contact with the blood (being developed by Micro Therapeutics, Inc.). The third one involves the packing of the sac with hydrocoils, platinum wires coated with a gel which quickly hydrates when in contact with blood (developed by MicroVention). A Digital Particle Image Velocimetry (DPIV) system is used to measure in vitro the velocity field inside a model of an ACOM aneurysm (an aneurysm forming in the anterior communicating artery). Physiological accurate pulsatile flow conditions are input to the arterial model through a programmable pump. The measurements show that although all treatment techniques lead to a reduction in both normal and tangential shear stresses on the aneurismal sac, each one of them also leads to different modifications of the flow in the parent vessel which may have consequences related to potential for clotting. Comparison of the untreated aneurysm with the above three treated cases also showed that the characteristics of the wall shear stresses on the parent

  9. A solid-phase mechanism of shock-wave formation of dust particles of heavy metals

    NASA Astrophysics Data System (ADS)

    Lin, E. E.; Mikhailov, A. L.; Khvorostin, V. N.

    2016-08-01

    The possibility of formation of dust particles in solid as a result of shock-wave destruction of the initial crystalline material structure and subsequent coalescence of atomic clusters (nanoparticles), which leads to the aggregation of mesocrystalline particles (grains) in the shocked layer, is discussed.

  10. High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose’s disease)

    PubMed Central

    2012-01-01

    Background Plantar fibromatosis is a benign disease creating nodules on the medial plantar side of affected patients. While surgical removal is regarded as the therapeutic mainstay, recurrence rates and impairment of daily activities remains substantial. High-energy focussed extracorporeal shockwave therapy has been suggested to be potentially effective in plantar fibromatosis in terms of pain reduction. Hypothesis High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis. Findings A total number of six patients (5 males, 58±4 years) were included with plantar fibromatosis (Ledderhose’s disease) associated with pain. Three patients were operated on previously, one had concomitant Dupuytren’s contracture. High-energy focussed ESWT was applied using a Storz Duolith SD1 (2000 impulses, 3 Hz, 1.24 mJ/mm2) in two sessions with 7 days between. Pain was 6±2 at baseline, 2±1 after 14 days and 1±1 after 3 months. Softening of the nodules was noted by all patients. No adverse effects were noted. Conclusions High-energy focussed extracorporeal shockwave energy reduces pain in painful plantar fibromatosis (Morbus Ledderhose). Further large-scale prospective trials are warranted to elucidate the value of high-energy focussed extracorporeal shockwave therapy (ESWT) in plantar fibromatosis in terms of recurrence and efficacy. PMID:23031080

  11. Ultrafast Time Response Pressure-Sensitive Paint for Unsteady Shock-Wave Research

    NASA Astrophysics Data System (ADS)

    Numata, Daiju; Asai, Keisuke

    Pressure-Sensitive Paint (PSP) is an optical pressure measurement technique widely used in aerodynamic experiments, and has been applied to unsteady shock-wave phenomena [1, 2]. However, one of the largest problems to apply PSP to high-speed and unsteady phenomena is the response time of PSP.

  12. Numerical study of shock-wave mitigation through matrices of solid obstacles

    NASA Astrophysics Data System (ADS)

    Chaudhuri, A.; Hadjadj, A.; Sadot, O.; Ben-Dor, G.

    2013-02-01

    Shock-wave propagation through different arrays of solid obstacles and its attenuation are analyzed by means of numerical simulations. The two-dimensional compressible Navier-Stokes equations are solved using a fifth-order weighted essentially non-oscillatory scheme, in conjunction with an immersed-boundary method to treat the embedded solids within a cartesian grid. The present study focuses on the geometrical aspects of the solid obstacles, particularly at lower effective flow area, where the frictional forces are expected to be important. The main objective is to analyze the controlling mechanism for shock propagation and attenuation in complex inhomogeneous and porous medium. Different parameters are investigated such as the geometry of the obstacles, their orientation in space as well as the relaxation lengths between two consecutive columns. The study highlights a number of interesting phenomena such as compressible vortices and shock-vortex interactions that are produced in the post-shock region. This also includes shock interactions, hydrodynamic instabilities and non-linear growth of the mixing. Ultimately, the Kelvin-Helmholtz instability invokes transition to a turbulent mixing region across the matrix columns and eddies of different length scales are generated in the wake region downstream of the solid blocks. The power spectrum of instantaneous dynamic pressure shows the existence of a wide range of frequencies which scales nearly with f -5/3. In terms of shock attenuation, the results indicate that the staggered matrix of reversed triangular prism (where the base of the triangular prism is facing the incoming shock) is the most efficient arrangement. In this case, both static and dynamic pressure impulses show significant reduction compared to the other studied configurations, which confirms the effectiveness of this type of barrier configuration. Furthermore, the use of combination of reverse-reverse arrangement of triangular prism obstacle maze is

  13. RESEARCH PAPERS : Shock-wave equation of state of rhyolite

    NASA Astrophysics Data System (ADS)

    Anderson, William W.; Yang, Wenbo; Chen, George; Ahrens, Thomas J.

    1998-01-01

    We have obtained new shock-wave equation of state (EOS) and release adiabat data for rhyolite. These data are combined with those of Swegle (1989, 1990) to give an experimental Hugoniot which is described by Us = 2.53(+/-0.08) + 3.393(+/-0.37)Up for Up ≪ 0.48 km s-1 , Us = 3.85(+/-0.05) + 0.65(+/-0.03)Up for 0.48 <= Up ≪ 2.29 km s-1 , Us = 1.52(+/-0.08) + 1.67(+/-0.02)Up for 2.29 <= Up ≪ 4.37 km s-1 , and Us = 3.40(+/-034) + 1.24(+/-0.06)Up for Up ≫= 4.37 km s-1 , with ρ0 = 2.357 +/- 0.052 Mg m-3 . We suggest that the Hugoniot data give evidence of three distinct phases-both low- and high-pressure solid phases and, possibly, a dense molten phase. EOS parameters for these phases are ρ0 = 2.494 +/- 0.002 Mg m-3 , KS0 = 37 +/- 2 GPa, K' = 6.27 +/- 0.25, and Γ = 1.0(V/V0 ) for the low-pressure solid phase; ρ0 = 3.834 +/- 0.080 Mg m-3 , KS0 = 128 +/- 20 GPa, K' = 3.7 +/- 1.4, and Γ = 1.5 +/- 0.5 for the solid high-pressure phase; and ρ0 = 3.71 +/- 0.10 Mg m-3 , KS0 = 127 +/- 25 GPa, K' = 2.1 +/- 1.0, and Γ = 1.5 +/- 1.0 for the dense liquid. Transition regions of the Hugoniot cover the ranges of 9-34 GPa for the low-pressure-high-pressure solid transition and 90-120 GPa for the high-pressure solid-liquid transition. Release paths from high-pressure states, calculated from the EOS parameters, suggest that the material remains in the high-pressure solid phase upon release. Release paths from both the high-pressure solid and liquid fall above the Hugoniot until the Hugoniot enters the low-pressure-high-pressure mixed phase region, when the release paths then cross the Hugoniot and fall below it, ending at significantly higher zero-pressure densities than that of the low-pressure phase. The low-pressure release paths fall very close to the Hugoniot. Estimates of residual heat deposition, based on shock-release path hysteresis, range from 20 to 60 per cent of the shock Hugoniot energy.

  14. Clinical experience with shock-wave lithotripsy using the Siemens Modularis Vario lithotripter

    PubMed Central

    Hassouna, Mohamed E.; Oraby, Samir; Sameh, Wael; El-Abbady, Ahmed

    2011-01-01

    Purpose To assess the effectiveness of a lithotripter (Modularis Vario; Siemens, AG Healthcare, Munich, Germany) in the management of renal and ureteric stones. Patients and methods In all, 1146 adult patients with renal or ureteric stones were treated at one urological centre using the latest model of the Modularis Vario lithotripter. The effectiveness of lithotripsy and re-treatment rate were assessed. Data were obtained on stone location, stone size, shock wave usage, success rate, and complications. Results Between May 2007 and November 2009, 698 patients with renal stones and 448 with ureteric stones underwent extracorporeal shock-wave lithotripsy (ESWL). The mean (SD) renal stone size was 12.8 (3.8) mm; a mean of 1.36 sessions was required, with a mean (SD) number of 3744 (1961) shocks delivered per renal stone. After 3 months, the success rate defined as the patient being stone-free or with residual fragments of <4 mm; for renal stones the rate was 91.1%, with a 6.9% complication rate in the form of steinstrasse and severe renal colic. The mean (SD) ureteric stone size was 10.4 (2.7) mm. A mean of 1.37 sessions was required, with a mean (SD) of 4551 (2467) shocks delivered for each ureteric stone. The success rate for ureteric stones was 89.5%, with a 5.6% complication rate. The overall efficiency quotient was 0.66. Conclusion The Siemens Modularis Vario lithotripter is a safe and effective machine for treating renal and ureteric stones. PMID:26579276

  15. Criticality and characteristic neutronic analysis of a transient-state shockwave in a pulsed spherical gaseous uranium-hexafluoride reactor

    NASA Astrophysics Data System (ADS)

    Boles, Jeremiah Thomas

    The purpose of this study is to analyze the theoretical criticality of a spherical uranium-hexafluoride reactor with a transient, pulsed shockwave emanating from the center of the sphere in an outward-radial direction. This novel nuclear reactor design, based upon pulsed fission in a spherical enclosure is proposed for possible use in direct energy conversion, where the energy from fission products is captured through the use of electrostatic fields or through induction. An analysis of the dynamic behavior of the shockwave in this reactor is the subject of this thesis. As a shockwave travels through a fluid medium, the characteristics of the medium will change across the shockwave boundary. Pressure, temperature, and density are all affected by the shockwave. Changes in these parameters will affect the neutronic characteristics of a fissile medium. If the system is initially in a subcritical state, the increases in pressure, temperature, and density, all brought about by the introduction of the shockwave, will increase the reactivity of the nuclear system, creating a brief super critical state that will return to a subcritical state after the shockwave dissipates. Two major problems are required to be solved for this system. One is the effects of the shockwave on the gas, and the second is the resulting effects on system criticality. These problems are coupled due to the unique nature of the speed of the expanding shockwave in the uranium-hexafluoride medium and the energy imparted to the system by the shockwave with respect to the fissile uranium-hexafluoride. Using compressible flow and shockwave theories, this study determines the properties of the gaseous medium for reference points before, during, and behind the shockwave as it passes through the fissile medium. These properties include pressure changes, temperature changes, and density changes that occur to the system. Using the parameters calculated from the shockwave, the neutron transport equation is

  16. Extracorporeal shockwave therapy in osteoporotic osteoarthritis of the knee in rats: an experiment in animals

    PubMed Central

    2014-01-01

    Introduction This study investigated the effectiveness of extracorporeal shockwave therapy (ESWT) in osteoporotic (OP) osteoarthritis (OA) of rat knee. Methods Fifty-six rats were divided into seven groups including sham, OA, OP, OA + OP, OA + ESWT, OP + ESWT, and OA + OP + ESWT groups. The evaluations included gross pathology, bone mineral density (BMD), micro-computed tomography (micro-CT) scan, bone-strength test, histopathologic examination, and immunohistochemical analysis. Results On gross pathology, group OA + OP showed larger areas of osteoarthritic changes than did groups OA and OP, as compared with the sham group. BMD and bone strength significantly decreased in groups OA, OP, and OA + OP relative to the sham group, and ESWT significantly improved BMD and bone-strength changes. On micro-CT scan, the subchondral plate thickness significantly decreased, and the bone porosity increased in groups OA, OP, and OA + OP, and ESWT significantly improved the changes in subchondral-plate thickness and bone porosity. In histopathologic examination, Mankin score and safranin O score significantly increased in groups OA and group OA + OP, but not in group OP relative to the sham group, and ESWT significantly improved the changes. In immunohistochemical analysis, Dickkopf-1 (DKK-1) significantly increased, but vessel endothelial growth factor (VEGF), proliferating cell nuclear antigen (PCNA), and bone morphogenetic protein 2 (BMP-2) decreased in groups OA, OP, and OA + OP relative to the sham group, and ESWT significantly reversed the changes. Conclusions Osteoporosis increased the severity of cartilage damage in osteoarthritis of the knee. ESWT showed effectiveness in the reduction of osteoporotic osteoarthritis of the knee in rats. PMID:24994452

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

    PubMed Central

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

    2007-01-01

    Evidence suggests that inertial cavitation plays an important role in the renal injury incurred during shock-wave lithotripsy. However, it is unclear how tissue damage is initiated, and significant injury typically occurs only after a sufficient dose of shock waves. While it has been suggested that shock-induced shearing might initiate injury, estimates indicate that individual shocks do not produce sufficient shear to do so. In this paper, we hypothesize that the cumulative shear of the many shocks is damaging. This mechanism depends upon whether there is sufficient time between shocks for tissue to relax to its unstrained state. We investigate the mechanism with a physics-based simulation model wherein the the basement membranes that define the tubules and vessels in the inner medulla are represented as elastic shells surrounded by viscous fluid. Material properties are estimated from in vitro tests of renal basement membranes and documented mechanical properties of cells and extracellular gels. Estimates for the net shear deformation from a typical lithotripter shock (~ 0.1%) are found from a separate dynamic shock simulation. The results suggest that the larger interstitial volume (~ 40%) near the papilla tip gives the tissue there a relaxation time comparable to clinical shock delivery rates (~ 1Hz), thus allowing shear to accumulate. Away from the papilla tip, where the interstitial volume is smaller (≲ 20%), the model tissue relaxes completely before the next shock would be delivered. Implications of the model are that slower delivery rates and broader focal zones should both decrease injury, consistent with some recent observations. PMID:17507147

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

    PubMed Central

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

    1985-01-01

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

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

    PubMed

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

    2016-04-01

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

  20. Comparative assessment of water treatment using polymeric and inorganic coagulants

    NASA Astrophysics Data System (ADS)

    Manda, Innocent K. M.; Chidya, Russel C. G.; Saka, John D. K.; Biswick, Timothy T.

    2016-06-01

    Portable water plays a vital role in improving human life, particularly in controlling the spread of diseases. However, problems associated with lack of potable water are still common especially in developing countries including Malawi. Until now little information exists on the effectiveness of available commercial coagulants used by national water boards in Malawi. Therefore, this study was undertaken in Southern Region Water Board (SRWB) to investigate the efficiency of polymeric coagulants (sufdfloc 3850 and algaefloc 19s) in turbidity reduction comparative with inorganic coagulant (aluminium sulphate) at Zomba, Liwonde, Mangochi, Chikwawa and Mulanje Treatment plants. The jar test method was used to determine the effectiveness of the water coagulants. The results revealed that sudfloc 3850 was most effective in reducing turbidity at Mangochi (99.4 ± 0.06%) and Liwonde (97.2 ± 0.04%) using 0.4 mg L-1 flocculant dose. The Zomba, Mulanje and Chikwawa plants gave 19.56 ± 0.03%, 29.23 ± 0.02% and 9.43 ± 0.02% total reductions respectively. Algaefloc 19s afforded the highest turbidity reduction at Liwonde and Mangochi plants (98.66 ± 0.06 and 97.48 ± 0.05% at a dose of 0.4 and 0.6 mg L-1 respectively), while Chikwawa provided the lowest (9.52 ± 0.01%). At the Zomba and Mulanje plants 20.5 ± 0.03% and 28.4 ± 0.04% reductions were obtained respectively. The inorganic flocculant, alum provided a 99.0 ± 0.05% and 98.6 ± 0.04% reduction at a dose of 4.0 mg L-1 and 6.0 mg L-1 at Zomba and Liwonde plants respectively. The lowest reductions in turbidity were achieved at Chikwawa (7.50 ± 0.01%), Mangochi (12.97 ± 0.02%) and Mulanje (25.00 ± 0.02). The best and optimum pH ranges for polymeric and inorganic coagulants were 7.20-7.80 and 7.35 to 7.57 respectively. The results further revealed that sudfloc 3850 and algaefloc 19s achieved faster formation of heavy flocs than alum. At 0.4 mg L-1 flocculant dosage sudfloc 3850 and algaefloc 19s required ten times

  1. A comparative analysis of odour treatment technologies in wastewater treatment plants.

    PubMed

    Estrada, José M; Kraakman, N J R Bart; Muñoz, Raúl; Lebrero, Raquel

    2011-02-01

    Biofiltration, activated sludge diffusion, biotrickling filtration, chemical scrubbing, activated carbon adsorption, regenerative incineration, and a hybrid technology (biotrickling filtration coupled with carbon adsorption) are comparatively evaluated in terms of environmental performance, process economics, and social impact by using the IChemE Sustainability Metrics in the context of odor treatment from wastewater treatment plants (WWTP). This comparative analysis showed that physical/chemical technologies presented higher environmental impacts than their biological counterparts in terms of energy, material and reagents consumption, and hazardous-waste production. Among biological techniques, the main impact was caused by the high water consumption to maintain biological activity (although the use of secondary effluent water can reduce both this environmental impact and operating costs), biofiltration additionally exhibiting high land and material requirements. From a process economics viewpoint, technologies with the highest investments presented the lowest operating costs (biofiltration and biotrickling filtration), which suggested that the Net Present Value should be used as selection criterion. In addition, a significant effect of the economy of scale on the investment costs and odorant concentration on operating cost was observed. The social benefits derived from odor abatement were linked to nuisance reductions in the nearby population and improvements in occupational health within the WWTP, with the hybrid technology exhibiting the highest benefits. On the basis of their low environmental impact, high deodorization performance, and low Net Present Value, biotrickling filtration and AS diffusion emerged as the most promising technologies for odor treatment in WWTP.

  2. Antimicrobial silk clothing in the treatment of atopic dermatitis proves comparable to topical corticosteroid treatment.

    PubMed

    Senti, G; Steinmann, L S; Fischer, B; Kurmann, R; Storni, T; Johansen, P; Schmid-Grendelmeier, P; Wuthrich, B; Kundig, T M

    2006-01-01

    Atopic dermatitis (AD) is aggravated by mechanical irritation and bacterial colonization. This study compared the efficacy of an antimicrobial silk fabric (DermaSilk) with that of a topical corticosteroid in the treatment of AD. Fifteen children were enrolled and wore a dress, where the left side was made of DermaSilk and the right side was made of cotton. The right arm and leg were treated daily with the corticosteroid mometasone for 7 days. The treatment efficacy was measured with a modified EASI (Eczema Area and Severity Index) and with an assessment by the patients/parents and by a physician. All patients were evaluated at baseline, as well as 7 and 21 days after the initial examination. All parameters showed that, irrespective of the treatment, there was a significant decrease of eczema after 7 days. No significant difference between DermaSilk-treated and corticosteroid-treated skin could be observed. DermaSilk showed potential to become an effective treatment of AD.

  3. Comparative removal of toxic pollutants by six wastewater treatment processes

    SciTech Connect

    Hannah, S.A.; Austern, B.M.; Eralp, A.E.; Wise, R.H.

    1986-01-01

    Five pilot-scale wastewater treatment processes that provided less than secondary treatment - primary clarification plus filtration, chemical clarification, high-rate trickling filter, aerated lagoon, and facultative lagoon - were evaluated for removal of priority pollutants from municipal wastewater. A conventional activated sludge system was operated in parallel as a control. Wastewater feed was spiked with 21 organics dissolved in toluene. Removal of ambient concentrations of live metals was also evaluated. The control typically removed 80 to 90% of volatiles and 85 to 95% of semivolatiles. The facultative lagoon was the best alternative process, followed by the aerated lagoon. Removals of a specific toxic pollutant depended on the properties of the chemical and its interactions with removal mechanisms used in each treatment process. 9 references, 2 tables.

  4. Summary of comparative results integrated nonthermal treatment and integrated thermal treatment systems studies

    SciTech Connect

    1996-12-01

    In July 1994, the Idaho National Engineering Laboratory (INEL), under a contract from U.S. Department of Energy`s (DOE) Environment Management Office of Science and Technology (OST, EM-50) published a report entitled {open_quotes}Integrated Thermal Treatment System Study - Phase 1 Results{close_quotes} (EGG-MS-11211). This report was the culmination of over a year of analysis involving scientists and engineers within the DOE complex and from private industry. The purpose of that study was {open_quotes}to conduct a systematic engineering evaluation of a variety of mixed low level waste (MLLW) treatment system alternatives.{close_quotes} The study also {open_quotes}identified the research and development, demonstrations, and testing and evaluation needed to assure unit operability in the most promising alternative system.{close_quotes} This study evaluated ten primary thermal treatment technologies, organized into complete {open_quotes}cradle-to-grave{close_quotes} systems (including complete engineering flow sheets), to treat DOE MLLW and calculated mass balances and 20-year total life cycle costs (TLCC) for all systems. The waste input used was a representative heterogenous mixture of typical DOE MLLW. An additional study was conducted, and then, based on response to these studies, additional work was started to investigate and evaluate non-thermal treatment options on a footing comparable to the effort devoted to thermal options. This report attempts to present a summary overview of the thermal and non-thermal treatment technologies which were examined in detail in the process of the above mentioned reviews.

  5. Comparing active pediatric obesity treatments using meta-analysis.

    PubMed

    Gilles, Allyson; Cassano, Michael; Shepherd, Elizabeth J; Higgins, Diana; Hecker, Jeffrey E; Nangle, Douglas W

    2008-10-01

    The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways: increasing the "dose" of behavioral components and increasing parental involvement. Although limited to just one investigation, support for the use of medication was also found. The addition of cognitive therapy techniques did not appear to increase, and possibly detracted from, the efficacy of established treatments.

  6. Comparative removal of toxic pollutants by six wastewater treatment processes

    SciTech Connect

    Hannah, S.A.; Austern, B.M.; Eralp, A.E.; Wise, R.H.

    1986-01-01

    Five pilot-scale wastewater treatment processes providing less than secondary treatment were evaluated for capability to remove priority pollutants from municipal wastewater. The selected processes were primary clarification plus filtration, chemical clarification, high rate trickling filter, aerated lagoon and facultative lagoon. A conventional activated sludge system was operated in parallel with the alternative processes to serve as a control. Wastewater feed was spiked with 21 organics dissolved in toluene. Removals of ambient levels of five metals were also determined. The control activated sludge provided the best removals of organics.

  7. Atomoxetine Treatment for ADHD: Younger Adults Compared with Older Adults

    ERIC Educational Resources Information Center

    Durell, Todd; Adler, Lenard; Wilens, Timothy; Paczkowski, Martin; Schuh, Kory

    2010-01-01

    Objective: Atomoxetine is a nonstimulant medication for treating child, adolescent, and adult ADHD. This meta-analysis compared the effects in younger and older adults. Method: A post hoc analysis was conducted using data from two double-blind, placebo-controlled clinical trials. Data from patients aged 18-25 years were compared with data from…

  8. Atomoxetine Treatment for ADHD: Younger Adults Compared with Older Adults

    ERIC Educational Resources Information Center

    Durell, Todd; Adler, Lenard; Wilens, Timothy; Paczkowski, Martin; Schuh, Kory

    2010-01-01

    Objective: Atomoxetine is a nonstimulant medication for treating child, adolescent, and adult ADHD. This meta-analysis compared the effects in younger and older adults. Method: A post hoc analysis was conducted using data from two double-blind, placebo-controlled clinical trials. Data from patients aged 18-25 years were compared with data from…

  9. [Comparative evaluation of clinical effectiveness of treatment of giardiasis].

    PubMed

    2014-09-01

    Giardia is the most common causes of protozoan diarrhea that leads to significant morbidity and mortality worldwide. The purpose of this study was to determine the clinical efficiency of different scheme of therapy giardiasis with new original plant preparation "Sausalin" (Kazakhstan). We conducted open clinical trial with participation of 93 patients with giardiasis. According the method of treatment the patients were divided into three groups.  Group I - Sausalin at the dose 300 mg/day; group II - Metronidazole at 750 mg/ day; group III - combination of Sausalin 300 mg/day and Metronidazole 750 mg/ day. The treatment was conducted during 10 days. The protozoal clearance rate and clinical symptoms were assessed. There were no significant differences in the efficiency of treatments in group I and group II. The protozoal clearance rate was 68% in group I (Sausalin); in group II -  42,1% (metronidazole). In group III - 83,2% (combination therapy) (р=0.001; 95% CI 54,6-89,7). There was no negative effect on clinical and biochemical blood analysis. We detected statistically significant differences in the dynamics of clinical symptoms (defecation disorders, dyspepsia, abdominal pain, asthenia) of giardiasis in a group of patients receiving Sausalin.The scheme with new drug Sausalin can be used as alternative treatment of Giardiasis. Moreover, the use of the Sausalin is improved the clinical symptoms and safety of therapy.

  10. Comparing Active Pediatric Obesity Treatments Using Meta-Analysis

    ERIC Educational Resources Information Center

    Gilles, Allyson; Cassano, Michael; Shepherd, Elizabeth J.; Higgins, Diana; Hecker, Jeffrey E.; Nangle, Douglas W.

    2008-01-01

    The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways:…

  11. Comparing Active Pediatric Obesity Treatments Using Meta-Analysis

    ERIC Educational Resources Information Center

    Gilles, Allyson; Cassano, Michael; Shepherd, Elizabeth J.; Higgins, Diana; Hecker, Jeffrey E.; Nangle, Douglas W.

    2008-01-01

    The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways:…

  12. Treatment/Comparative therapeutics: cancer of the larynx and hypopharynx.

    PubMed

    McMullen, Caitlin P; Smith, Richard V

    2015-07-01

    This article reviews the management of laryngeal and hypopharyngeal squamous cell carcinoma. Available therapies for early and late stage cancers are discussed, and the literature is reviewed. The indications and outcomes of surgical and nonsurgical modalities are discussed and compared.

  13. Inactivation of Ascaris eggs in soil by microwave treatment compared to UV and ozone treatment.

    PubMed

    Mun, Sungmin; Cho, Shin-Hyeong; Kim, Tong-Soo; Oh, Byung-Taek; Yoon, Jeyong

    2009-09-01

    This study reports on the effect of microwave radiation for inactivation of Ascaris lumbricoides eggs in 25 g of soil compared to ultraviolet irradiation and ozone expose. Microwave radiation at 700 W with 14% water content (w/w) achieved approximately 2.5 log inactivation of eggs in soil within 60s. On the other hand, UV irradiation at 3 mW cm(-2) with and without shaking soil for 3600 s achieved approximately 0.32 and 0.01 log inactivation of eggs, respectively. In ozone treatment, 0.13 log inactivation of eggs was achieved with 5.8+/-0.7 mg L(-1) of dissolved ozone dose for 30 min in a continuous diffusion reactor. In addition, the inactivation of eggs by three disinfection techniques was conducted in water in order to compare the inactivation efficiency of eggs in soil. The inactivation efficiency of microwave radiation was found to be no significant difference between in soil and water. However, the inactivation efficiency of UV irradiation was significantly increased in water while in ozone expose there was no significant difference between in soil and water. Microwave treatment thus proved to be the most efficient method in controlling A. lumbricoides eggs in soil.

  14. Enhancement of laser plasma extreme ultraviolet emission by shockwave-laser interaction

    SciTech Connect

    Bruijn, Rene de; Koshelev, Konstantin N.; Zakharov, Serguei V.; Novikov, Vladimir G.; Bijkerk, Fred

    2005-04-15

    A double laser pulse heating scheme has been applied to generate plasmas with enhanced emission in the extreme ultraviolet (EUV). The plasmas were produced by focusing two laser beams (prepulse and main pulse) with a small spatial separation between the foci on a xenon gas jet target. Prepulses with ps-duration were applied to obtain high shockwave densities, following indications of earlier published results obtained using ns prepulses. EUV intensities around 13.5 nm and in the range 5-20 nm were recorded, and a maximum increase in intensity exceeding 2 was measured at an optimal delay of 140 ns between prepulse and main pulse. The gain in intensity is explained by the interaction of the shockwave produced by the prepulse with the xenon in the beam waist of the main pulse. Extensive simulation was done using the radiative magnetohydrodynamic code Z{sup *}.

  15. Cylindrical shockwave-induced compression mechanism in femtosecond laser Bessel pulse micro-drilling of PMMA

    NASA Astrophysics Data System (ADS)

    Wang, Guoyan; Yu, Yanwu; Jiang, Lan; Li, Xiaowei; Xie, Qian; Lu, Yongfeng

    2017-04-01

    Femtosecond (fs) laser Bessel pulses can be employed for high-quality and high-speed fabrication of high-aspect-ratio uniform microhole arrays. This technique exhibits prominent potential in three-dimensional packaging, fluidic devices, fiber sensing, biomedical devices, and aeronautics. However, the fundamental mechanisms remain mysterious. Using the femtosecond time-resolved pump-probe shadowgraph technique, this study revealed that the generation of cylindrical shockwaves inside the bulk material and the corresponding compression mechanism play key roles in the formation of high-aspect-ratio microholes. The phenomena were observed in all experiments of Bessel beam drilling of polymethyl methacrylate. In the aforementioned cases, the compression mechanism was confirmed by measuring sample mass losses that were experimentally determined to be negligible. By contrast, neither cylindrical shockwave nor compression mechanism was observed when a fused silica or Gaussian laser beam was involved.

  16. Shock-wave equation-of-state studies at Los Alamos

    SciTech Connect

    Morris, C.E.

    1990-01-01

    A history of the shock-wave equation-of-state (EOS) studies at Los Alamos is given. Particular emphasis is placed on the pioneering research in the 1950s where many of the experimental techniques and methods of analysis were developed, which we now take for granted. A brief review of shock-wave physics is given, which illustrates important hydrodynamic and thermodynamic concepts. Recent studies on the EOS of Ti are presented with emphasis on the {alpha}-to-{omega} phase transition. VISAR wave profiles on polycrystalline Ni and single-crystal Ni are presented to determine the strengths of these materials at pressure. Low-density polystyrene foam Hugoniot experiments are described and results analyzed. 21 refs., 14 figs.

  17. Laser plasma shockwave cleaning of SiO 2 particles on gold film

    NASA Astrophysics Data System (ADS)

    Ye, Yayun; Yuan, Xiaodong; Xiang, Xia; Dai, Wei; Chen, Meng; Miao, Xinxiang; Lv, Haibing; Wang, Haijun; Zheng, Wanguo

    2011-04-01

    A Nd:YAG laser (1064 nm) induces optical breakdown of the airborne above the gold-coated K9 glass surface and the created shockwave removes the SiO2 particles contaminated on the gold films. The laser cleaning efficiency has been characterized by optical microscopy, dark field imaging, ultraviolet-visible-near infrared spectroscopy, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy and the Image-pro software. The relationships between removal ratio and particle position and laser gap distance have been studied in the case of single pulse laser cleaning. The results show that the 1064 nm laser induced plasma shockwave can effectively remove the SiO2 particles. The removal ratio can reach above 90%. The effects of particle position and laser gap distance on the cleaning efficiency are simulated for the single pulse laser cleaning. The simulated results are consistent with the experimental ones.

  18. Tenderization of chicken and turkey breasts with electrically produced hydrodynamic shockwaves.

    PubMed

    Claus, J R; Schilling, J K; Marriott, N G; Duncan, S E; Solomon, M B; Wang, H

    2001-07-01

    Eighty early deboned (45 min, post mortem) postrigor chicken breasts were exposed (24 h post mortem) to two levels (number of pulse firing networks, PFN; 45% energy) of electrically produced hydrodynamic shockwaves (HSW). In addition, 21 turkey breasts (72 h post mortem) were HSW treated (two PFN, 72% energy). Samples were water cooked in bags (78°C internal). Two PFN's were required to decrease (P<0.05) chicken Warner-Bratzler shear (WBS) force by 22% from the control (4.67 kg). WBS force of the HSW treated turkey breast decreased (P<0.05) by 12% from the control (3.20 kg). Cooking loss was higher (P<0.05) in the turkey breast portions but not in the chicken breasts. The electrically produced shockwave process has the potential to provide chicken processors with the ability to early debone and produce tender breasts and to provide turkey processors with tenderness-enhanced fillets.

  19. Comparative environmental analysis of waste brominated plastic thermal treatments.

    PubMed

    Bientinesi, M; Petarca, L

    2009-03-01

    The aim of this research activity is to investigate the environmental impact of different thermal treatments of waste electric and electronic equipment (WEEE), applying a life cycle assessment methodology. Two scenarios were assessed, which both allow the recovery of bromine: (A) the co-combustion of WEEE and green waste in a municipal solid waste combustion plant, and (B) the staged-gasification of WEEE and combustion of produced syngas in gas turbines. Mass and energy balances on the two scenarios were set and the analysis of the life cycle inventory and the life cycle impact assessment were conducted. Two impact assessment methods (Ecoindicator 99 and Impact 2002+) were slightly modified and then used with both scenarios. The results showed that scenario B (staged-gasification) had a potentially smaller environmental impact than scenario A (co-combustion). In particular, the thermal treatment of staged-gasification was more energy efficient than co-combustion, and therefore scenario B performed better than scenario A, mainly in the impact categories of "fossil fuels" and "climate change". Moreover, the results showed that scenario B allows a higher recovery of bromine than scenario A; however, Br recovery leads to environmental benefits for both the scenarios. Finally the study demonstrates that WEEE thermal treatment for energy and matter recovery is an eco-efficient way to dispose of this kind of waste.

  20. Comparative environmental analysis of waste brominated plastic thermal treatments

    SciTech Connect

    Bientinesi, M. Petarca, L.

    2009-03-15

    The aim of this research activity is to investigate the environmental impact of different thermal treatments of waste electric and electronic equipment (WEEE), applying a life cycle assessment methodology. Two scenarios were assessed, which both allow the recovery of bromine: (A) the co-combustion of WEEE and green waste in a municipal solid waste combustion plant, and (B) the staged-gasification of WEEE and combustion of produced syngas in gas turbines. Mass and energy balances on the two scenarios were set and the analysis of the life cycle inventory and the life cycle impact assessment were conducted. Two impact assessment methods (Ecoindicator 99 and Impact 2002+) were slightly modified and then used with both scenarios. The results showed that scenario B (staged-gasification) had a potentially smaller environmental impact than scenario A (co-combustion). In particular, the thermal treatment of staged-gasification was more energy efficient than co-combustion, and therefore scenario B performed better than scenario A, mainly in the impact categories of 'fossil fuels' and 'climate change'. Moreover, the results showed that scenario B allows a higher recovery of bromine than scenario A; however, Br recovery leads to environmental benefits for both the scenarios. Finally the study demonstrates that WEEE thermal treatment for energy and matter recovery is an eco-efficient way to dispose of this kind of waste.

  1. Shock-Wave and Plasma-Pinch Mechanisms of Galactic Cosmic-Ray Production

    SciTech Connect

    Trubnikov, B.A.

    2005-07-01

    Based on recent discoveries, we show that it is appropriate to complement the standard shock-wave model for the production of galactic cosmic rays by a plasma-pinch model. The latter describes well the production of high-energy cosmic rays, yields a simple formula for their intensity, and allows the threshold pattern of the knee-type kink in the secondary particle spectrum and a number of unusual phenomena observed above the threshold to be explained.

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

    DTIC Science & Technology

    2015-07-01

    an ability to attenuate and disperse shocks . Polyurea is a segmented thermoplastic elastomer which possesses a meso-scale segregated microstructure...polyurea possesses a high shockwave-mitigation capacity, i.e. an ability to attenuate and disperse shocks . Polyurea is a segmented thermoplastic...Polyurea is presently being used both in ballistic-protection and blast-/ shock -wave mitigation applications. However, the phenomena and processes behind

  3. A VISAR Velocity Interferometer System at MRL for Slapper Detonator and Shockwave Studies

    DTIC Science & Technology

    1991-12-01

    VISAR schematic diagram. 8 The transmitted fraction of the beam enters the modified Michelson -type interferometer where it is first split into equal...Thus the phase difference will be 1 2 (A.12) 30 39 2n 2If-1A.13) In the arrangement of the Michelson interferometer used for length measurements, A2...A VISAR Velocity Interferometer L System at MRL for Slapper Detonator and Shockwave Studies David J. Hatt MRL Technical Report MRL-TR-91-42 Abstract

  4. International shock-wave database project : report of the requirements workshop.

    SciTech Connect

    Aidun, John Bahram; Lomonosov, Igor V.; Levashov, Pavel R.

    2012-03-01

    We report on the requirements workshop for a new project, the International Shock-Wave database (ISWdb), which was held October 31 - November 2, 2011, at GSI, Darmstadt, Germany. Participants considered the idea of this database, its structure, technical requirements, content, and principles of operation. This report presents the consensus conclusions from the workshop, key discussion points, and the goals and plan for near-term and intermediate-term development of the ISWdb. The main points of consensus from the workshop were: (1) This international database is of interest and of practical use for the shock-wave and high pressure physics communities; (2) Intermediate state information and off-Hugoniot information is important and should be included in ISWdb; (3) Other relevant high pressure and auxiliary data should be included to the database, in the future; (4) Information on the ISWdb needs to be communicated, broadly, to the research community; and (5) Operating structure will consist of an Advisory Board, subject-matter expert Moderators to vet submitted data, and the database Project Team. This brief report is intended to inform the shock-wave research community and interested funding agencies about the project, as its success, ultimately, depends on both of these groups finding sufficient value in the database to use it, contribute to it, and support it.

  5. Thermodynamic parameters of mixtures with allowance for phase transition components under shock-wave loading

    NASA Astrophysics Data System (ADS)

    Kinelovskii, S. A.; Maevskii, K. K.

    2017-02-01

    The shock-wave synthesis and compaction using powder mixtures are the one of perspective directions of new materials creation. The results of numerical experiments on modeling of shock wave loading of mixtures with allowance for phase transition components in their composition are presented. The significant change in volume in the region of phase transition components included in the mixtures allows us to expand the range of variation of thermodynamic parameters of the mixtures under shock wave loading. The calculation model is based on the assumption that all components of mixture under shock-wave loading are in thermodynamic equilibrium (model TEC). The model TEC allows us to describe the region of the polymorphic phase transition, considering the material in the region of phase transition as a mixture of low-pressure phase and high-pressure phase. The good agreement of these model calculations with the data of different authors defined on the basis of experiments is obtained. Thermodynamic parameters of the nitrides mixture, solid and porous mixtures with quartz as component were reliably described. This model is useful for determining the compositions and volume fractions of the components of the mixture to obtain the specified parameters of solid and porous materials under shock-wave loading.

  6. 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.

  7. A new SWL titanium stent (Zebra Stent): resistance to shockwave exposure.

    PubMed

    Buchholz, Noor N P; Cannaby, Clive; Fong, Ruby; Gray, Andrew; Andrews, Henry O; Birch, Malcolm J

    2005-06-01

    Recently, a new-concept lumen-less Teflon-coated double-J wire stent (Zebra stent) has been introduced to facilitate residual stone clearance, in particular after SWL. Its metal core expresses highly mismatched acoustic impedance. It was the aim of this study to exclude damage to the stent through shockwaves. Also, its Teflon coating should to some degree prevent encrustation, and stents removed from stone formers were examined for encrustation. Series of 2000 shockwaves of an average and a maximum energy were applied to defined areas of Zebra stents in a waterbath on a Siemens Multiline Lithotriptor. Stents were then examined for core and sheath damage by digital photography, scanning electron microscopy, and microradiography. In addition, two Zebra stents and one conventional double-J stent from two stone formers were assessed in the same way for damage and encrustation. There was no damage whatsoever to either of the stents. Whereas there was considerable encrustation on the conventional double-J stent, there was none on the Zebra stents after 4 and 5 weeks in situ. Zebra stents resist shockwaves to a maximum number and energy sufficiently to be applied safely under SWL. Whether they resist encrustation to a higher degree in the short term than conventional stents remains to be established.

  8. Comparing outcomes of adjunctive treatment in depression: aripiprazole versus bupropion.

    PubMed

    Nasr, Suhayl; Wendt, Burdette; Popli, Anand; Crayton, John

    2014-06-01

    Adjunctive therapy in depression is often used in patients with an inadequate response to antidepressant therapy. Utilizing a chart review from a private, outpatient psychiatric clinic, patients with adjunctive medication added to their antidepressant were reviewed. Demographic information, diagnoses, medication history, and QIDS SR16 depression scores were collected and recorded at each visit and entered into a database. Significant reductions were observed in the QIDS score of aripiprazole (n=70) and bupropion (n=83) patients after the first visit. At the first visit, 70% of aripiprazole patients had lower QIDS score compared to baseline visit, with 17% achieving remission, whereas 66% of bupropion users had lower scores at the first visit compared to baseline visit, with 23% achieving remission. At the end of the observation period 50% of patients on aripiprazole achieved remission compared to 33% of bupropion patients. Both groups of patients had significant reductions in their QIDS symptom scores of sadness, concentration, and general interest. In addition, aripiprazole patients had a decrease in the thoughts of death and suicide score while bupropion patients had decreases in the low energy score. None of the differences in QIDS line-item scores between aripiprazole and bupropion patients were statistically significant. This study was a small scale, retrospective study that did not have a placebo control group. Aripiprazole and bupropion were comparable in significantly lowering patients' QIDS SR16 scores and helping over 50% of the patients achieve remission. Differences in line-item QIDS score were also observed. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Posthospitalization Outcomes for Psychiatric Sex Offenders: Comparing Two Treatment Protocols.

    PubMed

    Stinson, Jill D; McVay, Lee Ann; Becker, Judith V

    2016-05-01

    This study evaluates the effectiveness of safe offender strategies (SOS) in comparison with relapse prevention (RP) in a sample of 91 inpatient males in a secure psychiatric setting. All men evidenced a history of violent sexual offending and were diagnosed with serious psychiatric disorders and/or intellectual disabilities. Participants who received SOS (n= 58) and RP (n= 33) were followed from 6 to 36 months post release. SOS clients were significantly less likely to be arrested (0%) or rehospitalized (5.2%) than RP clients (9% arrested; 54.5% rehospitalized). In addition, SOS clients were more likely to transition continuously to less restrictive alternatives, with no returns to high security, in comparison with RP clients. The authors discuss implications for use of SOS, a treatment that facilitates skills development and affects global self-regulatory functioning, particularly in sex offenders with serious mental illness or intellectual impairment, in promoting community reintegration and limiting returns to psychiatric settings.

  10. Audiovisual distraction reduces pain perception during shockwave lithotripsy.

    PubMed

    Marsdin, Emma; Noble, Jeremy G; Reynard, John M; Turney, Benjamin W

    2012-05-01

    Lithotripsy is an established method to fragment kidney stones that can be performed without general anesthesia in the outpatient setting. Discomfort and/or noise, however, may deter some patients. It has been demonstrated that audiovisual distraction (AV) can reduce sedoanalgesic requirements and improve patient satisfaction in nonurologic settings, but to our knowledge, this has not been investigated with lithotripsy. This randomized controlled trial was designed to test the hypothesis that AV distraction can reduce perceived pain during lithotripsy. All patients in the study received identical analgesia before a complete session of lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter. Patients were randomized to two groups: One group (n=61) received AV distraction via a wall-mounted 32″ (82 cm) television with wireless headphones; the other group (n=57) received no AV distraction. The mean intensity of treatment was comparable in both groups. Patients used a visual analogue scale (0-10) to record independent pain and distress scores and a nonverbal pain score was documented by the radiographer during the procedure (0-4). In the group that received AV distraction, all measures of pain perception were statistically lower. The patient-reported pain score was reduced from a mean of 6.1 to 2.4 (P<0.0001), and the distress score was reduced from a mean of 4.4 to 1.0 (P=0.0001). The mean nonverbal score recorded by the radiographer was reduced from 1.5 to 0.5 (<0.0001). AV distraction significantly lowered patients' reported pain and distress scores. This correlated with the nonverbal scores reported by the radiographer. We conclude that AV distraction is a simple method of improving acceptance of lithotripsy and optimizing treatment.

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

    PubMed

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

    2015-04-01

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

  12. Stenting in extracorporeal shockwave lithotripsy; may enhance the passage of the fragments!

    PubMed

    Mustafa, Mahmoud; Ali-El-Dein, Bedier

    2009-03-01

    To prospectively evaluate the role of double J (DJ) stent in enhancing the passage of fragments in patients undergoing extracorporeal shockwave lithotripsy (SWL) for renal stones with diameters less than 2.5 cm. Between November 2005 and January 2007, 38 patients with an average age of 47.05 years (range 16-73) were included and underwent SWL for renal stones. The inclusion criteria were radio-opaque renal stone not located in the lower pole, complete disintegeration of the stone, normal renal function, no metabolic abnormalities, no major renal abnormalities and no symptomatic urinary tract infection. The patients were randomized to either a stented (11 patients) or stentless (27 patients) group. The average stone diameters in stentless and stented groups were 1.54 cm and 1.77 cm, respectively (p > 0.05). Double J stent was removed when there was no further passage of the fragments for 6 weeks after stone disintegration. All patients were given non-steroidal anti-inflammatory drugs for one week after ESWL treatment. Stone passage and the data of DJ were determined with plain X-ray of the urinary tract (UTP). The severity of lower urinary tract symptoms, loin pain and the need for intravenous or intramuscular analgesics were recorded. The overall stone-free rate at 3 months was 92.1%. Two patients in the stented and one patient in the stentless group were partially free of stones. Steinstrasse were observed in two patients (5.3%); one patient in the stentless group and another one after the removal of DJ stent. Only one patient in the stented group had severe lower urinary tract symptoms which responded neither to oral nor to other forms of analgesics, and therefore DJ stent was removed. The remaining patients were in no need for analgesics other than the oral therapy. Placement of DJ stent for the purpose of improving free stone rate or enhancing the passage of the fragments during SWL is unnecessary in renal stone with diameters less than 2.5 cm. However, further

  13. Can low-intensity extracorporeal shockwave therapy improve erectile dysfunction? A prospective, randomized, double-blind, placebo-controlled study.

    PubMed

    Olsen, Anne B; Persiani, Marie; Boie, Sidsel; Hanna, Milad; Lund, Lars

    2015-01-01

    The aim of this study was to investigate whether low-intensity extracorporeal shockwave therapy (LI-ESWT) can be used as a treatment for men with erectile dysfunction of organic origin. This prospective, randomized, blinded, placebo-controlled study included 112 men unable to have intercourse either with or without medication. Erectile dysfunction was assessed at screening and 5, 12 and 24 weeks after treatment. Assessment was performed by interview and using the Erection Hardness Scale (EHS) and the International Index of Erectile Function (IIEF-15) questionnaire. The men were randomly assigned either to LI-ESWT (n = 51, active group) or placebo (n = 54, placebo group). They received five treatments over 5 weeks. Both the participants and the doctors were blinded to the treatment. After 10 weeks, the placebo group received active treatment (active placebo group). Twenty-nine men (57%, active group) were able to obtain an erection after treatment and to have sexual intercourse without the use of medication. In the placebo group, only five men (9%) showed similar results (p = 0.0001). The EHS after 5 weeks showed that men in the active group experienced a significant improvement in their erectile dysfunction, but no significant result was found with the use of the IIEF - Erectile Function domain. This placebo-controlled study over 5 weeks shows that 57% of the men who suffered from erectile dysfunction had an effect from LI-ESWT. After 24 weeks, seven (19%, active group) and nine (23%, active placebo group) men were still able to have intercourse without medication. This study shows a possible cure in some patients, but more research, longer follow-up in the placebo group and an international multicentre randomized study are needed.

  14. 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.

  15. Incident shock-wave characteristics in air, argon, carbon dioxide, and helium in a shock tube with unheated helium driver

    NASA Technical Reports Server (NTRS)

    Miller, C. G., III; Jones, J. J.

    1975-01-01

    Incident shock-wave velocities were measured in the Langley 6-inch expansion tube, operated as a shock tube, with air, argon, carbon dioxide, and helium as test gases. Unheated helium was used as the driver gas and most data were obtained at pressures of approximately 34 and 54 MN/sq m. A range of pressure ratio across the diaphragm was obtained by varying the quiescent test-gas pressure, for a given driver pressure, from 0.0276 to 34.5 kN/sq m. Single- and double-diaphragm modes of operation were employed and diaphragms of various materials tested. Shock velocity was determined from microwave interferometer measurements, response of pressure transducers positioned along interferometer measurements, response of pressure transducers positioned along the driven section (time-of-arrival gages), and to a lesser extent, measured tube-wall pressure. Velocities obtained from these methods are compared and limitations of the methods discussed. The present results are compared with theory and the effects of diaphragm mode (single or double diaphragm), diaphragm material, heating of the driver gas upon pressurization of the driver section, diaphragm opening time, interface mixing, and two-dimensional (nonplanar) flow are discussed.

  16. 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.

  17. Comparing treatment options for chronic inflammatory neuropathies and choosing the right treatment plan.

    PubMed

    Nobile-Orazio, Eduardo; Gallia, Francesca; Terenghi, Fabrizia; Bianco, Mariangela

    2017-08-01

    Chronic inflammatory neuropathies are disorders caused by an immune response to peripheral nerve. They include chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy (MMN) and neuropathy associated with anti-MAG IgM monoclonal gammopathy and other less frequent neuropathies. Several immune therapies have been proven to be effective in these neuropathies even if the best therapeutic option is still unsettled. Areas covered: The authors reviewed the literature to compare the efficacy and safety of currently used immune therapies in these neuropathies. The authors also analyzed the effect of other immune suppressive agents and of biological agents including rituximab, eculizumab, natalizumab, alemtuzumab and fingolimod that were found effective in other autoimmune diseases. Expert commentary: Despite the reported efficacy of a number of new immune therapies in some patients with immune mediated neuropathies, their efficacy has not been so far confirmed in randomized controlled studies. High-dose intravenous immunoglobulin (IVIg) (and subcutaneous immunoglobulin [SCIg] for maintenance treatment), steroids and plasma exchange remain the only therapy of proven efficacy in CIDP, IVIg in MMN and, with certain limits, rituximab and, occasionally plasma exchange in neuropathy associated with anti-MAG antibodies. New biological agents are also on the horizon but their efficacy needs to be proved in controlled studies.

  18. 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.

  19. 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

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

    PubMed Central

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

    2016-01-01

    Extracorporeal shockwave (ESW) has been shown of great potential in promoting the osteogenesis of bone marrow mesenchymal stem cells (BMSCs), but it is unknown whether this osteogenic promotion effect can also be achieved in other MSCs (i.e., tendon-derived stem cells (TDSCs) and adipose-derived stem cells (ADSCs)). In the current study, we aimed not only to compare the osteogenic effects of BMSCs induced by ESW to those of TDSCs and ADSCs; but also to investigate the underlying mechanisms. We show here that ESW (0.16 mj/mm2) significantly promoted the osteogenic differentiation in all the tested types of MSCs, accompanied with the downregulation of miR-138, but the activation of FAK, ERK1/2, and RUNX2. The enhancement of osteogenesis in these MSCs was consistently abolished when the cells were pretreated with one of the following conditions: overexpression of miR-138, FAK knockdown using specific siRNA, and U0126, implying that all of these elements are indispensable for mediating the effect of ESW. Moreover, our study provides converging genetic and molecular evidence that the miR-138-FAK-ERK1/2-RUNX2 machinery can be generally activated in ESW-preconditioned MSCs, suggesting that ESW may be a promising therapeutic strategy for the enhancement of osteogenesis of MSCs, regardless of their origins. PMID:26863924

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

    NASA Astrophysics Data System (ADS)

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

    2016-02-01

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

  2. Low-Intensity Extracorporeal Shockwave Therapy in Sexual Medicine: A Questionnaire-Based Assessment of Knowledge, Clinical Practice Patterns, and Attitudes in Sexual Medicine Practitioners.

    PubMed

    Fode, Mikkel; Lowenstein, Lior; Reisman, Yacov

    2017-06-01

    Low-intensity extracorporeal shockwave therapy (LI-ESWT) has emerged as a treatment option for male sexual dysfunction. However, results have been contradictory. To investigate the knowledge, practice patterns, and attitudes regarding LI-ESWT among experts in sexual medicine. A study-specific questionnaire was handed out at the 18th Congress for the European Society for Sexual Medicine. Participants were queried on their knowledge about LI-ESWT and about their use of the equipment. Descriptive data on the knowledge of LI-ESWT and perception of treatment effects. One hundred ninety-two questionnaires were available for analysis. Most respondents were physicians (79.7%) and most of these specialized in urology (58.9%). Overall, 144 of 192 (75%) reported that they were familiar with LI-ESWT in sexual medicine. Twenty-seven (14.1%) had performed the treatment. Of the 117 non-users who were familiar with LI-ESWT, 37 sometimes referred patients for the treatment. Nevertheless, 103 of 144 (71.5%) stated that they considered LI-ESWT an effective treatment for erectile dysfunction (ED) and 10 of 144 (6.9%) considered it an effective treatment for Peyronie disease. Of participants who regarded LI-ESWT an effective ED treatment, 91.2% would consider the treatment specifically for vasculogenic ED and 81.6% would combine it with phosphodiesterase type 5 inhibitors. Most participants (83.7%) regarded LI-ESWT as safe. A urology background (odds ratio = 2.4; 95% CI = 1.3-4.8; P = .0093) and working in a private setting (odds ratio = 2.8; 95% CI = 1.5-5.3; P = .0084) were significant predictors of familiarity with LI-ESWT in sexual medicine and of being an LI-ESWT user. Likewise, urologists were significantly more likely than non-urologists to consider the treatment effective (odds ratio = 2.8; 95% CI = 1.1-7.1; P = .033). LI-ESWT is well known among experts in sexual medicine and the treatment is perceived as safe and effective against vasculogenic ED when combined with

  3. Shockwave turbulent boundary layer interaction control using magnetically driven surface discharges

    NASA Astrophysics Data System (ADS)

    Kalra, Chiranjeev Singh

    The dissertation demonstrates the potential for shockwave-turbulent boundary layer interaction control in air using low current DC constricted surface discharges forced by moderate strength magnetic fields. Experiments are conducted in a Mach 2.6 indraft air tunnel with discharge currents up to 300 mA and magnetic field strengths up to 5 Tesla. Separation and non-separation inducing shocks are generated with diamond shape shockwave generators located on the wall opposite to the surface electrodes, and flow properties are measured with schlieren imaging, static wall pressure probes and acetone flow visualization. Also, an efficient, time dependent, two-dimensional Navier-Stokes numerical code for shockwave boundary layer interaction in air is developed. To replicate the experiments done at high Reynolds number, the code is divided into time independent and time dependent regimes to significantly reduce computation time. The effect of plasma control on boundary layer separation depends on the direction of the Lorentz force ( j d16 xB d16 ). It is observed that by using a Lorentz force that pushes the discharge upstream, separation can be induced or further strengthened even with discharge currents as low as 30 mA in a 3 Tesla magnetic field. If shock induced separation is present, it is observed that by using a Lorentz force that pushes the discharge downstream, separation can be suppressed, but this required higher currents, greater than 80 mA. Acetone planar laser scattering is used to image the flow structure in the test section and the reduction in the size of recirculation bubble and its elimination are observed experimentally as a function of actuation current and magnetic field strength. Computational results are in good agreement with experiments in terms of the flow structure as shown by Schlieren imaging, acetone planar laser scattering, and the static pressure profile on the test section wall.

  4. External Validation and Evaluation of Reliability and Validity of the Triple D Score to Predict Stone-Free Status After Extracorporeal Shockwave Lithotripsy.

    PubMed

    Ozgor, Faruk; Tosun, Muhammed; Kayali, Yunus; Savun, Metin; Binbay, Murat; Tepeler, Abdulkadir

    2017-02-01

    The Triple D scoring system is defined as novel and simple nomogram using the main parameters (skin-to-stone distance, stone density, and volume) to indicate most appropriate patients for extracorporeal shockwave lithotripsy (SWL). We aimed to evaluate the accuracy of the Triple D scoring system in predicting SWL success rates. In two tertiary academic centers, charts were retrospectively analyzed of patients who had, between January 2014 and May 2016, been treated by SWL for radiopaque kidney stones. A total of 200 patients were enrolled into the study. Parameters were calculated for each of the three specified variables. Since one point was assigned for any parameter that was less than the cutoff value, Triple D scores ranged from 0 (worst) to 3 (best). Stone-free status was achieved in 115 patients (57.5%), and 85 patients had one or more residual fragments (42.5%). Differences in stone characteristics, including stone location, density, and volume, were statistically significant in patients whether SWL achieved stone-free status or not (p < 0.001, p < 0.001, and p < 0.001, respectively). Triple D scores were significantly higher in patients treated with SWL compared with patients in whom SWL failed (p < 0.001). Triple D scores of 0, 1, 2, and 3 correlated with stone-free rates of 41.7%, 33.7%, 69.4%, and 97%, respectively. The multivariate analyses revealed that Triple D score and stone location were identified as independent factors affecting SWL success (p < 0.001 and p = 0.008, respectively). The mean number of SWL sessions was significantly higher in patients with SWL failure (p = 0.003). Our study externally validates that the Triple D scoring system is associated with SWL success in the treatment of renal and ureteral stones. Further studies are warranted to assess clinical usefulness and the accuracy of this nomogram in different patient groups.

  5. Nonstationary phenomena in the region of shock-wave interaction with a boundary layer at transonic flow velocities

    NASA Astrophysics Data System (ADS)

    Sidorenko, A. A.; Budovskii, A. D.; Polivanov, P. A.; Vishnyakov, O. I.

    2017-06-01

    Nonstationary characteristics of detached flow have been experimentally studied during interaction of the boundary layer with a shock wave that appears on a profiled bump in transonic flow. The experiments were performed with variable shock-wave intensity and position in a T-325 wind tunnel. The flow was studied using methods of schlieren imaging, measuring average pressure and its pulsations on the surface of a model, and determining velocity fields by particle image velocimetry. Analysis of the experimental data showed that the observed shock-wave oscillations and flow pulsations in the detachment zone were related to disturbances present in the oncoming boundary layer.

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

    PubMed Central

    2017-01-01

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

  7. Experimental study of dynamic properties of porous materials under shock-wave loading

    NASA Astrophysics Data System (ADS)

    Zubareva, A. N.; Efremov, V. P.; Mochalova, V. M.; Utkin, A. V.

    2016-11-01

    The paper presents new experimental data on properties of porous media under shock-wave loading. We considered materials with different nature of porosity. The porosity in the silicone rubber and the epoxy resin was produced by glass microspheres filler. Open porosity was realized in a fibrous material made from glass fibers with corundum. It was shown that two-wave configuration was formed in materials with closed porosity. Such structure of the pulse with a precursor was not observed in samples with open porosity. As a result of analysis of experimental data, Hugoniots for the investigated materials were obtained.

  8. [Effects of shock-wave lithotripsy (ESWL) on electrolytic and hormonal balance in nephrolithiasis patients].

    PubMed

    Dzhavad-Zade, S M; Abdullaev, S Sh

    1998-01-01

    Blood concentrations of parathyroid hormone, aldosterone, hydrocortisone, Na+, K+, Ca2+, 24-h urine concentration of Ca2+, blood pressure were measured on day 3 and 7 after extracorporeal shock-wave lithotripsy. A total of 54 patients with nephrolithiasis (NL) were examined. In NL patients with hypertension the above lithotripsy led to a fall in pressure by 15-20%, to correction of initial hormonal and electrolytic unbalance. There were marked changes in the levels of parathyroid hormone, total Ca2+ in the blood and 24-h urine.

  9. Shock-wave processes evolution in fused quartz under intense energy action

    NASA Astrophysics Data System (ADS)

    Efremov, V. P.; Ivanov, M. F.; Kiverin, A. D.; Yakovenko, I. S.

    2016-11-01

    The paper considers gas-dynamical processes evolving as a result of laser action in fused quartz. A conventional approach is used to construct a model for equation of state which provides an adequate description of the silica state at high densities of energy typical for local optical silica damage. Shock-wave processes generated in the medium due to the local laser energy deposition are calculated using fully conservative numerical technique. The obtained results provide relatively accurate description of the process in a wide range of parameters and allow further research to get clear interpretation of high-speed propagation of the laser absorbing front through the silica optical fiber.

  10. Femtosecond-laser-induced shockwaves in water generated at an air-water interface.

    PubMed

    Strycker, B D; Springer, M M; Traverso, A J; Kolomenskii, A A; Kattawar, G W; Sokolov, A V

    2013-10-07

    We report generation of femtosecond-laser-induced shockwaves at an air-water interface by millijoule femtosecond laser pulses. We document and discuss the main processes accompanying this phenomenon, including light emission, development of the ablation plume in the air, formation of an ablation cavity, and, subsequently, a bubble developing in water. We also discuss the possibility of remotely controlling the characteristics of laser-induced sound waves in water through linear acoustic superposition of sound waves that results from millijoule femtosecond laser-pulse interaction with an air-water interface, thus opening up the possibility of remote acoustic applications in oceanic and riverine environments.

  11. Laser-Induced Shockwave Paired with FRET: A Method to Study Cell Signaling

    PubMed Central

    GOMEZ-GODINEZ, VERONICA; PREECE, DARYL; SHI, LINDA; KHATIBZADEH, NIMA; ROSALES, DERRICK; PAN, YIJIA; LEI, LIE; WANG, YINGXIAO; BERNS, MICHAEL W.

    2015-01-01

    Cells within the body are subject to various forces; however, the details concerning the way in which cells respond to mechanical stimuli are not well understood. We demonstrate that laser-induced shockwaves (LIS) combined with biosensors based on fluorescence resonance energy transfer (FRET) is a promising new approach to study biological processes in single live cells. As “proof-of-concept,” using a FRET biosensor, we show that in response to LIS, cells release intracellular calcium. With the parameters used, cells retain their morphology and remain viable. LIS combined with FRET permits observation of the cells immediate response to a sudden shear force. PMID:25639252

  12. Extracorporeal shockwave therapy for chronic proximal plantar fasciitis.

    PubMed

    Strash, Walter W; Perez, Richard R

    2002-10-01

    Although much enthusiasm surrounds applying extracorporeal shock wave therapy for various musculoskeletal conditions, its effects are not well understood and warrant continued study. Certain body tissues or organs may be damaged either acutely or chronically by ESWT; however, it is unequivocal that lung tissue may be damaged. It is theorized that neovascularization is responsible for improvement in symptoms of plantar fasciitis. Neovascularization is the direct effect of macrophage stimulation through cytokines. ESWT has effects at the cellular level--does it interfere with metabolic activity or enhance it? The noninvasive nature and minimal complications of appropriately applied ESWT are its primary advantages. Symptoms may continue to improve for three weeks to six months after treatment; the effects of shock wave therapy seem to be time dependent. ESWT is an effective form of treatment for proximal insertional plantar fasciitis after exhaustive, conservative forms of treatment have failed.

  13. Comparing Efficacies of Neurocognitive Treatment and Homework Assistance Programs for Children with Learning Difficulties.

    ERIC Educational Resources Information Center

    Lamminmaki, Tuija; And Others

    1997-01-01

    This study compared two treatments with 94 Chilean children having learning difficulties. The first treatment consisted of multiple training components targeting specific cognitive and behavioral factors; the second treatment provided emotional support and supervision of school tasks. Findings indicated both groups improved on most of the outcome…

  14. [Extracorporeal shock-wave lithotripsy in horseshoe kidney].

    PubMed

    Blasco Casares, F J; Ibarz Servio, L; Ramón Dalmau, M; Ruiz Marcellán, F J

    1994-05-01

    Presentation of our experience in the use of extracorporeal shock wave lithotripsy (ESWL) for the treatment of lithiasis that occurred in 34 renal units from 28 patients with horseshoe kidneys. All patients but one were placed in supine decubitus with the calculus positioned in F2. A total of 47 sessions were performed for 34 treatments apart from 3 ureteroscopies for ureteral voiding. The results of the follow-up is absence of lithiasis in 13 renal units, debris of less than 3 mm in six, non-removable debris in 13 cases and relapse in two.

  15. Superiority of preventive antibiotic treatment compared with standard treatment of poststroke pneumonia in experimental stroke: a bed to bench approach

    PubMed Central

    Hetze, Susann; Engel, Odilo; Römer, Christine; Mueller, Susanne; Dirnagl, Ulrich; Meisel, Christian; Meisel, Andreas

    2013-01-01

    Stroke patients are prone to life-threatening bacterial pneumonia. Previous experimental stroke studies have demonstrated that preventive antibiotic treatment (PAT) improves outcome compared with placebo treatment, which however does not model the clinical setting properly. Here we investigate whether PAT is superior to the current clinical ‘gold standard' for treating poststroke infections. Therefore, we modeled stroke care according to the current stroke guidelines recommending early antibiotic treatment after diagnosing infections. To reliably diagnose pneumonia in living mice, we established a general health score and a magnetic resonance imaging protocol for radiologic confirmation. Compared with standard treatment after diagnosis by these methods, PAT not only abolished pneumonia successfully but also improved general medical outcome. Both, preventive and standard antibiotic treatment using enrofloxacin improved survival in a similar way compared with placebo treatment. However, in contrast to standard treatment, only PAT improved functional outcome assessed by gait analysis. In conclusion, standard and preventive treatment approach reduced poststroke mortality, however at the cost of a worse neurologic outcome compared with preventive approach. These data support the concept of PAT for treating patients at risk for poststroke infections and warrant phase III trials to prove this concept in clinical setting. PMID:23361393

  16. EXTRACORPOREAL SHOCKWAVE TERAPY TO TREAT CHRONIC MUSCLE INJURY

    PubMed Central

    Astur, Diego Costa; Santos, Bruno; de Moraes, Eduardo Ramalho; Arliani, Gustavo Gonçalves; dos Santos, Paulo Roberto Dias; Pochini, Alberto de Castro

    2015-01-01

    ABSTRACT Objective: To evaluate the low energy extracorporeal shock waves therapy (ESWT) associated with physical therapy in the treatment of chronic muscle injuries classified as grades 2 and 3 in the lower limbs of amateur athletes. Methods: Eight athletes presenting with lower limb muscle injury for more than three weeks were treated with physiotherapy and ESWT. We evaluated the following parameters during treatment: palpable gap, muscle strength, pain, and Tegner score, as well as ultrasound image features and the ability to return to sports practice. Results: The average time of the first evaluation of the injury was 8.75 weeks. All patients presented muscle strength grade V after eight weeks. The pain score evolved from 5.75 to 0.5 points of the visual analogue scale (VAS), at the end of the treatment. The Tegner score after treatment was six points on average. Patients returned to sports practice after 8.14 weeks. Conclusion: ESWT associated with physical therapy proved to be effective to treat long-term muscle injury, with good performance and the ability to return to sport practice for all patients. Level of Evidence IV, Case Series, Prospective Study. PMID:26981031

  17. Effects of extracorporeal shockwave therapy on nanostructural and biomechanical responses in the collagenase-induced Achilles tendinitis animal model.

    PubMed

    Yoo, Seung Don; Choi, Samjin; Lee, Gi-Ja; Chon, Jinmann; Jeong, Yong Seol; Park, Hun-Kuk; Kim, Hee-Sang

    2012-11-01

    The aim of this study was to quantitatively investigate the effects of extracorporeal shockwave therapy (ESWT) on the nanostructure and adhesion force of collagen fibrils in a rat model of collagenase-induced Achilles tendinitis (CIAT) using histology and atomic force microscopy. A total of 45 rats were divided into experimental groups of three rats each: a control group, 27 CIAT rats with nine time points, and 15 ESWT rats with five time points. Progressive changes in nanostructure including the fibrillary diameter and D-periodicity, and biomechanical properties including the fibrillary adhesion forces in each healing phase were investigated over a 5-week period after collagenase injection. On postoperative day 3, CIAT rats showed granulomatous tissue associated with subacute inflammation, and a deterioration in nanostructure and mechanical properties compared to controls. On postoperative day 12, the ESWT group showed increased vascularity, fibroblastic activity, lymphocyte and plasma cell infiltration, dense histocytes, and disorganization of the fibers compared to the CIAT group. The ESWT group showed and improvement in nanostructure and mechanical properties compared to controls, while the CIAT group showed a deterioration in nanostructure and mechanical properties compared to controls. On postoperative day 26, the ESWT group showed 30% inflamed tissue and 70% fibrotic tissue, while the CIAT group showed chronic inflammation. By the end of the experiments, in both groups the changes had reversed and the tissues were similar in appearance to those in the control group. Following ESWT the deformed and irregular collagen network returned to a well-aligned normal collagen network nanostructure. These results suggest that ESWT may promote the healing response in Achilles tendinitis.

  18. Effects of one session radial extracorporeal shockwave therapy on post-stroke plantarflexor spasticity: a single-blind clinical trial.

    PubMed

    Radinmehr, Hojjat; Nakhostin Ansari, Noureddin; Naghdi, Soofia; Olyaei, Gholamreza; Tabatabaei, Azadeh

    2017-03-01

    Purpose To examine the effects of radial extracorporeal shockwave therapy (rESWT) on plantarflexor spasticity after stroke. Method Twelve patients with stroke were randomly included for this prospective, single-blind clinical trial. Patients received one rESWT session (0.340 mJ/mm(2), 2000 shots) on plantarflexor muscle. The Modified Modified Ashworth Scale (MMAS), H-reflex tests, ankle range of motion (ROM), passive plantarflexor torque (PPFT) and timed up and go test (TUG) were measured at baseline (T0), immediately after treatment (T1) and one hour after the end of the treatment (T2). Results Patients had improved the MMAS scores for both the gastrocnemius and the soleus muscles, active and passive ROM, PPFT and TUG over time after rESWT. For the PPFT, it was greater at high velocity than at low velocity, and there was a significant three-way interaction between time, knee position (extended/flexed) and velocity (low/high). The H-reflex latency had decreased at T1, but there was no significant effect on Hmax/Mmax ratio. Conclusions The rESWT improved plantarflexor spasticity, and the effects sustained for one hour, whereas it was not effective in improving spinal excitability. Implications for Rehabilitation One session radial extracorporeal shock wave therapy (rESWT) is safe and effective in improving post stroke plantarflexor spasticity, ankle active and passive range of motion, passive torque, and walking capability. The spasticity scores improved for both the gastrocnemius and the soleus muscles and persisted one hour after rESWT. The magnitude of resistive plantarflexor passive torque in the knee extended position and high velocity was larger over time suggesting greater gastrocnemius spasticity than soleus. The rESWT had no significant effects on alpha motorneuron excitability.

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

    PubMed Central

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

    2016-01-01

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

  20. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial

    PubMed Central

    Vahdatpour, Babak; Kianimehr, Lida; Ahrar, Mohmmad Hossein

    2016-01-01

    Background: Intralesional injection of autologous blood-derived products has recently gained attention as a potential treatment for plantar fasciitis (PF). We compared platelet-rich plasma (PRP) and whole blood (WB) for the treatment of chronic PF. Materials and Methods: Patients with chronic PF received either an intralesional injection of 3 cc PRP prepared by double centrifuge technique or WB (n = 17 in each group). Overall, morning and walking pain severity were assessed by 11-point numerical rating scale, and function was assessed by the Roles and Maudsley score (RMS) at baseline and 1-month and 3 months after treatment. Ultrasonography was performed to measure plantar fascia thickness at baseline and 3 months after treatment. Results: Pain scores were reduced over the study in the PRP (mean change = −5.00 ± 1.17 to −5.47 ± 1.46) and WB groups (mean change = −5.29 ± 2.56 to −6.47 ± 2.83), with no difference between groups (P > 0.05). One month and 3 months after treatment, successful treatment (RMS of ≤ 2) was respectively observed in 29.4% and 82.3% of the PRP and in 47.1% and 76.4% of the WB groups (P > 0.05). Also, fascia thickness was decreased in both the PRP and WB groups (mean change = −1.74 ± 1.11 vs. −1.21 ± 0.73 mm, respectively, P = 0.115). Conclusions: Significant improvement in pain and function, as well as decrease in plantar fascia thickness, was observed by intralesional injection of the PRP and WB in patients with chronic PF. The study results indicate similar effectiveness between PRP and WB for the treatment of chronic PF in short-term. PMID:27274499

  1. Generation of Shock-Wave Disturbances at Plasma-Vapor Bubble Oscillation

    NASA Astrophysics Data System (ADS)

    Kuznetsova, N. S.; Yudin, A. S.; Voitenko, N. V.

    2015-11-01

    The complex physical and mathematical model describing all steps of plasma-vapor bubble evolution in the system of the water-ground condensed media is presented. Discharge circuit operation, discharge plasma channel expansion, its transformation into the vapor-plasma bubble and its pulsation, pressure wave generation and propagation of the mechanical stress waves in the ground are self-consistently considered in the model. The model allows investigation of the basic laws of stored energy transformation into the discharge plasma channel, next to the plasma-vapor bubble and transformation of this energy to the energy of pressure wave compressing the surrounding ground. Power characteristics of wave disturbances generated by gas-vapor bubble oscillation in liquid depending on the circuit parameters are analyzed for the prediction of the ground boundary displacement. The dynamics of the shock-wave propagation in water-ground condensed media depending on the rate of the plasma channel energy release is investigated. Simulation of the shock-wave phenomena at a plasma-vapor bubble oscillation in condensed media consecutively describes the physical processes underlying technology for producing piles by electro-discharge stuffing. The quantitative model verified by physical experimental tests will allow optimization of pulse generator parameters and electrode system construction of high-voltage equipment.

  2. Comparing Treatment Policies with Assistance from the Structural Nested Mean Model

    PubMed Central

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

    2015-01-01

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

  3. Fetotoxicity and teratogenesis of SWL treatment in the rabbit.

    PubMed

    Frankenschmidt, A; Heisler, M

    1998-02-01

    The potential effects of extracorporeal application of shockwaves on an embryo or fetus were explored in an animal model. In experimental Series A, the fetuses of 30 gravid rabbits were exposed to piezoelectrically induced and sonographically guided shockwaves on Day 25 or 20 of gestation under technical conditions corresponding to extracorporeal lithotripsy in humans. Fetotoxicity was examined by abdominal section 24 hours or 9 days later, and immediate/intermediate damage was assessed (resorptions, viability, gross injuries, and microscopic lesions of the target and neighboring fetuses). In series B, the kidneys of an additional 28 gravid rabbits (including a control group) were exposed to the same shockwave treatment on Day 11 of gestation in order to investigate indirect embryotoxic effects, including teratogenic potency. One day before the expected birth, the maternal kidneys, uteri, and adjacent organs were examined for lesions, and the 156 offspring were assessed for embryolethal, embryonoxious, or teratogenic sequelae. Shockwave targeting of the cranium, thorax, abdomen, or placenta was usually lethal to the fetuses. When the uterine wall or the space between two fetuses was targeted, the fetuses suffered from superficial hematoma, as was found in the surrounding soft tissues within a radius of 1.5 cm. Fetuses outside this region were vital and free of lesions. Shockwave treatment of the maternal kidney resulted in renal petechial hemorrhage or subcapsular hematoma. However, statistically significant embryotoxic or teratogenetic effects could be demonstrated neither from maternal data (resorptions) nor from fetal findings (body measurements, vitality test, inner organs, skeletal deformities). When using a piezoelectric lithotripter with a small focus of high energy, lesions of a fetus are to be expected only when it is located in or close to the focus. It seems that embryotoxic or teratogenic sequelae do not occur when shockwaves are focused outside the

  4. 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,

  5. Modeling of chemical reactions in the mixture of Al-Ni powders under shock-wave compression

    SciTech Connect

    Horie, Y.; Kipp, M.E.

    1987-07-01

    Based upon microstructural observations of post-shock samples, a mathematical model was developed for chemical changes in the mixture of elemental Al and Ni powders from the passage of high-pressure shock-wave. The model was solved and illustrated using the one-dimensional Sandia code WONDY-IV.

  6. [Extracorporeal shockwave lithotripsy in patients with coagulation disorders].

    PubMed

    Ruiz Marcellán, F J; Mauri Cunill, A; Cabré Fabré, P; Argentino Gancedo Rodríguez, V; Güell Oliva, J A; Ibarz Servio, L; Ramón Dalmau, M

    1992-03-01

    During treatment of renal lithiasis with extracorporeal shock wave lithotripsy (ESWL) hemorrhagic events, especially renal hematoma, may present. A coagulation study is warranted in order to institute hemotherapy for blood factor deficiencies. We reviewed the records of 4,000 patients that had undergone ESWL. Of these, 17 (12 males, 5 females) presented coagulation disorders. The bleeding diatheses were due to platelet deficiency in 6 cases, plasma defects in 5, platelet and plasma disorders in 2, and capillary wall defects in 5 cases. The underlying cause was hepatosplenic disease in 12 cases, iatrogenic in 1, connectivopathy and corticoids in 2, and capillary purpura of unknown cause in 2 cases. Due to this protocol, no patient presented hemorrhage or hematoma from shock wave-induced lesions. These results show that a complete coagulation study must be performed in order to institute the necessary measures in patients with disorders of hemostasis due to the high risk of hematoma repeatedly reported in the literature.

  7. Randomised, cross-over comparison of sevoflurane and ketamine-midazolam anaesthesia in children undergoing extracorporeal shock-wave lithotripsy.

    PubMed

    Kocabas, Seden; Ugur, Gulden; Erhan, Elvan; Ozyar, Bulent; Nazli, Oktay

    2008-02-01

    The aim of this study was to assess the haemodynamic responses, adverse events and recovery characteristics associated with sevoflurane and ketamine-midazolam anaesthesia for paediatric extracorporeal shock-wave lithotripsy. Twenty children aged 2-11 years, who were undergoing two consecutive lithotripsy sessions at an interval of 4 weeks were enrolled and randomised to receive either inhalation or dissociative anaesthesia at their first session. The alternative anaesthesia protocol was used at their second session. Inhalation anaesthesia was induced with 8% sevoflurane and 70% N(2)O in oxygen; 10 microg/kg atropine and 2 microg/kg fentanyl were then administered. Anaesthesia was maintained with 2%-3% end-tidal sevoflurane and 70% N(2)O in oxygen via a laryngeal mask airway. Dissociative anaesthesia was induced intravenously with 10 mug/kg atropine, 0.05 mg/kg midazolam, 1.5 mg/kg ketamine and maintained with 0.5-1.0 mg/kg ketamine. Haemodynamic parameters were recorded before and after induction, after the start of the procedure, and every 10 minutes thereafter. Postoperatively, the times to responding to command, sitting, ambulating, achieving an Aldrete score > or = 9, and achieving a post-anaesthetic discharge score > or = 9 were recorded. Systolic and diastolic arterial pressures at all measurements throughout the procedure were higher with ketamine-midazolam than with sevoflurane (P<0.05). Heart rates were comparable between groups, except after induction and after start of the procedure in which they were higher with ketamine-midazolam (P<0.05). All recovery endpoints were achieved earlier with sevoflurane than with ketamine-midazolam (P<0.05). Nausea-vomiting incidences were similar in both groups. Sevoflurane and ketamine-midazolam both provided effective anaesthesia for paediatric lithotripsy. The recovery and discharge times were shorter after anaesthesia with sevoflurane compared with ketamine-midazolam in children undergoing lithotripsy.

  8. How Often Do Comparative Randomised Controlled Trials in the Field of Eczema Fail to Directly Compare the Treatments Being Tested?

    PubMed

    Ratib, Sonia; Wilkes, Sally R; Nankervis, Helen; Thomas, Kim S; Williams, Hywel C

    2015-06-17

    The objective of the study was to identify all parallel design randomised controlled trials (RCTs) comparing treatments for eczema in recent dermatology literature that have failed to report a between-group analysis. The GREAT database (www.greatdatabase.org.uk) was searched to identify parallel group RCTs comparing two or more interventions published in the English language in the last decade, 2004 to 2013. The primary outcome was the number of studies that had not reported a between-group analysis for any of the outcomes. Where possible we re-analysed the data to determine whether a between-group analysis would have given a different conclusion to that reported. Out of a total of 304 RCTs in the study period, 173 (56.9%) met the inclusion criteria. Of the 173 eligible studies, 12 (6.9%) had not conducted a between-group analysis for any of the reported outcomes. There was no clear improvement over time. Five of the eight studies that were re-analysed yielded non-significant between-group differences yet reported significant within-group comparisons. All but one of the 12 studies implied that the experimental intervention was successful despite not undertaking any between-group comparisons. Although the proportion of all RCTs that fail to report an appropriate between-group analysis is small, the fact that any scientist who purports to compare one treatment against another then chooses to omit the key comparison statistic is worrying.

  9. 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

  10. The Comparative Effectiveness of Outpatient Treatment for Adolescent Substance Abuse: A Meta-Analysis

    PubMed Central

    Tanner-Smith, Emily E.; Wilson, Sandra Jo; Lipsey, Mark W.

    2012-01-01

    Meta-analysis was used to synthesize research on the effects of outpatient treatment on substance use outcomes for adolescents with substance use disorders. An extensive literature search located 45 eligible experimental or quasi-experimental studies reporting 73 treatment-comparison group pairs, with many of the comparison groups also receiving some treatment. The first analysis examined 250 effect sizes for the substance use outcomes of adolescents receiving different types of treatment relative to the respective comparison groups. As a category, family therapy programs were found to be more effective than their comparison conditions, whereas no treatment programs were less effective. However, not all treatment types were compared with each other in the available research, making it difficult to assess the comparative effectiveness of the different treatments. To provide a more differentiated picture of the relative improvement in substance use outcomes for different treatments, a second analysis examined 311 pre-post effect sizes measuring changes in substance use for adolescents in the separate treatment and comparison arms of the studies. The adolescents in almost all types of treatment showed reductions in substance use. The greatest improvements were found for family therapy and mixed and group counseling. Longer treatment duration was associated with smaller improvements, but other treatment characteristics and participant characteristics had little relationship to the pre-post changes in substance use. Based on these findings family therapy is the treatment with the strongest evidence of comparative effectiveness, although most types of treatment appear to be beneficial in helping adolescents reduce their substance use. PMID:22763198

  11. 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.

  12. A model for traumatic brain injury using laser induced shockwaves

    NASA Astrophysics Data System (ADS)

    Selfridge, A.; Preece, D.; Gomez, V.; Shi, L. Z.; Berns, M. W.

    2015-08-01

    Traumatic brain injury (TBI) represents a major treatment challenge in both civilian and military medicine; on the cellular level, its mechanisms are poorly understood. As a method to study the dysfunctional repair mechanisms following injury, laser induced shock waves (LIS) are a useful way to create highly precise, well characterized mechanical forces. We present a simple model for TBI using laser induced shock waves as a model for damage. Our objective is to develop an understanding of the processes responsible for neuronal death, the ways in which we can manipulate these processes to improve cell survival and repair, and the importance of these processes at different levels of biological organization. The physics of shock wave creation has been modeled and can be used to calculate forces acting on individual neurons. By ensuring that the impulse is in the same regime as that occurring in practical TBI, the LIS model can ensure that in vitro conditions and damage are similar to those experienced in TBI. This model will allow for the study of the biochemical response of neurons to mechanical stresses, and can be combined with microfluidic systems for cell growth in order to better isolate areas of damage.

  13. [Extracorporeal shockwave biliary lithotripsy. Physical basis and clinical application].

    PubMed

    Méndez-Sánchez, N; Uribe-Esquivel, M; Bosques, F; de la Mora, G; Sánchez, J M; Ponciano, G

    1990-01-01

    Extracorporeal shock waves lithotripsy is a new procedure discovered and applied in the present decade to treat urinary and biliary stones. Shock waves are acoustic waves similar to sonic waves which follow the acoustic laws and therefore the shock waves can be refracted or reflected depending on the medium interface. Due to the high water content, the human body can be crossed by shock waves which eventually may be focused on the target stone. There are several commercially available shock waves generators, i.e. the spark gap emisors which were the first ones, and the piezoceramic and electromagnetic emisors. To focus the shock waves on a biliary stone the machines are provided with fluoroscopic or ultrasound devices or with both in the most advanced machines. Using an electromagnetic emisor (Lithostar plus) our group has treated 78 patients with biliary stones without analgesia or anesthesia. Total stone fragmentation was achieved in 85% of the cases. In patients with cholesterol gallstones who undergo lithotripsy, an adjuvant treatment with oral cholesterol solvent is mandatory. Extracorporeal biliary lithotripsy is free of mortality, and the morbidity is less than 5%.

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

    PubMed Central

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

    2014-01-01

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

  15. Comparing Offenders against Women and Offenders against Children on Treatment Outcome in Offenders with Intellectual Disability

    ERIC Educational Resources Information Center

    Lindsay, William R.; Michie, Amanda M.; Steptoe, Lesley; Moore, Fhionna; Haut, Fabian

    2011-01-01

    Background: Several studies have shown the positive effects of sex offender treatment for men with intellectual disabilities who have perpetrated sex offences or inappropriate sexual behaviour. The present study investigates the process of treatment change and compares two groups of offenders against adults and offenders against children. Method:…

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

    EPA Science Inventory

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

  17. A Comparative Evaluation of Minimal Therapist Contact and 15-Session Treatment for Female Orgasmic Dysfunction.

    ERIC Educational Resources Information Center

    Morokoff, Patricia J.; LoPiccolo, Joseph

    1986-01-01

    Compared a four-session minimal therapist contact (MTC) program for treatment of lifelong global orgasmic dysfunction in women to a 15-session full therapist contact (FTC) program. Both programs were effective in producing female orgasm and in improving satisfaction with the sexual relationship and, for women in MTC treatment, happiness in…

  18. A Comparative Evaluation of Minimal Therapist Contact and 15-Session Treatment for Female Orgasmic Dysfunction.

    ERIC Educational Resources Information Center

    Morokoff, Patricia J.; LoPiccolo, Joseph

    1986-01-01

    Compared a four-session minimal therapist contact (MTC) program for treatment of lifelong global orgasmic dysfunction in women to a 15-session full therapist contact (FTC) program. Both programs were effective in producing female orgasm and in improving satisfaction with the sexual relationship and, for women in MTC treatment, happiness in…

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

    EPA Science Inventory

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

  20. Extracorporeal shockwave lithotripsy for salivary calculi in pediatric patients.

    PubMed

    Ottaviani, F; Marchisio, P; Arisi, E; Capaccio, P

    2001-10-01

    Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler ultrasonography (US) enables an accurate diagnosis of lithiasis to be made without exposure to the radiation of traditional imaging techniques. The development of minimally invasive techniques in the ENT field has made salivary lithotripsy a feasible alternative to traditional invasive surgery. The safety and efficacy of shock wave lithotripsy for salivary calculi were evaluated in pediatric patients. Seven children (5 males; age 4-15 years) with single calculi (mean diameter 4.4 mm) of the submandibular (n = 4) and parotid glands (n = 3) underwent extracorporeal electromagnetic shock wave lithotripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchymal (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients were followed up clinically and with US for 6-72 months (mean 32 months). Complete disintegration of the calculi was achieved in five cases while in two cases a residual fragment < 2 mm in diameter was observed. None of the patients had recurrence of calculi in the treated gland. Mild self-limited adverse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest that EESWL is effective, safe and well tolerated; the minimal invasiveness of the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring enables the efficacy of EESWL to be evaluated during both treatment and follow-up, with only slight discomfort for the pediatric patient.

  1. A SYSTEMATIC REVIEW COMPARING HYSTERECTOMY TO LESS INVASIVE TREATMENTS FOR ABNORMAL UTERINE BLEEDING

    PubMed Central

    Matteson, Kristen A.; Abed, Husam; Wheeler, Thomas L.; Sung, Vivian W.; Rahn, David D.; Schaffer, Joseph I.; Balk, Ethan M.

    2011-01-01

    Study Objective To compare hysterectomy and less invasive alternatives for abnormal uterine bleeding (AUB) in 7 clinically important domains Design Systematic review Setting Randomized clinical trials (RCTs) comparing bleeding, quality of life, pain, sexual health, satisfaction, need for subsequent surgery, and/or adverse events between hysterectomy and less invasive treatment options Patients Women with AUB, predominantly from ovulatory disorders and endometrial causes Interventions Systematic review of the literature (from inception to January 2011) comparing hysterectomy to alternatives for AUB treatment. Eligible trials were extracted into standardized forms. Trials were graded using a predefined 3-level rating and the strengths of evidence for each outcome were evaluated with the GRADE system. Measurements and Main Results Nine RCTs (18 articles) were eligible. Endometrial ablation, levonorgestrel intrauterine system (LNG-IUS), and medications were associated with lower risk of adverse events but higher risk of additional treatments treatments than hysterectomy. Compared to ablation, hysterectomy had superior long-term pain and bleeding control. Compared to LNG-IUS, hysterectomy had superior control of bleeding. No other differences between treatments were found. Conclusion Less invasive treatment options for AUB result in improvement in quality of life but carry significant risk of retreatment secondary to unsatisfactory results. While hysterectomy is the most effective treatment for AUB, it carries the highest risk for adverse events. PMID:22078015

  2. Shockwave compression of Argon gas at several initial densities

    NASA Astrophysics Data System (ADS)

    Dattelbaum, Dana; Goodwin, Peter; Garcia, Daniel; Gustavsen, Richard; Lang, John; Aslam, Tariq; Sheffield, Stephen; Gibson, Lloyd; Morris, John; Los Alamos National Laboratory Team

    2015-06-01

    Experimental data of the principal Hugoniot locus of gas-phase noble gases are rare. The majority of Hugoniot data is either from shock tube experiments on low-pressure gases or from plate impact experiments on cryogenic, liquefied gases. In both cases, physics regarding shock compressibility, thresholds for the on-set of ionization, and dissociation chemistry are difficult to infer for gases at intermediate densities. We have developed an experimental target for gas gun-driven plate impact experiments on gases at initial pressures between 200-1000 psi. Using optical velocimetry, we directly determine shock and particle velocities on the principal Hugoniot locus, as well as clearly differentiate ionization thresholds. The target design also results in multiply shocking the gas in a quasi-isentropic fashion yielding off-Hugoniot compression data. Using an impactor with higher impedance than the drive plate, we are able to achieve initial particle velocities well in excess of the impactor velocities. We will describe the results of plate impact experiments on Ar with initial densities between 0.02-0.05 g/cm3. By coupling optical fibers to the targets, we have measured the time-resolved optical emission, spectrally-resolved with a spectrometer coupled to an optical streak camera, and with a 5-color optical pyrometer for temperature determination. The experimental results are compared with hydrodynamic simulations using ideal gas and Sesame tabular equations of state.

  3. RANS Modeling of Benchmark Shockwave / Boundary Layer Interaction Experiments

    NASA Technical Reports Server (NTRS)

    Georgiadis, Nick; Vyas, Manan; Yoder, Dennis

    2010-01-01

    This presentation summarizes the computations of a set of shock wave / turbulent boundary layer interaction (SWTBLI) test cases using the Wind-US code, as part of the 2010 American Institute of Aeronautics and Astronautics (AIAA) shock / boundary layer interaction workshop. The experiments involve supersonic flows in wind tunnels with a shock generator that directs an oblique shock wave toward the boundary layer along one of the walls of the wind tunnel. The Wind-US calculations utilized structured grid computations performed in Reynolds-averaged Navier-Stokes mode. Three turbulence models were investigated: the Spalart-Allmaras one-equation model, the Menter Shear Stress Transport wavenumber-angular frequency two-equation model, and an explicit algebraic stress wavenumber-angular frequency formulation. Effects of grid resolution and upwinding scheme were also considered. The results from the CFD calculations are compared to particle image velocimetry (PIV) data from the experiments. As expected, turbulence model effects dominated the accuracy of the solutions with upwinding scheme selection indicating minimal effects.!

  4. Dissipation of Molecular Cloud Turbulence by Magnetohydrodynamic Shockwaves

    NASA Astrophysics Data System (ADS)

    Lehmann, Andrew; Wardle, Mark

    2015-08-01

    The character of star formation is intimately related to the supersonic magnetohydrodynamic (MHD) turbulent dynamics of the giant molecular clouds in which stars form. A significant amount of the turbulent energy dissipates in low velocity shock waves. These shocks cause molecular line cooling of the compressed and heated gas, and so their radiative signatures probe the nature of the turbulence. In MHD fluids the three distinct families of shocks—fast, intermediate and slow—differ in how they compress and heat the molecular gas, and so observational differences between them may also distinguish driving modes of turbulent regions.Here we use a two-fluid model to compare the characteristics of one-dimensional fast and slow MHD shocks. Fast MHD shocks are magnetically driven, forcing ion species to stream through the neutral gas ahead of the shock front. This magnetic precursor heats the gas sufficiently to create a large, warm transition zone where all the fluid variables only weakly change in the shock front. In contrast, slow MHD shocks are driven by gas pressure where neutral species collide with ion species in a thin hot slab that closely resembles an ordinary gas dynamic shock.We computed observational diagnostics for fast and slow shocks at velocities vs = 2-4 km/s and preshock Hydrogen nuclei densities n(H) = 102-4 cm-3. We followed the abundances of molecules relevant for a simple oxygen chemistry and include cooling by CO, H2 and H2O. Estimates of intensities of CO rotational lines show that high-J lines, above J = 6→5, are more strongly excited in slow MHD shocks. We discuss how these shocks could help interpret recently observed anomalously strong mid- and high-J CO lines emitted by warm gas in the Milky Way and external galaxies, and implications for simulations of MHD turbulence.

  5. [Physical therapy as part of a complex orthopedic rheumatology approach. Physiotherapy, cryotherapy, extracorporeal shockwave lithotripsy, local intra-articular joint injections].

    PubMed

    Arnold, I; Guttke, T

    2012-07-01

    In this review only some of the physical therapeutic options for treating chronic inflammatory diseases are discussed. These include a wide variety of procedures and should not exclusively be assessed using the criteria of evidence-based medicine because in most studies there was no blinding or for ethical reasons no placebo group was included. Nevertheless, these treatment options are quite essential as part of a multimodal treatment concept for patients with inflammatory joint diseases. The increasing interest in adjuvant therapeutic options emphasizes the need for further well designed studies concerning the effectiveness of physical therapy. Dynamic exercise is closely integrated into the treatment strategy for rheumatoid arthritis. In addition to a conditioning stimulus to joints and cartilage it is known that physical therapy is useful in preventing mechanisms of disease chronification. Locally applied and whole body cryotherapy leads to muscular relaxation resulting in a more effective treatment intensity of subsequent exercise. With extracorporeal shockwave therapy (ESWT) a new promising therapeutic approach is available. However, the evidence level is still weak when used for patients with rheumatoid arthritis. Locally applied steroid injections still have a significant value when treating inflammatory synovial conditions.

  6. Comparative Efficacy of Radiofrequency and Pulsed Dye Laser in the Treatment of Rosacea.

    PubMed

    Kim, Sue-Jeong; Lee, Young; Seo, Young-Joon; Lee, Jeung-Hoon; Im, Myung

    2017-02-01

    Laser and light-based therapies have been used successfully in the treatment of rosacea; however, evidence is lacking regarding the efficacy of radiofrequency (RF). This study evaluated the efficacy of RF in the treatment of rosacea compared with pulsed dye laser (PDL). Thirty patients with rosacea (erythematotelangiectatic rosacea [ETR], n = 20; papulopustular rosacea [PPR], n = 10) were enrolled in a randomized, controlled, split-face study. The patients were treated with RF on one side and PDL on the other side. Each treatment consisted of 3 sessions at 4-week intervals and followed up until 4 weeks after the last treatment. Efficacy was assessed by rosacea severity score, erythema index, lesion counts, physician's subjective evaluation, and patient's satisfaction. Radiofrequency and PDL resulted in significant improvement in severity scores and erythema and 70% of the patients receiving RF treatment showed a clinical improvement of >50%. No significant difference was noted between RF and PDL treatment in ETR. However, RF treatment led to a significantly greater decrease in papulopustular lesion count and rosacea severity score in PPR compared with PDL treatment. RF therapy was effective in the treatment of rosacea. It should be considered an alternative therapeutic option, especially in PPR.

  7. Comparing Virtual Reality Exposure Therapy to Prolonged Exposure in the Treatment of Soldiers with PTSD

    DTIC Science & Technology

    2010-06-01

    1 AD_________________ Award Number: W81XWH-08-2-0015 TITLE: Comparing Virtual Reality Exposure Therapy to Prolonged Exposure...SUBTITLE Comparing Virtual Reality Exposure Therapy to Prolonged 5a. CONTRACT NUMBER Exposure in the Treatment of Soldiers with PTSD 5b...evaluating the efficacy of virtual reality exposure therapy (VRET) by comparing it to prolonged exposure therapy (PE) and a waitlist (WL) group in the

  8. Comparing outcomes of 'voluntary' and 'quasi-compulsory' treatment of substance dependence in Europe.

    PubMed

    Schaub, Michael; Stevens, Alex; Berto, Daniele; Hunt, Neil; Kerschl, Viktoria; McSweeney, Tim; Oeuvray, Kerrie; Puppo, Irene; Santa Maria, Alberto; Trinkl, Barbara; Werdenich, Wolfgang; Uchtenhagen, Ambros

    2010-01-01

    This study evaluates quasi-compulsory drug treatment (QCT) arrangements for substance-dependent offenders receiving treatment instead of imprisonment in comparison to voluntary treatment within five European countries. Participants were interviewed with the European Addiction Severity Index, the ASI-crime module, questions on perception of pressure and self-efficacy, and the Readiness-to-Change Questionnaire at treatment entry and after 6, 12, and 18 months. Reductions in substance use and crime as well as improvements in health and social integration were observed in QCT and voluntary treatment groups. After controlling for various factors, subjects in the QCT and the comparison group showed similar reductions in substance use and crime over time. Study retention was comparable in both groups. QCT is as effective as voluntary treatment provided in the same services in reducing substance use and crime. Copyright 2009 S. Karger AG, Basel.

  9. MD simulation of steady shock-wave fronts with phase transition in single-crystal iron

    NASA Astrophysics Data System (ADS)

    Zhakhovsky, V. V.; Migdal, K. P.; Inogamov, N. A.; Anisimov, S. I.

    2017-01-01

    Overdriven shock waves propagating in main crystallographic directions of single-crystal bcc iron were studied with moving-window molecular dynamics (MD) technique. To simulate correctly the shock-induced bcc-to-hcp phase transition in iron a new EAM potential fitted to the cold pressure curves and pressure transition at 13 GPa was developed with the stress matching method. We demonstrate that structure of shock fronts depends on orientation of crystal. A peculiar structure of steady shock-wave front in [100] direction is observed. While the ultra-fast α → ɛ transition initiated in uniaxially compressed crystal along [100] in elastic zone transforms bcc completely to hcp phase, transformation in other directions is performed only partially with production of metastable composition of nanometer-sized bcc-hcp-fcc grains.

  10. Shock-wave compression of silica gel as a model material for comets

    NASA Astrophysics Data System (ADS)

    Arasuna, Akane; Okuno, Masayuki; Chen, Liliang; Mashimo, Tsutomu; Okudera, Hiroki; Mizukami, Tomoyuki; Arai, Shoji

    2016-07-01

    A shock-wave compression experiment using synthesized silica gel was investigated as a model for a comet impact event on the Earth's surface. The sample shocked at 20.7 GPa showed considerable structural changes, a release of water molecules, and the dehydration of silanol (Si-OH) that led to the formation of a new Si-O-Si network structure containing larger rings (e.g., six-membered ring of SiO4 tetrahedra). The high aftershock temperature at 20.7 GPa, which could be close to 800 °C, influenced the sample structure. However, some silanols, which were presumed to be the mutually hydrogen-bonded silanol group, remained at pressures >20.7 GPa. This type of silanol along with a small number of water molecules may remain even after shock compression at 30.9 GPa, although the intermediate structure of the sample recovered was similar to that of silica glass.

  11. Quantum molecular dynamics simulation of shock-wave experiments in aluminum

    SciTech Connect

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

    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, 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.

  12. The Shock-Wave Patterns on a Cranked-Wing Configuration

    NASA Technical Reports Server (NTRS)

    Sammonds, Robert I.

    1960-01-01

    The shock-wave patterns of a complex configuration with cranked cruciform wings and a cone-cylinder body were examined to determine the interaction of the body bow wave with the flow field about the wing. Also of interest, was the interaction of the forward (760 sweptback) wing leading-edge wave with the rear (600 sweptback) wing leading-edge wave. The shadowgraph pictures of the model in free flight at a Mach number of 4.9, although not definitive, appear to indicate that the body bow wave crosses the outer wing panel after first being refracted either by the leading-edge wave of the 600 sweptback wing or by pressure fields in the flow crossing the wing.

  13. CHARADE: A characteristic code for calculating rate-dependent shock-wave response

    SciTech Connect

    Johnson, J.N.; Tonks, D.L.

    1991-01-01

    In this report we apply spatially one-dimensional methods and simple shock-tracking techniques to the solution of rate-dependent material response under flat-plate-impact conditions. This method of solution eliminates potential confusion of material dissipation with artificial dissipative effects inherent in finite-difference codes, and thus lends itself to accurate calculation of elastic-plastic deformation, shock-to-detonation transition in solid explosives, and shock-induced structural phase transformation. Equations are presented for rate-dependent thermoelastic-plastic deformation for (100) planar shock-wave propagation in materials of cubic symmetry (or higher). Specific numerical calculations are presented for polycrystalline copper using the mechanical threshold stress model of Follansbee and Kocks with transition to dislocation drag. A listing of the CHARADE (for characteristic rate dependence) code and sample input deck are given. 26 refs., 11 figs.

  14. The effect of shock-wave profile on dynamic brittle failure

    NASA Astrophysics Data System (ADS)

    Escobedo, J. P.; Brown, E. N.; Trujillo, C. P.; Cerreta, E. K.; Gray, G. T.

    2013-03-01

    The influence of shock-wave-loading profile on the failure processes in a brittle material has been investigated. Tungsten heavy alloy (WHA) specimens have been subjected to two shock-wave loading profiles with a similar peak stress of 15.4 GPa but different pulse durations. Contrary to the strong dependence of strength on wave profile observed in ductile metals, for WHA, specimens subjected to different loading profiles exhibited similar spall strength and damage evolution morphology. Post-mortem examination of recovered samples revealed that dynamic failure for both loading profiles is dominated by brittle cleavage fracture, with additional energy dissipation through crack branching in the more brittle tungsten particles. Overall, in this brittle material, all relevant damage kinetics and the spall strength are shown to be dominated by the shock peak stress, independent of pulse duration.

  15. 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.

  16. Shock-Wave and Finite-Strain Equations of State at Large Expansion

    NASA Astrophysics Data System (ADS)

    Jeanloz, Raymond

    The empirically observed linear relationship between shock-wave velocity and particle velocity is compatible with the Eulerian finite-strain equation of state under tension as well as compression, identifying an ideal value of dynamic strength -PH = K0S/(K0S' + 1) and dynamic cohesive energy EH - E0 = 8V0K0S/(K0S' + 1)2 (V, K and K' are volume, bulk modulus and its pressure derivative; subscripts 0, S and H refer to zero-pressure, isentrope and Hugoniot states). The corresponding finitestrain estimate of the isentropic cohesive energy is ES - E0 = 9V0K0S(2 + 2n - K0S')/(2n3), with strain parameter n = 2 for the Eulerian (spatial) frame of reference.

  17. Study of shockwave method for diagnosing the radiation fields of laser-driven gold hohlraums

    NASA Astrophysics Data System (ADS)

    Li, Yongsheng; Lan, Ke; Huo, Wenyi; Lai, Dongxian; Gao, Yaoming; Pei, Wenbing

    2013-11-01

    Besides the routinely used broad-band x-ray spectrometer (Dante or SXS), ablative shock-wave method is often used to diagnose the radiation fields of laser-driven Hohlraums. The x-ray ablation process of Aluminum and Titanium is studied numerically with a 1-D radiation hydrodynamic code RDMG [F. Tinggui et al., Chin. J. Comput. Phys. 16, 199 (1999)], based on which a new scaling relation of the equivalent radiation temperature with the ablative shock velocity in Aluminum plates is proposed, and a novel method is developed for determining simultaneously the radiation temperature and the M-band (2-4 keV) fraction in laser-driven gold Hohlraums.

  18. The isolated perfused kidney: an in vitro test system for evaluation of renal tissue damage induced by high-energy shockwaves sources.

    PubMed

    Bergsdorf, Th; Thüroff, S; Chaussy, Ch

    2005-09-01

    Most of our knowledge of shockwave-induced renal damage is based on animal experiments and clinical observation. We developed a tissue model using isolated porcine kidneys perfused with Berliner Blau dye in physiologic saline using a Ureteromat Perez-Castro peristaltic pump connected to the renal artery. Reproducible results were obtained under a variety of experimental conditions. Further refinements of the model might consist of interposition of tissue layers in the shockwave path or simulation of ventilatory movements.

  19. Orthodontic treatment need among special health care needs school children in Dharwad, India: A comparative study

    PubMed Central

    Nayak, Prajna P; Prasad, KVV; Bhat, Y Manohar

    2015-01-01

    Objectives: The aim was to assess and compare the prevalence of orthodontic treatment need among various special health care needs (SHCN) schoolchildren and adolescents in Dharwad, India. Materials and Methods: This cross-sectional study was carried out among 492 subjects in age group of 12-19 years (mean age 14.02 ± 1.84 standard deviation [SD]) who were examined for occlusal anomalies using dental aesthetic index (DAI). They were classified into five groups as: Visual impairment, speech and hearing disability (SH), physical disability, mentally subnormal and multiple disabilities (MD). Chi-square test was used to compare the orthodontic treatment need among various SHCN groups. One-way ANOVA and ANCOVA were performed to test any significant differences in mean DAI scores among the SHCN groups. Results: None of the children were undergoing or had undergone orthodontic treatment for malocclusion. Mean DAI score was 28.81 ± 11.64 (SD). Orthodontic treatment was indicated in 50.2% of study population who had DAI scores of 26 and above. Mandatory orthodontic treatment (DAI >=36) was required in as high as 29% of MD individuals when compared to only 10% of SH individuals. Significant differences in DAI scores were found between the SHCN groups. Conclusions: The need for orthodontic treatment among SHCN individuals was found to be high. Yet, absence of any orthodontic treatment for any child points out to the fact that the dental services are highly needed in these individuals. PMID:26020038

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

    PubMed Central

    Brandi, Hugo; Gomez, Valentin; Luque, Daniel

    2016-01-01

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

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

    PubMed

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

    2016-05-01

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

  2. Treatment success in cancer: industry compared to publicly sponsored randomized controlled trials.

    PubMed

    Djulbegovic, Benjamin; Kumar, Ambuj; Miladinovic, Branko; Reljic, Tea; Galeb, Sanja; Mhaskar, Asmita; Mhaskar, Rahul; Hozo, Iztok; Tu, Dongsheng; Stanton, Heather A; Booth, Christopher M; Meyer, Ralph M

    2013-01-01

    To assess if commercially sponsored trials are associated with higher success rates than publicly-sponsored trials. We undertook a systematic review of all consecutive, published and unpublished phase III cancer randomized controlled trials (RCTs) conducted by GlaxoSmithKline (GSK) and the NCIC Clinical Trials Group (CTG). We included all phase III cancer RCTs assessing treatment superiority from 1980 to 2010. Three metrics were assessed to determine treatment successes: (1) the proportion of statistically significant trials favouring the experimental treatment, (2) the proportion of the trials in which new treatments were considered superior according to the investigators, and (3) quantitative synthesis of data for primary outcomes as defined in each trial. GSK conducted 40 cancer RCTs accruing 19,889 patients and CTG conducted 77 trials enrolling 33,260 patients. 42% (99%CI 24 to 60) of the results were statistically significant favouring experimental treatments in GSK compared to 25% (99%CI 13 to 37) in the CTG cohort (RR = 1.68; p = 0.04). Investigators concluded that new treatments were superior to standard treatments in 80% of GSK compared to 44% of CTG trials (RR = 1.81; p<0.001). Meta-analysis of the primary outcome indicated larger effects in GSK trials (odds ratio = 0.61 [99%CI 0.47-0.78] compared to 0.86 [0.74-1.00]; p = 0.003). However, testing for the effect of treatment over time indicated that treatment success has become comparable in the last decade. While overall industry sponsorship is associated with higher success rates than publicly-sponsored trials, the difference seems to have disappeared over time.

  3. Treatment Success in Cancer: Industry Compared to Publicly Sponsored Randomized Controlled Trials

    PubMed Central

    Djulbegovic, Benjamin; Kumar, Ambuj; Miladinovic, Branko; Reljic, Tea; Galeb, Sanja; Mhaskar, Asmita; Mhaskar, Rahul; Hozo, Iztok; Tu, Dongsheng; Stanton, Heather A.; Booth, Christopher M.; Meyer, Ralph M.

    2013-01-01

    Objective To assess if commercially sponsored trials are associated with higher success rates than publicly-sponsored trials. Study Design and Settings We undertook a systematic review of all consecutive, published and unpublished phase III cancer randomized controlled trials (RCTs) conducted by GlaxoSmithKline (GSK) and the NCIC Clinical Trials Group (CTG). We included all phase III cancer RCTs assessing treatment superiority from 1980 to 2010. Three metrics were assessed to determine treatment successes: (1) the proportion of statistically significant trials favouring the experimental treatment, (2) the proportion of the trials in which new treatments were considered superior according to the investigators, and (3) quantitative synthesis of data for primary outcomes as defined in each trial. Results GSK conducted 40 cancer RCTs accruing 19,889 patients and CTG conducted 77 trials enrolling 33,260 patients. 42% (99%CI 24 to 60) of the results were statistically significant favouring experimental treatments in GSK compared to 25% (99%CI 13 to 37) in the CTG cohort (RR = 1.68; p = 0.04). Investigators concluded that new treatments were superior to standard treatments in 80% of GSK compared to 44% of CTG trials (RR = 1.81; p<0.001). Meta-analysis of the primary outcome indicated larger effects in GSK trials (odds ratio = 0.61 [99%CI 0.47–0.78] compared to 0.86 [0.74–1.00]; p = 0.003). However, testing for the effect of treatment over time indicated that treatment success has become comparable in the last decade. Conclusions While overall industry sponsorship is associated with higher success rates than publicly-sponsored trials, the difference seems to have disappeared over time. PMID:23555593

  4. Randomised controlled trial of intravenous antibiotic treatment for cellulitis at home compared with hospital

    PubMed Central

    Corwin, Paul; Toop, Les; McGeoch, Graham; Than, Martin; Wynn-Thomas, Simon; Wells, J Elisabeth; Dawson, Robin; Abernethy, Paul; Pithie, Alan; Chambers, Stephen; Fletcher, Lynn; Richards, Dee

    2005-01-01

    Objectives To compare the efficacy, safety, and acceptability of treatment with intravenous antibiotics for cellulitis at home and in hospital. Design Prospective randomised controlled trial. Setting Christchurch, New Zealand. Participants 200 patients presenting or referred to the only emergency department in Christchurch who were thought to require intravenous antibiotic treatment for cellulitis and who did not have any contraindications to home care were randomly assigned to receive treatment either at home or in hospital. Main outcome measures Days to no advancement of cellulitis was the primary outcome measure. Days on intravenous and oral antibiotics, days in hospital or in the home care programme, complications, degree of functioning and pain, and satisfaction with site of care were also recorded. Results The two treatment groups did not differ significantly for the primary outcome of days to no advancement of cellulitis, with a mean of 1.50 days (SD 0.11) for the group receiving treatment at home and 1.49 days (SD 0.10) for the group receiving treatment in hospital (mean difference 0.01 days, 95% confidence interval -0.3 to 0.28). None of the other outcome measures differed significantly except for patients' satisfaction, which was greater in patients treated at home. Conclusions Treatment of cellulitis requiring intravenous antibiotics can be safely delivered at home. Patients prefer home treatment, but in this study only about one third of patients presenting at hospital for intravenous treatment of cellulitis were considered suitable for home treatment. PMID:15604157

  5. Required duration of mass ivermectin treatment for onchocerciasis elimination in Africa: a comparative modelling analysis.

    PubMed

    Stolk, Wilma A; Walker, Martin; Coffeng, Luc E; Basáñez, María-Gloria; de Vlas, Sake J

    2015-10-22

    The World Health Organization (WHO) has set ambitious targets for the elimination of onchocerciasis by 2020-2025 through mass ivermectin treatment. Two different mathematical models have assessed the feasibility of reaching this goal for different settings and treatment scenarios, namely the individual-based microsimulation model ONCHOSIM and the population-based deterministic model EPIONCHO. In this study, we harmonize some crucial assumptions and compare model predictions on common outputs. Using a range of initial endemicity levels and treatment scenarios, we compared the models with respect to the following outcomes: 1) model-predicted trends in microfilarial (mf) prevalence and mean mf intensity during 25 years of (annual or biannual) mass ivermectin treatment; 2) treatment duration needed to bring mf prevalence below a provisional operational threshold for treatment interruption (pOTTIS, i.e. 1.4 %), and 3) treatment duration needed to drive the parasite population to local elimination, even in the absence of further interventions. Local elimination was judged by stochastic fade-out in ONCHOSIM and by reaching transmission breakpoints in EPIONCHO. ONCHOSIM and EPIONCHO both predicted that in mesoendemic areas the pOTTIS can be reached with annual treatment, but that this strategy may be insufficient in very highly hyperendemic areas or would require prolonged continuation of treatment. For the lower endemicity levels explored, ONCHOSIM predicted that the time needed to reach the pOTTIS is longer than that needed to drive the parasite population to elimination, whereas for the higher endemicity levels the opposite was true. In EPIONCHO, the pOTTIS was reached consistently sooner than the breakpoint. The operational thresholds proposed by APOC may have to be adjusted to adequately reflect differences in pre-control endemicities. Further comparative modelling work will be conducted to better understand the main causes of differences in model-predicted trends

  6. Comparative analysis of effluent water quality from a municipal treatment plant and two on-site wastewater treatment systems.

    PubMed

    Garcia, Santos N; Clubbs, Rebekah L; Stanley, Jacob K; Scheffe, Brian; Yelderman, Joe C; Brooks, Bryan W

    2013-06-01

    Though decentralized on-site technologies are extensively employed for wastewater treatment around the globe, an understanding of effluent water quality impairments associated with these systems remain less understood than effluent discharges from centralized municipal wastewater treatment facilities. Using a unique experimental facility, a novel comparative analysis of effluent water quality was performed from model decentralized aerobic (ATS) and septic (STS) on-site wastewater treatment systems and a centralized municipal wastewater treatment plant (MTP). The ATS and STS units did not benefit from further soil treatment. Each system received common influent wastewater from the Waco, Texas, USA Metropolitan Area Regional Sewerage System. We tested the hypothesis that MTP effluent would exhibit higher water quality than on-site effluents, based on parameters selected for study. A tiered testing approach was employed to assess the three effluent discharges: select routine water quality parameters (Tier I), whole effluent toxicity (Tier II), and select endocrine-active compounds (Tier III). Contrary to our hypothesis, ATS effluent was not statistically different from MTP effluents, based on Tier I and III parameters, but reproductive responses of Daphnia magna were slightly more sensitive to ATS than MTP effluents. STS effluent water quality was identified as most degraded of the three wastewater treatment systems. Parameters used to assess centralized wastewater treatment plant effluent water quality such as whole effluent toxicity and endocrine active substances appear useful for water quality assessments of decentralized discharges. Aerobic on-site wastewater treatment systems may represent more robust options than traditional septic systems for on-site wastewater treatment in watersheds with appreciable groundwater - surface water exchange.

  7. Dosimetric feasibility of cone-beam CT-based treatment planning compared to CT-based treatment planning

    SciTech Connect

    Yoo, Sua . E-mail: sua.yoo@duke.edu; Yin, F.-F.

    2006-12-01

    Purpose: Cone-beam computed tomography (CBCT) images are currently used for positioning verification. However, it is yet unknown whether CBCT could be used in dose calculation for replanning in adaptive radiation therapy. This study investigates the dosimetric feasibility of CBCT-based treatment planning. Methods and Materials: Hounsfield unit (HU) values and profiles of Catphan, homogeneous/inhomogeneous phantoms, and various tissue regions of patients in CBCT images were compared to those in CT. The dosimetric consequence of the HU variation was investigated by comparing CBCT-based treatment plans to conventional CT-based plans for both phantoms and patients. Results: The maximum HU difference between CBCT and CT of Catphan was 34 HU in the Teflon. The differences in other materials were less than 10 HU. The profiles for the homogeneous phantoms in CBCT displayed reduced HU values up to 150 HU in the peripheral regions compared to those in CT. The scatter and artifacts in CBCT became severe surrounding inhomogeneous tissues with reduced HU values up to 200 HU. The MU/cGy differences were less than 1% for most phantom cases. The isodose distributions between CBCT-based and CT-based plans agreed very well. However, the discrepancy was larger when CBCT was scanned without a bowtie filter than with bowtie filter. Also, up to 3% dosimetric error was observed in the plans for the inhomogeneous phantom. In the patient studies, the discrepancies of isodose lines between CT-based and CBCT-based plans, both 3D and IMRT, were less than 2 mm. Again, larger discrepancy occurred for the lung cancer patients. Conclusion: This study demonstrated the feasibility of CBCT-based treatment planning. CBCT-based treatment plans were dosimetrically comparable to CT-based treatment plans. Dosimetric data in the inhomogeneous tissue regions should be carefully validated.

  8. Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial.

    PubMed

    Tamm, Leanne; Denton, Carolyn A; Epstein, Jeffery N; Schatschneider, Christopher; Taylor, Heather; Arnold, L Eugene; Bukstein, Oscar; Anixt, Julia; Koshy, Anson; Newman, Nicholas C; Maltinsky, Jan; Brinson, Patricia; Loren, Richard E A; Prasad, Mary R; Ewing-Cobbs, Linda; Vaughn, Aaron

    2017-05-01

    This trial compared attention-deficit/hyperactivity disorder (ADHD) treatment alone, intensive reading intervention alone, and their combination for children with ADHD and word reading difficulties and disabilities (RD). Children (n = 216; predominantly African American males) in Grades 2-5 with ADHD and word reading/decoding deficits were randomized to ADHD treatment (medication + parent training), reading treatment (reading instruction), or combined ADHD + reading treatment. Outcomes were parent and teacher ADHD ratings and measures of word reading/decoding. Analyses utilized a mixed models covariate-adjusted gain score approach with posttest regressed onto pretest. Inattention and hyperactivity/impulsivity outcomes were significantly better in the ADHD (parent Hedges's g = .87/.75; teacher g = .67/.50) and combined (parent g = 1.06/.95; teacher g = .36/41) treatment groups than reading treatment alone; the ADHD and Combined groups did not differ significantly (parent g = .19/.20; teacher g = .31/.09). Word reading and decoding outcomes were significantly better in the reading (word reading g = .23; decoding g = .39) and combined (word reading g = .32; decoding g = .39) treatment groups than ADHD treatment alone; reading and combined groups did not differ (word reading g = .09; decoding g = .00). Significant group differences were maintained at the 3- to 5-month follow-up on all outcomes except word reading. Children with ADHD and RD benefit from specific treatment of each disorder. ADHD treatment is associated with more improvement in ADHD symptoms than RD treatment, and reading instruction is associated with better word reading and decoding outcomes than ADHD treatment. The additive value of combining treatments was not significant within disorder, but the combination allows treating both disorders simultaneously. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  9. Additional treatment of wastewater reduces endocrine disruption in wild fish--a comparative study of tertiary and advanced treatments.

    PubMed

    Baynes, Alice; Green, Christopher; Nicol, Elizabeth; Beresford, Nicola; Kanda, Rakesh; Henshaw, Alan; Churchley, John; Jobling, Susan

    2012-05-15

    Steroid estrogens are thought to be the major cause of feminization (intersex) in wild fish. Widely used wastewater treatment technologies are not effective at removing these contaminants to concentrations thought to be required to protect aquatic wildlife. A number of advanced treatment processes have been proposed to reduce the concentrations of estrogens entering the environment. Before investment is made in such processes, it is imperative that we compare their efficacy in terms of removal of steroid estrogens and their feminizing effects with other treatment options. This study assessed both steroid removal and intersex induction in adult and early life stage fish (roach, Rutilus rutilus). Roach were exposed directly to either secondary (activated sludge process (ASP)), tertiary (sand filtrated (SF)), or advanced (chlorine dioxide (ClO(2)), granular activated charcoal (GAC)) treated effluents for six months. Surprisingly, both the advanced GAC and tertiary SF treatments (but not the ClO(2) treatment) significantly removed the intersex induction associated with the ASP effluent; this was not predicted by the steroid estrogen measurements, which were higher in the tertiary SF than either the GAC or the ClO(2). Therefore our study highlights the importance of using both biological and chemical analysis when assessing new treatment technologies.

  10. A Cost Analysis Comparing CHAMPUS to Treatment Provided within Ireland Army Community Hospital

    DTIC Science & Technology

    1992-09-01

    section; and Cholelithiasis (gallbladder removal). Next, the costs of providing treatment at Ireland Army Community Hospital for the same diagnoses...within the MTF was $6,958 as compared to $10,384 per case when treatment was provided by CHAMPUS providers outside the MTF. Cholelithiasis , removal of the...gall bladder. was found to be cheaper if performed within the MTF but not significantly less expensive. Cholelithiasis performed within the MTF cost

  11. Weighted log-rank statistic to compare shared-path adaptive treatment strategies.

    PubMed

    Kidwell, Kelley M; Wahed, Abdus S

    2013-04-01

    Adaptive treatment strategies (ATSs) more closely mimic the reality of a physician's prescription process where the physician prescribes a medication to his/her patient, and based on that patient's response to the medication, modifies the treatment. Two-stage randomization designs, more generally, sequential multiple assignment randomization trial designs, are useful to assess ATSs where the interest is in comparing the entire sequence of treatments, including the patient's intermediate response. In this paper, we introduce the notion of shared-path and separate-path ATSs and propose a weighted log-rank statistic to compare overall survival distributions of multiple two-stage ATSs, some of which may be shared-path. Large sample properties of the statistic are derived and the type I error rate and power of the test are compared with the standard log-rank test through simulation.

  12. Cost-effectiveness of bazedoxifene compared with raloxifene in the treatment of postmenopausal osteoporotic women.

    PubMed

    Hiligsmann, Mickael; Ben Sedrine, Wafa; Reginster, Jean-Yves

    2013-04-01

    Bazedoxifene is a novel selective estrogen receptor modulator (SERM) for the prevention and treatment of osteoporosis. In addition to the therapeutic value of a new agent, evaluation of the cost-effectiveness compared with relevant alternative treatment(s) is an important consideration to facilitate healthcare decision making. This study evaluated the cost-effectiveness of bazedoxifene compared with raloxifene for the treatment of postmenopausal women with osteoporosis. The cost-effectiveness of treatment for 3 years with bazedoxifene was compared with raloxifene using an updated version of a previously validated Markov microsimulation model. Analyses were conducted from a Belgian healthcare payer perspective and, the base-case population was women (aged 70 years) with bone mineral density T-score ≤ -2.5. The effects of bazedoxifene and raloxifene on fracture risk were derived from the 3-year results of a randomized, double-blind, placebo-controlled and active-controlled study, including postmenopausal women with osteoporosis. The cost-effectiveness analysis based on efficacy data from the overall clinical trial indicated that bazedoxifene and raloxifene were equally cost-effective. When the results were examined based on the subgroup analysis of women at higher risk of fractures, bazedoxifene was dominant (lower cost for higher effectiveness) compared with raloxifene in most of the simulations. Sensitivity analyses confirmed the robustness of the results, which were largely independent of starting age of treatment, fracture risk, cost, and disutility. In addition, when the cost of raloxifene was reduced by one-half or when incorporating the raloxifene effects on reducing breast cancer, bazedoxifene remained cost-effective, at a threshold of €35,000 per quality-adjusted life-years gained, in 85% and 68% of the simulations, respectively. Under the assumption of improved antifracture efficacy of bazedoxifene over raloxifene in women with high risk of fractures

  13. Comparative Efficacy of Four Treatments in Patients with Graves' Disease: a Network Meta-analysis.

    PubMed

    Ren, Z; Qin, L; Wang, J Q; Li, Y; Li, J; Zhang, R-G

    2015-05-01

    The question of which treatment should be preferred for the treatment of Graves' disease is debatable, and pairwise meta-analyses could not obtain hierarchies of these treatments. Our intention was to integrate the evidence to provide hierarchies of the comparative efficacy of 4 treatments (radioiodine, radioiodine+prednisone, antithyroid drugs and surgery). We conducted a Bayesian-framework network meta-analysis of randomized controlled trials (RCTs) to compare 4 treatments in patients with Graves' disease. The eligible RCTs were identified by searching Amed, the British Nursing Index, Embase, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Google scholar, SIGLE, the National Technical Information Service, the National Research Register (UK) and the Current Controlled Trials databases. The data for 2 outcomes (e.g., ophthalmopathy and recurrence) were independently extracted by 2 authors. A total of 4 RCTs were ultimately included. Radioiodine+prednisone therapy showed statistical significance in reducing the incidence of new or deteriorative ophthalmopathy comparing with the other 3 therapies. Compared with radioiodine, therapy with antithyroid drugs therapy as well as surgery significantly decreased the incidence of new or deteriorative ophthalmopathy. Radioiodine therapy significantly reduced the rate of recurrence when compared to therapy with antithyroid drugs or surgery. For decreasing the incidence of new or deteriorative ophthalmopathy, the 4 treatments were ranked as follows: radioiodine+prednisone therapy, therapy with antithyroid drugs, surgery and radioiodine therapy. For reducing the rate of recurrence, 3 treatments were ranked as follows: radioiodine therapy, therapy with antithyroid drugs and surgery. Radioiodine+prednisone therapy might have the least probability of leading to an exacerbation or new appearance of ophthalmopathy, and radioiodine therapy might have the least probability of causing a recurrence. © Georg Thieme

  14. Comparative overview of primary sedimentation-based mechanical stage in some Romanian wastewater treatment systems

    NASA Astrophysics Data System (ADS)

    Zaharia, C.

    2017-08-01

    Nowadays, wastewater (WW) treatment facilities are considered significant exposure pathways for solid particles, and also significant concerns of any quality conscious manufacturer. Most solid particles have some forms of organic coating either used as active material or to suspend and/or stabilize different present solid materials, having increase in toxicity that must be reduced, or sometimes even totally eliminated, especially if effluent is either discharged directly to surface water, or distributed through industrial water supplies. Representatives providing innovative technologies, comprehensive supports and expertise in wastewater and sludge treatment field are known, each one using modern treatment technology and facilities. Mechanical treatment is indispensable in primary treatment steps of both municipal and industrial WW applications, its main goal being separation of floating, settling and suspended materials (especially into a primary sedimentation-based treatment step). The aim of this work is to present comparatively the performance in solids removal of conventional mechanical WW treatment stages, especially those based on primary sedimentation, or sedimentation-like operations applied for Romanian urban WW treatment plants (serving two towns with ca 18,000 inhabitants), industrial WW treatment plants (deserving industries of vegetal food processing and organic chemicals’ manufacturing) and additional information on valorisation of separated solid material and improvement possibilities.

  15. Combined paroxetine and clonazepam treatment strategies compared to paroxetine monotherapy for panic disorder.

    PubMed

    Pollack, Mark H; Simon, Naomi M; Worthington, John J; Doyle, Alicia L; Peters, Patricia; Toshkov, Fany; Otto, Michael W

    2003-09-01

    Despite the widespread application of combined selective serotonin reuptake inhibitors (SSRI) and benzodiazepine treatment for panic disorder, there has been relatively little systematic assessment of the safety and efficacy of this therapeutic strategy. Although the limited number of studies to date suggest a more rapid onset of benefit with combined treatment, this study is the first to address the critical question of whether continued combined treatment confers superior efficacy. This study is a randomized, double-blind, three-arm study in patients with panic disorder (n = 60), comparing the efficacy and safety of paroxetine and placebo (PP), paroxetine coadministered with clonazepam followed by a tapered benzodiazepine discontinuation phase (PC-D), and ongoing combination treatment (PC-M). All treatment groups demonstrated significant improvement by endpoint. There was a significant advantage for the combined treatment groups early in treatment but, subsequently, outcome in all three groups was similar. A trend towards greater achievement of endpoint remission status for the PC-D group was attenuated when variability in baseline severity was considered. The results of this study should be interpreted in the context of a relatively moderate sample size and higher rates of early dropout. Combined treatment with paroxetine and clonazepam resulted in more rapid response than with the SSRI alone, but there was no differential benefit beyond the initial few weeks of therapy. Initiating combined treatment followed by benzodiazepine taper after a few weeks may provide early benefit while avoiding the potential adverse consequences of long-term combination therapy.

  16. Meta-analysis Comparing Different Behavioral Treatments for Late-Life Anxiety

    PubMed Central

    Thorp, Steven R.; Ayers, Catherine R.; Nuevo, Roberto; Stoddard, Jill A.; Sorrell, John T.; Wetherell, Julie Loebach

    2009-01-01

    Objective To evaluate the efficacy of different types of behavioral treatments for geriatric anxiety [cognitive-behavioral therapy (CBT) alone, CBT with relaxation training (RT), and RT alone]. Method We compared effect sizes from 19 trials. Analyses were based on uncontrolled outcomes (comparing post-treatment and pre-treatment scores) and effects relative to control conditions on both anxiety and depressive symptoms. Results Treatments for older adults with anxiety symptoms were, on average, more effective than active control conditions. Effect sizes were comparable to those reported elsewhere for CBT for anxiety in the general population or for pharmacotherapy in anxious older adults. CBT (alone or augmented with RT) does not appear to add anything beyond RT alone, although a direct comparison is challenging given differences in control conditions. Effects on depressive symptoms were smaller, with no differences among treatment types. Conclusion Results suggest that behavioral treatments are effective for older adults with anxiety disorders and symptoms. Results must be interpreted with caution given the limitations of the literature, including differing sample characteristics and control conditions across studies. PMID:19155744

  17. Miconazole nitrate compared with chlordantoin in the treatment of vaginal candidiasis.

    PubMed Central

    Morris, D F; Sugrue, D L

    1975-01-01

    In a double-blind study of the treatment of vaginal candidiasis, miconazole nitrate gave a cure-rate of 88 per cent. (29 out of 33) compared with 58 per cent. (21 out of 36) using chlordantoin. Although approximately two-thirds of the patients who responded did so to a 10-day course of treatment, the different rates of cure with these preparations at this stage were not statistically significant. However, when a second course of treatment was given to those women who still had proven candidiasis, the overall cure-rate with miconazole was significantly greater than that with chlordantoin. PMID:1093633

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

    PubMed

    Larsen, Jytte; Skjoldborg, Ulla Slothuus

    2004-03-01

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

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

    NASA Astrophysics Data System (ADS)

    Heberling, Matthew T.; Nietch, Christopher T.; Thurston, Hale W.; Elovitz, Michael; Birkenhauer, Kelly H.; Panguluri, Srinivas; Ramakrishnan, Balaji; Heiser, Eric; Neyer, Tim

    2015-11-01

    We present a framework to compare water treatment costs to source water protection costs, an important knowledge gap for drinking water treatment plants (DWTPs). This trade-off helps to determine what incentives a DWTP has to invest in natural infrastructure or pollution reduction in the watershed rather than pay for treatment on site. To illustrate, we use daily observations from 2007 to 2011 for the Bob McEwen Water Treatment Plant, Clermont County, Ohio, to understand the relationship between treatment costs and water quality and operational variables (e.g., turbidity, total organic carbon [TOC], pool elevation, and production volume). Part of our contribution to understanding drinking water treatment costs is examining both long-run and short-run relationships using error correction models (ECMs). Treatment costs per 1000 gallons (per 3.79 m3) were based on chemical, pumping, and granular activated carbon costs. Results from the ECM suggest that a 1% decrease in turbidity decreases treatment costs by 0.02% immediately and an additional 0.1% over future days. Using mean values for the plant, a 1% decrease in turbidity leads to $1123/year decrease in treatment costs. To compare these costs with source water protection costs, we use a polynomial distributed lag model to link total phosphorus loads, a source water quality parameter affected by land use changes, to turbidity at the plant. We find the costs for source water protection to reduce loads much greater than the reduction in treatment costs during these years. Although we find no incentive to protect source water in our case study, this framework can help DWTPs quantify the trade-offs.

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

    PubMed

    Kaya, Erkan; Zinnuroglu, Murat; Tugcu, Ilknur

    2011-02-01

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

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

    PubMed

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

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

  2. Surgical treatment compared with eccentric training for patellar tendinopathy (Jumper's Knee). A randomized, controlled trial.

    PubMed

    Bahr, Roald; Fossan, Bjørn; Løken, Sverre; Engebretsen, Lars

    2006-08-01

    Although the surgical treatment of patellar tendinopathy (jumper's knee) is a common procedure, there have been no randomized, controlled trials comparing this treatment with forms of nonoperative treatment. The purpose of the present study was to compare the outcome of open patellar tenotomy with that of eccentric strength training in patients with patellar tendinopathy. Thirty-five patients (forty knees) who had been referred for the treatment of grade-IIIB patellar tendinopathy were randomized to surgical treatment (twenty knees) or eccentric strength training (twenty knees). The eccentric training group performed squats on a 25 degrees decline board as a home exercise program (with three sets of fifteen repetitions being performed twice daily) for a twelve-week intervention period. In the surgical treatment group, the abnormal tissue was removed by means of a wedge-shaped full-thickness excision, followed by a structured rehabilitation program with gradual progression to eccentric training. The primary outcome measure was the VISA (Victorian Institute of Sport Assessment) score (possible range, 0 to 100), which was calculated on the basis of answers to a symptom-based questionnaire that was developed specifically for patellar tendinopathy. The patients were evaluated after three, six, and twelve months of follow-up. There was no difference between the groups with regard to the VISA score during the twelve-month follow-up period, but both groups had improvement (p < 0.001). The mean combined VISA score for the two groups increased from 30 (95% confidence interval, 25 to 35) before the start of treatment to 49 (95% confidence interval, 42 to 55) at three months, 58 (95% confidence interval, 51 to 65) at six months, and 70 (95% confidence interval, 62 to 78) at twelve months. In the surgical treatment group, five knees had no symptoms, twelve had improvement but were still symptomatic, two were unchanged, and one was worse after twelve months (p = 0.49 compared

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

    NASA Astrophysics Data System (ADS)

    Wan, W. C.; Malamud, G.; Shimony, A.; Di Stefano, C. A.; Trantham, M. R.; Klein, S. R.; Soltis, J. D.; Shvarts, D.; Drake, R. P.; Kuranz, C. C.

    2017-03-01

    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 4x1013 W/cm2 laser pulse from 19 ns to 28 ns, and increasing the ablator thickness from 185 μm to 500 μm. We present data demonstrating the performance of the platform.

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

    PubMed

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

    2015-01-01

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

  5. Implementation and outcome of child psychotherapy compared with other psychiatric treatments in a naturalistic clinical setting.

    PubMed

    Ryynänen, Taimi; Alen, Markku; Koivumaa-Honkanen, Heli; Joskitt, Leena; Ebeling, Hanna

    2015-04-01

    Mental health problems of children are commonly treated by psychotherapy and other psychosocial treatments. Studies comparing different treatments in naturalistic clinical settings are few, however. We assessed the differences: 1) in symptoms and diagnoses; 2) in treatment outcome between psychotherapy and other psychosocial treatments; and 3) evaluated the effect of family background and life circumstances on the outcome. The data were collected from the psychiatric hospital records of Oulu University Hospital, Finland. All 118 children (aged < 16 years) referred to psychotherapy from the Department of Child Psychiatry in 1996-2005 and 118 age- and sex-matched children undergoing other psychosocial treatments were included. A lack of later recorded psychiatric problems was used as an indicator of good treatment outcome. On referral, functional ability was severely impaired in almost half of the children (Children's Global Assessment Scale score < 55). Internalizing symptoms were more common in the psychotherapy group, while no difference was found in externalizing symptoms between the groups. In both groups, later psychiatric problems were associated with a child's low functional ability and poor parental coping with their responsibilities. Children with internalizing problems had impaired prognosis if they had psychosocial treatments other than psychotherapy. Individual psychotherapy should especially be considered for children with internalizing symptoms, but the outcome of psychiatric treatment depends not only on children's own functional abilities, but also on parental abilities.

  6. A comparative analysis of standard and alternative antidepressants in the treatment of human immunodeficiency virus patients.

    PubMed

    Wagner, G J; Rabkin, J G; Rabkin, R

    1996-01-01

    Our research group has conducted clinical trials of standard (imipramine, fluoxetine, and sertraline) and alternative antidepressants (dextroamphetamine and testosterone replacement therapy) in the treatment of clinical depression among patients with human immunodeficiency virus (HIV) illness. This report presents secondary analyses of data pooled from these trials with the purpose of comparing the antidepressant efficacy of these various agents. In all trials, a DSM-III-R depressive disorder was the primary criterion for study entry, and each treatment resulted in significant improvement after both 2 and 6 weeks of treatment according to the Hamilton Depression Rating Scale (HDRS). Response rates for standard antidepressants ranged from 70% to 74%, with similar, high response rates found in trials of dextroamphetamine (93%) and testosterone (81%). The response rate of each active drug treatment was superior to that of placebo (33%). Each treatment was well-tolerated in terms of side effects, and there was essentially no effect of any treatment on CD4 cell count. Differences in trial design, entrance criteria, and measurements require that caution be used in interpreting these results; nonetheless, each of the five treatments studied demonstrated strong efficacy and possessed relatively unique benefits, providing health care providers with valuable treatment options in addressing individual needs of patients.

  7. Comparative efficacy of enrofloxacin and tulathromycin for treatment of preweaning respiratory disease in dairy heifers.

    PubMed

    Heins, B D; Nydam, D V; Woolums, A R; Berghaus, R D; Overton, M W

    2014-01-01

    Preweaning respiratory disease continues to have a substantial effect on the current and future productivity of dairy replacement animals. Establishing an effective treatment plan for the preweaned calf may have a significant effect on well-being and lifetime productivity by limiting any early development of chronic disease. The primary objective of this study was to examine the efficacy of treatment with tulathromycin (TUL) or enrofloxacin (ENR) on the risk of re-treatment, with a secondary objective of investigating the effect of disease and subsequent treatment choice on average daily gain (ADG). A total of 1,141 Holstein heifers from 4 farms were observed and systematically scored for evidence of respiratory disease from birth through weaning or the time of death. At the time of diagnosis, calves were randomly and blindly allocated into 2 treatment groups. The overall incidence of respiratory disease was 60.9%. In the univariable analysis, the incidence of re-treatment between 7 and 10d of initial therapy for calves treated with ENR was greater than that in calves treated with TUL (27.6 vs. 21.2%). After adjusting for farm ID, clinical score at first treatment, and weight at first treatment, the odds of re-treatment were 1.5 times higher for calves treated with ENR than with TUL. The percentage of calves that required more than one re-treatment was higher for calves that received ENR compared with those that received TUL (9.3 vs. 4.1%). We observed no difference in ADG between calves treated with ENR or TUL, and no difference in ADG between calves that were treated for respiratory disease and those that were not treated for respiratory disease. Appropriate drug therapy for preweaning respiratory disease may have an important role in reducing the odds of re-treatment during the preweaning period. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  8. Brazilian Green Propolis Compared to Miconazole Gel in the Treatment of Candida-Associated Denture Stomatitis

    PubMed Central

    Capistrano, Hermínia Marques; de Assis, Eliene Magda; Leal, Rosana Maria; Alvarez-Leite, Maria Eugênia; Brener, Sylvie; Bastos, Esther Margarida Alves Ferreira

    2013-01-01

    Aim. To evaluate the efficacy of Brazilian green propolis in comparison to miconazole gel in the treatment of Candida-associated denture stomatitis. Methods. Forty-five denture stomatitis patients, with palatal mucosa erythema levels classified according to Newtons's criteria and with positive culture to Candida spp., were randomly divided into three treatment groups: 15 received miconazole gel 2%, 15 received propolis gel 2,5%, and 15 received propolis 24% for mouthwash. After four daily use lasting two weeks, they were reexamined for the denture stomatitis degree and for a second culture of Candida. The Wilcoxon's test was applied to compare the results of clinical classification of the denture stomatitis and the Candida spp. colonies numbers, before and after each treatment. The Kruskall-Wallis's test was used to compare efficacy among the three treatment groups. Results. There were a significant reduction or complete remission of denture stomatitis (P < 0.05) and a significant decrease of Candida colonies for the three groups (P < 0.05). There was no difference in the efficacy among the treatment groups (P > 0.05). Conclusion. Brazilian green propolis has a similar effect as miconazole in the treatment of Candida-associated denture stomatitis being an alternative in the therapeutics of this condition. PMID:23737855

  9. Blue filter amblyopia treatment protocol for strabismic amblyopia: a prospective comparative study of 50 cases.

    PubMed

    Metzler, U; Ham, O; Flores, V; Claramunt, M; Sepulveda, C; Casanova, D

    1998-01-01

    Previous studies of monochromatic visual evoked potentials confirm the strong suppression of (the cortical representation of) paracentral retinal areas of functionally amblyopic eyes, by a flat response to a blue stimulus. A clinical trial stimulating these areas with blue light was encouraging, and justified a prospective comparison of this treatment with conventional classic treatment. In 50 strabismic children with amblyopia, the blue filter treatment protocol (flash stimulation with, and the wearing of, a blue filter during occlusion of the better eye for one hour daily) was compared with the classical treatment (full time total occlusion by patch) in a prospective matched and randomized study. Patients 3 to 7 years old without previous treatment and a visual acuity up to 0.3 were admitted to the study. Visual acuity and fixation behavior were used as the parameters of comparison. Visual Evoked Potentials by monochromatic flashes were also studied. Results of treatment were compared after 6 months. The visual acuity outcome for the blue filter treatment was "statistically significantly" better (p=0.005). The greatest improvement was seen in the subgroup of children with eccentric fixation (p=0.01). Fixation behavior also showed a better outcome from the blue filter treatment (p=0.05) favoring especially children between 3 and 5 years. In children of this age with a visual acuity better than 0.1 we found a very "statistically significant" difference between the two treatments (p=0.004). In children 3 to 5 years old with poorer visual acuity we also found a "statistically significant" difference in the two treatments (p=0.04). The interocular difference of amplitude on the Visual Evoked Potentials also demonstrated more improvement in children treated with the blue filter. This treatment improved especially the cortical response to blue flash stimulation, correlating to paracentral retinal areas. The blue filter treatment protocol provided better results for

  10. A Systematic Review of Comparative Efficacy of Treatments and Controls for Depression

    PubMed Central

    Khan, Arif; Faucett, James; Lichtenberg, Pesach; Kirsch, Irving; Brown, Walter A.

    2012-01-01

    Background Although previous meta-analyses have examined effects of antidepressants, psychotherapy, and alternative therapies for depression, the efficacy of these treatments alone and in combination has not been systematically compared. We hypothesized that the differences between approved depression treatments and controls would be small. Methods and Findings The authors first reviewed data from Food and Drug Administration Summary Basis of Approval reports of 62 pivotal antidepressant trials consisting of data from 13,802 depressed patients. This was followed by a systematic review of data from 115 published trials evaluating efficacy of psychotherapies and alternative therapies for depression. The published depression trials consisted of 10,310 depressed patients. We assessed the percentage symptom reduction experienced by the patients based on treatment assignment. Overall, antidepressants led to greater symptom reduction compared to placebo among both unpublished FDA data and published trials (F = 38.5, df = 239, p<0.001). In the published trials we noted that the magnitude of symptom reduction with active depression treatments compared to controls was significantly larger when raters evaluating treatment effects were un-blinded compared to the trials with blinded raters (F = 2.17, df = 313, p<0.05). In the blinded trials, the combination of antidepressants and psychotherapy provided a slight advantage over antidepressants (p = 0.027) and psychotherapy (p = 0.022) alone. The magnitude of symptom reduction was greater with psychotherapies compared to placebo (p = 0.019), treatment-as-usual (p = 0.012) and waiting-list (p<0.001). Differences were not seen with psychotherapy compared to antidepressants, alternative therapies or active intervention controls. Conclusions In conclusion, the combination of psychotherapy and antidepressants for depression may provide a slight advantage whereas antidepressants alone and psychotherapy

  11. COMPARING RBF WITH BENCH-SCALE CONVENTIONAL TREATMENT FOR PRECURSOR REDUCTION

    EPA Science Inventory

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

  12. Comparing Cognitive Behavior Therapy, Problem Solving Therapy, and Treatment as Usual in a High Risk Population

    ERIC Educational Resources Information Center

    Stewart, Carment D.; Quinn, Andrea; Plever, Sally; Emmerson, Brett

    2009-01-01

    Cognitive behavior therapy (CBT), problem-solving therapy (PST), or treatment as usual (TAU) were compared in the management of suicide attempters. Participants completed the Beck Hopelessness Scale, Beck Scale for Suicidal Ideation, Social Problem-Solving Inventory, and Client Satisfaction Questionnaire at pre- and posttreatment. Both CBT and PST…

  13. Comparing Cognitive Behavior Therapy, Problem Solving Therapy, and Treatment as Usual in a High Risk Population

    ERIC Educational Resources Information Center

    Stewart, Carment D.; Quinn, Andrea; Plever, Sally; Emmerson, Brett

    2009-01-01

    Cognitive behavior therapy (CBT), problem-solving therapy (PST), or treatment as usual (TAU) were compared in the management of suicide attempters. Participants completed the Beck Hopelessness Scale, Beck Scale for Suicidal Ideation, Social Problem-Solving Inventory, and Client Satisfaction Questionnaire at pre- and posttreatment. Both CBT and PST…

  14. Comparing the Effects of Four Instructional Treatments on EFL Students' Achievement in Writing Classified Ads

    ERIC Educational Resources Information Center

    Khodabandeh, Farzaneh

    2016-01-01

    The current study set out to compare the effect of traditional and non-traditional instructional treatments; i.e. explicit, implicit, task-based and no-instruction approaches on students' abilities to learn how to write classified ads. 72 junior students who have all taken a course in Reading Journalistic Texts at the Payame-Noor University…

  15. Delinquency and Crime Prevention: Overview of Research Comparing Treatment Foster Care and Group Care

    ERIC Educational Resources Information Center

    Osei, Gershon K.; Gorey, Kevin M.; Jozefowicz, Debra M. Hernandez

    2016-01-01

    Background: Evidence of treatment foster care (TFC) and group care's (GC) potential to prevent delinquency and crime has been developing. Objectives: We clarified the state of comparative knowledge with a historical overview. Then we explored the hypothesis that smaller, probably better resourced group homes with smaller staff/resident ratios have…

  16. Treatment Gain for Sexual Offenders against Children Predicts Reduced Recidivism: A Comparative Validity Study

    ERIC Educational Resources Information Center

    Beggs, Sarah M.; Grace, Randolph C.

    2011-01-01

    Objective: To determine whether pro-social treatment change in sexual offenders would predict reductions in recidivism beyond static and dynamic risk factors measured at pretreatment and whether different methods for assessing change based on self-reports and structured clinical rating systems would show convergent validity. Method: We compared 3…

  17. Delinquency and Crime Prevention: Overview of Research Comparing Treatment Foster Care and Group Care

    ERIC Educational Resources Information Center

    Osei, Gershon K.; Gorey, Kevin M.; Jozefowicz, Debra M. Hernandez

    2016-01-01

    Background: Evidence of treatment foster care (TFC) and group care's (GC) potential to prevent delinquency and crime has been developing. Objectives: We clarified the state of comparative knowledge with a historical overview. Then we explored the hypothesis that smaller, probably better resourced group homes with smaller staff/resident ratios have…

  18. Treatment Gain for Sexual Offenders against Children Predicts Reduced Recidivism: A Comparative Validity Study

    ERIC Educational Resources Information Center

    Beggs, Sarah M.; Grace, Randolph C.

    2011-01-01

    Objective: To determine whether pro-social treatment change in sexual offenders would predict reductions in recidivism beyond static and dynamic risk factors measured at pretreatment and whether different methods for assessing change based on self-reports and structured clinical rating systems would show convergent validity. Method: We compared 3…

  19. DUI/DWAI Offenders Compared to Clients Seen in an Outpatient Alcohol-Treatment Facility.

    ERIC Educational Resources Information Center

    Packard, Michele A.

    1987-01-01

    Examined client records to compare 50 subjects admitted to a drinking-driver program and 50 subjects admitted to an outpatient alcohol treatment clinic. Highly significant differences were found between groups on 10 of 12 drinking indices, suggesting that clients referred for alcohol-related traffic offenses represent a population different from…

  20. Comparing Spoken Language Treatments for Minimally Verbal Preschoolers with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Paul, Rhea; Campbell, Daniel; Gilbert, Kimberly; Tsiouri, Ioanna

    2013-01-01

    Preschoolers with severe autism and minimal speech were assigned either a discrete trial or a naturalistic language treatment, and parents of all participants also received parent responsiveness training. After 12 weeks, both groups showed comparable improvement in number of spoken words produced, on average. Approximately half the children in…

  1. COMPARING RBF WITH BENCH-SCALE CONVENTIONAL TREATMENT FOR PRECURSOR REDUCTION

    EPA Science Inventory

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

  2. Comparing Spoken Language Treatments for Minimally Verbal Preschoolers with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Paul, Rhea; Campbell, Daniel; Gilbert, Kimberly; Tsiouri, Ioanna

    2013-01-01

    Preschoolers with severe autism and minimal speech were assigned either a discrete trial or a naturalistic language treatment, and parents of all participants also received parent responsiveness training. After 12 weeks, both groups showed comparable improvement in number of spoken words produced, on average. Approximately half the children in…

  3. Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis--a systematic review.

    PubMed

    Huisstede, Bionka M A; Gebremariam, Lukas; van der Sande, Renske; Hay, Elaine M; Koes, Bart W

    2011-10-01

    Extracorporeal shock-wave therapy (ESWT) is suggested as a treatment alternative for calcific and non-calcific rotator cuff tendinosis (RC-tendinosis), which may decrease the need for surgery. In this study we assessed the evidence for effectiveness of ESWT for these disorders. The Cochrane Library, PubMed, Embase, Pedro, and Cinahl were searched for relevant systematic reviews and RCTs. Two reviewers independently extracted data and assessed the methodological quality. Seventeen RCTs (11 calcific, 6 non-calcific) were included. For calcific RC-tendinosis, strong evidence was found for effectiveness in favour of high-ESWT versus low-ESWT in short-term. Moderate evidence was found in favour of high-ESWT versus placebo in short-, mid- and long-term and versus low-ESWT in mid- and long-term. Moreover, high-ESWT was more effective (moderate evidence) with focus on calcific deposit versus focus on tuberculum major in short- and long-term. RSWT was more effective (moderate evidence) than placebo in mid-term. For non-calcific RC-tendinosis, no strong or moderate evidence was found in favour of low-, mid- or high-ESWT versus placebo, each other, or other treatments. This review shows that only high-ESWT is effective for treating calcific RC-tendinosis. No evidence was found for the effectiveness of ESWT to treat non-calcific RC-tendinosis. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  4. Comparative effectiveness of imaging modalities to determine metastatic breast cancer treatment response.

    PubMed

    Lee, Christoph I; Gold, Laura S; Nelson, Heidi D; Chou, Roger; Ramsey, Scott D; Sullivan, Sean D

    2015-02-01

    We performed a systematic review to address the comparative effectiveness of different imaging modalities in evaluating treatment response among metastatic breast cancer patients. We searched seven multidisciplinary electronic databases for relevant publications (January 2003-December 2013) and performed dual abstraction of details and results for all clinical studies that involved stage IV breast cancer patients and evaluated imaging for detecting treatment response. Among 159 citations reviewed, 17 single-institution, non-randomized, observational studies met our inclusion criteria. Several studies demonstrate that changes in PET/CT standard uptake values are associated with changes in tumor volume as determined by bone scan, MRI, and/or CT. However, no studies evaluated comparative test performance between modalities or determined relationships between imaging findings and subsequent clinical decisions. Evidence for imaging's effectiveness in determining treatment response among metastatic breast cancer patients is limited. More rigorous research is needed to address imaging's value in this patient population.

  5. Comparative study of permethrin 1% creme rinse and lindane shampoo for the treatment of head lice.

    PubMed

    Bowerman, J G; Gomez, M P; Austin, R D; Wold, D E

    1987-03-01

    The efficacy and safety of permethrin 1% creme rinse and lindane shampoo were compared for the treatment of head lice (Pediculus humanus var. capitis). A total of 1040 patients in the Nezahualcoyotl community of Mexico City representing 296 family groups were enrolled and randomized to treatment, with one patient in each family designated as the index patient. Among index patients 98% treated with permethrin and 76% treated with lindane were louse-free 2 weeks after treatment (P less than 0.001). Comparable results were found with nonindex patients as well. Mild dermal reactions, such as pruritus or erythema, occurred in 1.2% of permethrin-treated patients and 2.6% of lindane-treated patients. There were no reports of central nervous system adverse effects or conjunctivitis.

  6. Counteraction between overshadowing and degraded contingency treatments: support for the extended comparator hypothesis.

    PubMed

    Urcelay, Gonzalo P; Miller, Ralph R

    2006-01-01

    Four experiments using rats in a Pavlovian lick-suppression preparation investigated the effects of combining 2 treatments known for their response-decrementing effects, namely, overshadowing and degraded contingency. Contrary to most contemporary learning theories, the extended comparator hypothesis predicts that these 2 treatments will counteract each other, and therefore, less of a decrement in conditioned responding should be observed than with either treatment alone. Experiments 1 and 2 confirmed this prediction in first-order conditioning and sensory preconditioning preparations, respectively. Experiment 3 demonstrated that posttraining extinction of the training context resulted in a recovery from degraded contingency and reversed the counteractive effect on overshadowing. Finally, Experiment 4 demonstrated that posttraining extinction of the overshadowing stimulus resulted in recovery from simple overshadowing and also reversed the counteractive effect on degraded contingency. These results are consistent with the extended comparator hypothesis but not traditional or recent acquisition-focused models.

  7. Cost-Effectiveness of Autologous Stem Cell Treatment as Compared to Conventional Chemotherapy for Treatment of Multiple Myeloma in India.

    PubMed

    Prinja, Shankar; Kaur, Gunjeet; Malhotra, Pankaj; Jyani, Gaurav; Ramachandran, Raja; Bahuguna, Pankaj; Varma, Subhash

    2017-03-01

    Recent innovations in treatment of multiple myeloma include autologous stem cell transplantation (ASCT) along with high dose chemotherapy (HDC). We undertook this study to estimate incremental cost per quality adjusted life year gained (QALY) with use of ASCT along with HDC as compared to conventional chemotherapy (CC) alone in treatment of multiple myeloma. A combination of decision tree and markov model was used to undertake the analysis. Incremental costs and effects of ASCT were compared against the baseline scenario of CC (based on Melphalan and Prednisolone regimen) in the patients of multiple myeloma. A lifetime study horizon was used and future costs and consequences were discounted at 5%. Consequences were valued in terms of QALYs. Incremental cost per QALY gained using ASCT as against CC for treatment of multiple myeloma was estimated using both a health system and societal perspective. The cost of providing ASCT (with HDC) for multiple myeloma patients was INR 500,631, while the cost of CC alone was INR 159,775. In the long run, cost per patient per year for ASCT and CC arms was estimated to be INR 119,740 and INR 111,565 respectively. The number of QALYs lived per patient in case of ASCT and HDC alone were found to be 4.1 and 3.5 years respectively. From a societal perspective, ASCT was found to incur an incremental cost of INR 334,433 per QALY gained. If the ASCT is initiated early to patients, the incremental cost for ASCT was found to be INR 180,434 per QALY gained. With current mix of patients, stem cell treatment for multiple myeloma is not cost effective at a threshold of GDP per capita. It becomes marginally cost-effective at 3-times the GDP per capita threshold. However, accounting for the model uncertainties, the probability of ASCT to be cost effective is 59%. Cost effectiveness of ASCT can be improved with early detection and initiation of treatment.

  8. A mixed treatment comparison to compare the efficacy and safety of botulinum toxin treatments for cervical dystonia.

    PubMed

    Han, Yi; Stevens, Andrea L; Dashtipour, Khashayar; Hauser, Robert A; Mari, Zoltan

    2016-04-01

    A systematic pair-wise comparison of all available botulinum toxin serotype A and B treatments for cervical dystonia (CD) was conducted, as direct head-to-head clinical trial comparisons are lacking. Five botulinum toxin products: Dysport(®) (abobotulinumtoxinA), Botox(®) (onabotulinumtoxinA), Xeomin(®) (incobotulinumtoxinA), Prosigne(®) (Chinese botulinum toxin serotype A) and Myobloc(®) (rimabotulinumtoxinB) have demonstrated efficacy for managing CD. A pair-wise efficacy and safety comparison was performed for all toxins based on literature-reported clinical outcomes. Multi-armed randomized controlled trials (RCTs) were identified for inclusion using a systematic literature review, and assessed for comparability based on patient population and efficacy outcome measures. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was selected as the efficacy outcome measurement for assessment. A mixed treatment comparison (MTC) was conducted using a Bayesian hierarchical model allowing indirect comparison of the interventions. Due to the limitation of available clinical data, this study only investigated the main effect of toxin treatments without explicitly considering potential confounding factors such as gender and formulation differences. There was reasonable agreement between the number of unconstrained data points, residual deviance and pair-wise results. This research suggests that all botulinum toxin serotype A and serotype B treatments were effective compared to placebo in treating CD, with the exception of Prosigne. Based on this MTC analysis, there is no significant efficacy difference between Dysport, Botox, Xeomin and Myobloc at week four post injection. Of the adverse events measured, neither dysphagia nor injection site pain was significantly greater in the treatment or placebo groups.

  9. Meso-scale Computational Investigation of Shock-Wave Attenuation by Trailing Release Wave in Different Grades of Polyurea

    NASA Astrophysics Data System (ADS)

    Grujicic, Mica; Snipes, J. S.; Ramaswami, S.; Yavari, R.; Ramasubramanian, M. K.

    2014-01-01

    Over the past several years, considerable research efforts have been made toward investigating polyurea, a segmented thermoplastic elastomer, and particularly its shock-mitigation capacity, i.e., an ability to attenuate and disperse shock-waves. These research efforts have clearly established that the shock-mitigation capacity of polyurea is closely related to its chemistry, processing route, and the resulting microstructure. Polyurea typically possesses a nano-segregated microstructure consisting of (high glass transition temperature, T g) hydrogen-bonded discrete hard domains and a (low T g) contiguous soft matrix. While the effect of polyurea microstructure on its shock-mitigation capacity is well-established, it is not presently clear what microstructure-dependent phenomena and processes control its shock-mitigation capacity. To help identify these phenomena and processes, meso-scale simulations of the formation of nano-segregated microstructure and its interaction with a leading shock-wave and a trailing release-wave is analyzed in the present work. The results obtained revealed that shock-induced hard-domain densification makes an important contribution to the superior shock-mitigation capacity of polyurea, and that the extent of densification is a sensitive function of the polyurea soft-segment molecular weight. In particular, the ability of release-waves to capture and neutralize shock-waves has been found to depend strongly on the extent of shock-induced hard-domain densification and, thus, on the polyurea soft-segment molecular weight.

  10. 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.

  11. Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance.

    PubMed

    Robinson, Emma; Titov, Nickolai; Andrews, Gavin; McIntyre, Karen; Schwencke, Genevieve; Solley, Karen

    2010-06-03

    Internet-based cognitive behavioural therapy (iCBT) for generalized anxiety disorder (GAD) has been shown to be effective when guided by a clinician. The present study sought to replicate this finding, and determine whether support from a technician is as effective as guidance from a clinician. Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program and 150 participants with GAD were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for GAD comprising six online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 10 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Penn State Worry Questionnaire (PSWQ) and the Generalized Anxiety Disorder-7 Item (GAD-7). Completion rates were high, and both treatment groups reduced scores on the PSWQ (p<0.001) and GAD-7 (p<0.001) compared to the delayed treatment group, but did not differ from each other. Within group effect sizes on the PSWQ were 1.16 and 1.07 for the clinician- and technician-assisted groups, respectively, and on the GAD-7 were 1.55 and 1.73, respectively. At 3 month follow-up participants in both treatment groups had sustained the gains made at post-treatment. Participants in the clinician-assisted group had made further gains on the PSWQ. Approximately 81 minutes of clinician time and 75 minutes of technician time were required per participant during the 10 week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment/control group did not improve. These results provide

  12. Comparative Effects of Gamma Irradiation and Ozone Treatment on Hygienic Quality of Korean Red Ginseng Powder

    NASA Astrophysics Data System (ADS)

    Byun, Myung-Woo; Yook, Hong-Sun; Kang, Il-Jun; Chung, Cha-Kwon; Kwon, Joong-Ho; Choi, Kang-Ju

    1998-06-01

    For the purpose of improving hygienic quality of Korean red ginseng powder, the comparative effects of gamma irradiation and ozone treatment on the microbial and physicochemical properties were investigated. Gamma irradiation at 7.5 kGy resulted in sterilization of total aerobic bacteria, molds and coliforms below detective levels, while ozone treatment for 8 hours up to 18 ppm did not sufficiently eliminate the microorganisms of the red ginseng powder. Physicochemical properties including compositions of the red ginseng saponin (ginsenosides) and fatty acids, pH and hydrogen doanting activity were not significantly changed by gamma irradiation, whereas, ozone treatment caused significant changes in fatty acid compositions, TBA value, pH, acidity and hydrogen donating activity. The results from this study led us to conclude that gamma irradiation was more effective than ozone treatment both for the improvement of hygienic quality and for the maintenance of physicochemical quality of red ginseng powder.

  13. [Comparative assessment of conservative treatment of chronic prostatitis with application of complex unit andro-gin].

    PubMed

    Golubchikova, V A; Alekseev, M Ia; Sitnikov, N V; Kochetov, A G; Podgornyĭ, V F

    2000-01-01

    The Andro-Gin unit used in combined treatment of 78 patients with chronic prostatitis (CP) and 16 women with chronic interstitial cystitis with inflammation in the internal genitalia (56.5% of the patients had sexual and spermatogenesis disorders) employed effects of simultaneous exposure to local magnetic field, electrostimulation of the small pelvis organs and prostate with introduction of contact rectal electrode, neurostimulation of pathogenic zones, low-intensity laser and light-diode radiator and color impulse therapy. Control group consisted of 85 patients with CP who received conventional physiotherapy. The comparative analysis has shown high efficiency of the unit Andro-Gin in the treatment of CP and its complications. Laboratory and clinical convalescence and persistent remission was registered in 98% of the patients of the study group. Combined treatment using Andro-Gin is twice more effective than other treatments.

  14. Comparative results of the conservative treatment in clubfoot by two different protocols.

    PubMed

    Cosma, Dan; Vasilescu, Dana; Vasilescu, Dan; Valeanu, Madalina

    2007-09-01

    The current study aims at presenting the results of the two methods of conservative treatment in clubfoot: the Romanian traditional method and the Ponseti method. The study population included 103 children (148 clubfeet) treated in our department between 1998 and 2005. Between 1998 and 2003, the conservative treatment protocol was based upon the Romanian method. The Ponseti method has been used since 2004. The main criterion for the assessment of the efficiency of the two conservative methods in clubfoot is the number of feet requiring surgical treatment - posteromedial release at 18 months. This criterion is clearly in favor of the Ponseti method: four feet (5%) needed posteromedial release in Ponseti group patients versus 13 feet (18%) in Romanian group patients (P=0.0193). The Ponseti method is safe, efficient in the conservative treatment of clubfoot and decreases the number of surgical interventions needed for the correction of the deformation compared with our traditional method.

  15. Structural analysis of the phimotic prepuce in patients with failed topical treatment compared with untreated phimosis.

    PubMed

    Favorito, Luciano Alves; Balassiano, Carlos M; Rosado, João Pedro; Cardoso, Luiz Eduardo M; Costa, Waldemar Silva; Sampaio, Francisco José Barcellos

    2012-01-01

    To evaluate histological alterations in prepuce of patients with phimosis submitted to topic treatment with betamethasone in association with hyaluronidase. We studied sixty patients (mean age 4.5), presenting true phimosis and treated with a topical treatment with betamethasone cream (0.2%) + hyaluronidase. The parents of seven of these patients opted for circumcision (control group). The other fifty-three patients were submitted to clinical treatment. The samples were stained with Weigert's resorcin-fuchsin (analysis of the elastic fibers) and Picro-Sirius Red, for analysis of the collagen. The volumetric density of the elastic fibers was determined by stereological methods. Only eight (15 %) of the fifty-three patients submitted to topical treatment presented failure, being indicated for circumcision (histological analysis). We observed an increase of the collagen type III of the patients submitted to topical treatment. The quantification showed a reduction of the volumetric density of the prepuce's elastic fibers of the patients submitted to the cream treatment, when compared to the control group (p = 0.056). The volumetric density of the elastic fibers of the prepuce at the group not submitted to topical treatment showed an average of 14.60% (11.06 to 21.64%); in the group submitted to the cream treatment, the volumetric density of the elastic fibers of the prepuce showed an average of 10.34% (3.45 to 17.9%). The topical treatment of phimosis with betamethasone 0.2 % + hyaluronidase had a success rate of 85 %. Patients with failure of the topical treatment with steroid had histological alterations in the prepuce.

  16. [Effectiveness of treatment of varicose veins assessed by epidemiological comparative studies].

    PubMed

    Górski, Grzegorz; Kielar, Maciej; Porzycki, Piotr; Sobański, Paweł; Noszczyk, Wojciech

    2004-07-01

    Effectiveness of varicose veins (VV) management, due to high prevalence of this condition, is an important medical, social and economical issue. The aim of the study was to compare cost effectiveness of VV treatment by comparison of the results of two epidemiological surveys performed in Warsaw Bródno population, in 1982-1984 (group I, n=4997) and 1998-2000 (group 11, n=3556). Analysis compared prevalence of varicose veins, venous ulcers, deep vein thrombosis (DVT) in relation to number of VV procedures performed, and cost of conservative and surgical treatment, subjective patients' assessment of treatment results. Varicose veins prevalence has not changed significantly in group I was 15.7% (men 9.3%, women 20.1%) vs. 13.7% (men 8.7%, women 15.9%) in group II. Similarly, prevalence of venous ulcers (0.76% vs 0.73%), and previous DVT among VV patients (8.9% vs 8.9%) have not changed in both groups. Percentage of patients treated surgically in relation to all VV patients (19.7% vs 26.1%), as well as treated conservatively (45.2% vs 48.8%) increased, the latter mainly due to significant increase of ratio of patients treated with phlebotropic drugs. Patients'assessment of conservative and surgical treatment has improved dramatically, cost of treatment remained similar. Despite significant surgical and conservative treatment efforts, prevalence of essential venous diseases in hospital catchment area remained unchanged. Amount of patients satisfied both with surgical and conservative treatment increased, perhaps mainly due to better efficacy of phlebotropic drugs and better access to specialist care. On the other hand, significant amount of patients doesn't start any treatment at all. We conclude that preventive varicose veins surgery during early stage of disease may not diminish prevalence of serious venous complications.

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

    PubMed Central

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

    2014-01-01

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

  18. Discovering, comparing, and combining moderators of treatment on outcome after randomized clinical trials: a parametric approach.

    PubMed

    Kraemer, Helena Chmura

    2013-05-20

    No one treatment is likely to affect all patients with a disorder in the same way. A treatment highly effective for some may be ineffective or even harmful for others. Statistically significant or not, the effect sizes of many treatments tend to be small. Consequently, emphasis in clinical research is gradually shifting (1) to increased focus on effect sizes and (2) to discovery and documentation of moderators of treatment effect on outcome in randomized clinical trials, that is, personalized medicine, in which individual differences between patients are explicitly acknowledged. How to test a null hypothesis of moderation of treatment outcome is reasonably well known. The focus here is on how, under parametric assumptions, to define the strength of moderation, that is, a moderator effect size, either for scientific purposes or for assessment of clinical significance, in order to compare moderators and choose among them and to develop a composite moderator, which might more strongly moderate the effect of a treatment on outcome than any single moderator that might ultimately provide guidance for clinicians as to whom to prescribe what treatment. Copyright © 2013 John Wiley & Sons, Ltd.

  19. Comparative efficacy and safety of mavacoxib and carprofen in the treatment of canine osteoarthritis

    PubMed Central

    Payne-Johnson, M; Becskei, C; Chaudhry, Y; Stegemann, M R

    2015-01-01

    A multi-site, masked, randomised parallel group study employing a double dummy treatment design was performed in canine veterinary patients to determine the comparative efficacy and safety of mavacoxib and carprofen in the treatment of pain and inflammation associated with osteoarthritis for a period of 134 days. Treatments were administered according to their respective summaries of product characteristics. Of 139 dogs screened, 124 were suitable for study participation: 62 of which were dosed with mavacoxib and 62 with carprofen. Both treatments resulted in a very similar pattern of considerable improvement as indicated in all parameters assessed by both owner and veterinarian. The primary efficacy endpoint ‘overall improvement’ was a composite score of owner assessments after approximately six weeks of treatment. Both drugs were remarkably effective, with 57/61 (93.4 per cent) of mavacoxib-treated dogs and 49/55 (89.1 per cent) of carprofen-treated dogs demonstrating overall improvement and with mavacoxib's efficacy being non-inferior to carprofen. The treatments had a similar safety profile as evidenced by documented adverse events and summaries of clinical pathology parameters. The positive clinical response to treatment along with the safety and dosing regimen of mavacoxib makes it an attractive therapy for canine osteoarthritis. PMID:25433056

  20. Bayesian sample sizes for exploratory clinical trials comparing multiple experimental treatments with a control.

    PubMed

    Whitehead, John; Cleary, Faye; Turner, Amanda

    2015-05-30

    In this paper, a Bayesian approach is developed for simultaneously comparing multiple experimental treatments with a common control treatment in an exploratory clinical trial. The sample size is set to ensure that, at the end of the study, there will be at least one treatment for which the investigators have a strong belief that it is better than control, or else they have a strong belief that none of the experimental treatments are substantially better than control. This criterion bears a direct relationship with conventional frequentist power requirements, while allowing prior opinion to feature in the analysis with a consequent reduction in sample size. If it is concluded that at least one of the experimental treatments shows promise, then it is envisaged that one or more of these promising treatments will be developed further in a definitive phase III trial. The approach is developed in the context of normally distributed responses sharing a common standard deviation regardless of treatment. To begin with, the standard deviation will be assumed known when the sample size is calculated. The final analysis will not rely upon this assumption, although the intended properties of the design may not be achieved if the anticipated standard deviation turns out to be inappropriate. Methods that formally allow for uncertainty about the standard deviation, expressed in the form of a Bayesian prior, are then explored. Illustrations of the sample sizes computed from the new method are presented, and comparisons are made with frequentist methods devised for the same situation.

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

    PubMed

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

    2010-06-08

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

  2. Anaerobic treatment of methanol condensate from pulp mill compared with anaerobic treatment of methanol using mesophilic UASB reactors.

    PubMed

    Badshah, Malik; Parawira, Wilson; Mattiasson, Bo

    2012-12-01

    The feasibility of anaerobic treatment of methanol condensate from pulp and paper mill in UASB reactor was investigated and compared with the anaerobic treatment of methanol. The UASB reactor treating methanol condensate was operated for 480 days with minimum problems of overload. COD removal from methanol condensate and methanol under normal operating conditions ranged from 84-86% to 86-98%, respectively. Under optimal conditions (OLR=5.0 g COD L(-1)day(-1), COD(influent)=11.40 g L(-1)) a methane yield of 0.29 NL CH(4) per g COD(removed) (at standard temperature and pressure) was achieved during the treatment of methanol condensate. The recovery time of the microorganisms after several overloads was decreasing each time probably due to the adaptation to methanol condensate. These findings indicate that methanol condensate can be efficiently treated in a UASB reactor with the benefit of biogas production. As a bonus effect of the treatment, much of the smell of the feed was eliminated.

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

    PubMed

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

    2014-07-30

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

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

    PubMed Central

    2014-01-01

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

  5. Comparable virus inactivation by bovine or vegetable derived Tween 80 during solvent/detergent treatment.

    PubMed

    Seitz, Holger; Blümel, Johannes; Schmidt, Ivo; Willkommen, Hannelore; Löwer, Johannes

    2002-09-01

    A mixture of Tri-n-butyl phosphate (TNBP) and Polysorbate 80 (Tween 80) is often used for virus inactivation during the manufacture of medicinal products derived from human plasma. This procedure, known as solvent/detergent treatment, is of high effectiveness for inactivation of enveloped viruses. Tween 80 can be manufactured from bovine tallow or from vegetable material. As the bovine-derived Tween 80 is normally used for the solvent/detergent treatment, the question has been raised whether vegetable-derived Tween 80 can be applied as an alternative substance for the solvent/detergent treatment. Comparable inactivation studies were therefore performed using Vesicular Stomatitis Virus (VSV), Pseudorabiesvirus (PRV), Semliki Forest Virus (SFV) and Bovine Diarrhoea Virus (BVDV). In principle, no differences were observed in the effectiveness of the solvent/detergent treatment when bovine or vegetable-derived Tween 80 was used. The comparability in the efficiency of both detergents for virus inactivation was shown to be independent of solvent/detergent concentration, of temperature (16 degrees C and 6 degrees C vs. 27 degrees C and 25 degrees C) and protein concentration (10% and 5% human albumin). In summary, vegetable-derived Tween 80 is of the same effectiveness as bovine-derived Tween 80, when used for virus inactivation by the solvent/detergent treatment. Copyright 2002 The International Association for Biologicals. Published by Elsevier Science Ltd. All rights reserved.

  6. Comparative assessment of the environmental sustainability of existing and emerging perchlorate treatment technologies for drinking water.

    PubMed

    Choe, Jong Kwon; Mehnert, Michelle H; Guest, Jeremy S; Strathmann, Timothy J; Werth, Charles J

    2013-05-07

    Environmental impacts of conventional and emerging perchlorate drinking water treatment technologies were assessed using life cycle assessment (LCA). Comparison of two ion exchange (IX) technologies (i.e., nonselective IX with periodic regeneration using brines and perchlorate-selective IX without regeneration) at an existing plant shows that brine is the dominant contributor for nonselective IX, which shows higher impact than perchlorate-selective IX. Resource consumption during the operational phase comprises >80% of the total impacts. Having identified consumables as the driving force behind environmental impacts, the relative environmental sustainability of IX, biological treatment, and catalytic reduction technologies are compared more generally using consumable inputs. The analysis indicates that the environmental impacts of heterotrophic biological treatment are 2-5 times more sensitive to influent conditions (i.e., nitrate/oxygen concentration) and are 3-14 times higher compared to IX. However, autotrophic biological treatment is most environmentally beneficial among all. Catalytic treatment using carbon-supported Re-Pd has a higher (ca. 4600 times) impact than others, but is within 0.9-30 times the impact of IX with a newly developed ligand-complexed Re-Pd catalyst formulation. This suggests catalytic reduction can be competitive with increased activity. Our assessment shows that while IX is an environmentally competitive, emerging technologies also show great promise from an environmental sustainability perspective.

  7. Laser (755 nm) and cryotherapy as depigmentation treatments for vitiligo: a comparative study.

    PubMed

    van Geel, N; Depaepe, L; Speeckaert, R

    2015-06-01

    Depigmentation therapy can be an option in adults with extensive and refractory vitiligo. Remaining pigmented patches can be removed using depigmentation creams (monobenzyl ether of hydroquinone 20%), laser therapy or cryotherapy. In contrast to cream treatment, laser therapy and cryotherapy are fast and targeted methods, capable of destroying melanocytes selectively on one specific area. Up till now, controlled trials comparing laser and cryotherapy as depigmenting treatment in vitiligo are lacking. We performed a retrospective comparative study in 22 generalized vitiligo patients. Thirty-one pigmented test regions were exposed to cryotherapy and 20 to 755 nm laser therapy. The mean surface area per test region was 3.55 cm2 and number of treatments per test region was limited to one single session in 84.3% and varied up to four sessions (2.0%). Overall no significant difference in the capacity to induce depigmentations was observed between cryotherapy (46.7%) and laser therapy (42.9%) after one treatment. The percentage of induced depigmentation was significantly different according to the body location (P = 0.005) with best results on the trunk, followed by the arms, face, neck and less on the hands. Variables that positively influenced depigmentation results were a younger age of vitiligo onset (P = 0.012), skin type V (P < 0.001) and clinical presence of Koebner's phenomenon (P = 0.039). Despite initial failure after one treatment, repetitive treatment sessions on eight test areas resulted in successful depigmentation. Side-effects were restricted to cryotherapy and concerned mainly hyperpigmentation in the face. To our knowledge, this is the first study comparing head-to-head depigmentation strategies intra- and inter-individually. We could demonstrate that in general laser and cryotherapy are equally effective in inducing depigmentations in generalized vitiligo patients. Retreatment of the same area may be required in case of initial failure. © 2014 European

  8. Treatment of vertigo with a homeopathic complex remedy compared with usual treatments: a meta-analysis of clinical trials.

    PubMed

    Schneider, Berthold; Klein, Peter; Weiser, Michael

    2005-01-01

    The increasing interest in alternative medical practices has led to a number of controlled studies on herbal and homeopathic agents. This paper presents the results of a meta-analysis of four recent clinical trials evaluating the homeopathic preparation Vertigoheel (VH) compared with usual therapies (betahistine, Ginkgo biloba extract, dimenhydrinate) for vertigo in a total of 1388 patients. Two trials were observational studies and the other two were randomised double-blind controlled trials. The duration of treatment (6-8 weeks) and dosage were comparable in all studies. Treatments were evaluated for the variables "number of vertigo episodes", "intensity of episodes" and "duration of episodes". As the studies differed in the age of patients and in the baseline values of vertigo, the individual reductions of number, intensity and duration of episodes were adjusted on equal age and baseline values (total means). An analysis of variance (with studies as random effects) showed no relevant influence of studies on the adjusted reductions and no relevant interaction between studies and treatment effects. The meta-analysis of all four trials showed equivalent reductions with VH and with control treatment: mean reduction of the number of daily episodes 4.0 for VH and 3.9 for control (standard error 0.11 for both groups); mean reduction of the duration (on a scale 0-4) for VH 1.1 and for the control 1.0 (standard error 0.03 for both groups); mean reduction of the intensity (on a scale 0-4) for VH 1.18 and for the control 1.8 (standard error 0.03 for both groups). In the non-inferiority analysis from all trials, VH was non-inferior in all variables. The results show the applicability of meta-analyses on the data from studies with homeopathicdrugs and support the results from the individual studies indicating good efficacy and tolerability of VH in patients with vertigo.

  9. Greater occipital nerve block in the treatment of triptan-overuse headache: A randomized comparative study.

    PubMed

    Karadaş, Ö; Özön, A Ö; Özçelik, F; Özge, A

    2017-04-01

    This study aims to investigate the efficiency of a single and repeated greater occipital nerve (GON) block using lidocaine in the treatment of triptan-overuse headache (TOH), whose importance has increased lately. In the study, 105 consecutive subjects diagnosed with TOH were evaluated. The subjects were randomized into three groups. In Group 1 (n=35), only triptan was abruptly withdrawn. In Group 2 (n=35), triptan was abruptly withdrawn and single GON block was performed. In Group 3 (n=35), triptan was abruptly withdrawn and three-stage GON block was performed. All patients were injected bilaterally with a total amount of 5 cc 1% lidocaine in each stage. During follow-up, the number of headache days per month, the severity of pain (VAS), the number of triptans used, and hsCRP and IL-6 levels were recorded three times; in the pretreatment period, in the second month post-treatment, and in the fourth month post-treatment. They were then compared. There was a statistically significant difference in the post-treatment fourth month in comparison with the pretreatment period in Group 3 (P<.05). Compared to Group 1, the number of headache days, VAS, and decrease in triptan need in Group 3 was statistically significant compared to Group 2 (P<.05). Compared to pretreatment, in the fourth month post-treatment, both hsCRP and IL-6 levels were lower only in Group 3 (P<.05). We are of the opinion that repeated GON block in addition to the discontinuation of medication has significant efficacy for TOH cases. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    PubMed

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

    2017-07-01

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

  11. Comparative analysis of 11 different radioisotopes for palliative treatment of bone metastases by computational methods

    SciTech Connect

    Guerra Liberal, Francisco D. C. E-mail: adriana-tavares@msn.com; Tavares, Adriana Alexandre S. E-mail: adriana-tavares@msn.com; Tavares, João Manuel R. S.

    2014-11-01

    Purpose: Throughout the years, the palliative treatment of bone metastases using bone seeking radiotracers has been part of the therapeutic resources used in oncology, but the choice of which bone seeking agent to use is not consensual across sites and limited data are available comparing the characteristics of each radioisotope. Computational simulation is a simple and practical method to study and to compare a variety of radioisotopes for different medical applications, including the palliative treatment of bone metastases. This study aims to evaluate and compare 11 different radioisotopes currently in use or under research for the palliative treatment of bone metastases using computational methods. Methods: Computational models were used to estimate the percentage of deoxyribonucleic acid (DNA) damage (fast Monte Carlo damage algorithm), the probability of correct DNA repair (Monte Carlo excision repair algorithm), and the radiation-induced cellular effects (virtual cell radiobiology algorithm) post-irradiation with selected particles emitted by phosphorus-32 ({sup 32}P), strontium-89 ({sup 89}Sr), yttrium-90 ({sup 90}Y ), tin-117 ({sup 117m}Sn), samarium-153 ({sup 153}Sm), holmium-166 ({sup 166}Ho), thulium-170 ({sup 170}Tm), lutetium-177 ({sup 177}Lu), rhenium-186 ({sup 186}Re), rhenium-188 ({sup 188}Re), and radium-223 ({sup 223}Ra). Results: {sup 223}Ra alpha particles, {sup 177}Lu beta minus particles, and {sup 170}Tm beta minus particles induced the highest cell death of all investigated particles and radioisotopes. The cell survival fraction measured post-irradiation with beta minus particles emitted by {sup 89}Sr and {sup 153}Sm, two of the most frequently used radionuclides in the palliative treatment of bone metastases in clinical routine practice, was higher than {sup 177}Lu beta minus particles and {sup 223}Ra alpha particles. Conclusions: {sup 223}Ra and {sup 177}Lu hold the highest potential for palliative treatment of bone metastases of all

  12. Geriatric Small Bowel Obstruction: An Analysis of Treatment and Outcomes Compared to a Younger Cohort

    PubMed Central

    Krause, William R.; Webb, Travis P.

    2016-01-01

    Background Small bowel obstruction (SBO) is a common condition, but little is known about its presentation, management, and outcomes in geriatric patients. Methods A retrospective review was performed comparing geriatric (≥65 years of age) and non-geriatric patients admitted with SBO. Admission characteristics, treatment, and outcomes were compared. Data analysis included Student’s t test and chi-square test or Fisher exact test. Results Among 80 geriatric and 136 non-geriatric patients no difference was observed between admission characteristics, treatment, time to or type of surgery, length of post-op stay, or overall complications. Cardiac complications (15% vs 0%, p=0.0082) and sub-acute care facility discharge (29% vs 5%, p<0.001) were more common for geriatric patients. Conclusions Compared to younger adults, elderly patients with SBO have similar presentations and overall outcomes with the exception of cardiac morbidity and discharge disposition. Pre-operative attention to cardiac risk profile and discharge disposition discussion should be encouraged. Summary This study analyzes geriatric patients presenting with small bowel obstruction when cared for by an Acute Care Surgery service. Compared to younger adults, the presentation, treatment response, and outcomes are similar with the exception of cardiac complications and discharge destination. PMID:25048569

  13. 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

  14. Olive oil waste treatment: a comparative and critical presentation of methods, advantages & disadvantages.

    PubMed

    Arvanitoyannis, Ioannis S; Kassaveti, Aikaterini; Stefanatos, Stelios

    2007-01-01

    Since olive oil industries were considered responsible for a great amount of pollution there has been a strong need for optimization of olive oil waste treatment systems. The currently employed systems are numerous and fall in the following large categories; bioremediation (ex-situ, in-situ), thermal processes (incineration, pyrolysis, gasification), evaporation, membrance processes, electrolysis, ozonation, digestion, coagulation/flocculation/precipitation, and distillation. Both advantages and disadvantages in conjunction with respective methodology and explicit flow diagrams were presented per waste treatment method. Furthermore, most recent studies were reported and more than twenty-five figures showing mainly the effectiveness of the current waste treatment methods versus time or temperature were displayed. The comparative presentation of the various olive oil waste treatment methodologies showed that though bioremediation stands for the most enviromentally friendly technique, its required longer treatment time in conjuction with its weakness to deal with elemental contaminants makes imperative the employment of a second alternative technique which could either be a membrance process (low energy cost, reliability, reduced capital cost) or a coagulation/flocculation method because of its low cost and high effectiveness. Biogas production appears to be another promising and energy effective waste treatment method. On the other hand, methods like distillation and ozonation (high cost) and electrolysis (experimental level) are unlikely to dominate this field unless their high cost is substantially reduced in the near future.

  15. A randomized cross-over study comparing cabergoline and quinagolide in the treatment of hyperprolactinemic patients.

    PubMed

    De Luis, D A; Becerra, A; Lahera, M; Botella, J I; Valero; Varela, C

    2000-01-01

    Quinagolide (QUI) and cabergoline (CAB) are dopamine agonists recently introduced for the treatment of hyperprolactinemia. In the present study, these drugs have been compared in terms of effectiveness and tolerability. Twenty patients (18 females and 2 males) with hyperprolactinemia (8 with microprolactinomas, 6 with idiopathic hyperprolactinemia and 6 with empty sella turcica syndrome) were treated with oral QUI (75 microg once daily) and CAB (0,5 mg twice weekly), in a randomized cross-over trial with placebo between both drugs. Each drug was administered for 12 weeks, separated by other 12 weeks with placebo. PRL levels decreased with both drugs at 2 or 4 weeks of starting the treatment, without differences between both drugs at weeks 4, 8 and 12. At week 12, normal PRL levels (<20 ng/ml) were attained in 90% patients with CAB and only in 75% patients with QUI (p<0.05). After discontinuation of treatment, significant increase in serum PRL was higher after QUI withdrawal than after CAB. Clinical efficacy of both treatments was similar in terms of improvement amenorrhea, oligomenorrhea, galactorrhea, and impotence. All patients completed both cycles of treatment, and the most frequent side-effects were nausea, headache and dizziness, without significant differences between CAB (30%) and QUI (55%). Our study indicates that, at the doses employed here, CAB showed a high percentage of patients with normal PRL at the end of treatment and long-lasting efficacy in the levels of PRL. Clinical response and side-effects were similar in both drugs.

  16. [Comparative study of the efficiency of itraconazole and ketoconazole in the treatment of experimental paracoccidioidomycosis].

    PubMed

    Negroni, R; Finquelievich, J L; Gosis, A S

    1987-01-01

    A comparative study between ketoconazole and itraconazole in the prophylactic and curative treatment of experimental paracoccidioidomycosis in rats and guinea pigs was carried out. Ninety seven Wistar rats were inoculated intracardiacally with the yeast-phase of P. brasiliensis with the purpose of evaluating the prophylactic treatment. Eighty one guinea pigs were injected intratesticularly with the same microorganism with the aim of studying the healing treatment. Both drugs were administered by gavage once a day. The prophylactic treatment started 3 days before the challenger inoculation and the healing treatment begun 10 days after the challenger inoculation. The animals were divided in four groups: I), control animals to which only the solvents of both drugs were administered; II), those which received ketoconazole 40 mg/kg/day; III), those treated with the same drug 80 mg/kg/day, and IV), animals treated with itraconazole 8 mg/kg/day. Seven to 30 days after starting the healing and prophylactic treatments the results were evaluated. Itraconazole seems to be as effective as ketoconazole at 5 fold lower dosage.

  17. Comparative Cost Analysis of Sequential, Adaptive, Behavioral, Pharmacological, and Combined Treatments for Childhood ADHD

    PubMed Central

    Page, Timothy F.; Fabiano, Gregory A.; Greiner, Andrew R.; Gnagy, Elizabeth M.; Pelham, William E.; Hart, Katie; Coxe, Stefany; Waxmonsky, James G.; Pelham, William E.

    2016-01-01

    Objective We conducted a cost-analysis of the behavioral, pharmacological, and combined interventions employed in a sequential, multiple assignment randomized, and adaptive trial investigating the sequencing and enhancement of treatment for ADHD children (Pelham et al., under review; N=152, 76% male, 80% Caucasian). Methods The quantity of resources expended on each child’s treatment was determined from records that listed the type, date, location, persons present, and duration of all services provided. The inputs considered were the amount of physician time, clinician time, paraprofessional time, teacher time, parent time, medication, and gasoline. Quantities of these inputs were converted into costs in 2013 USD using national wage estimates from the Bureau of Labor Statistics, the prices of 30-day supplies of prescription drugs from the national Express Scripts service, and mean fuel prices from the Energy Information Administration. Results Beginning treatment with a low-intensity regimen of behavior modification (group parent training) was less costly for a school-year of treatment ($961) than beginning treatment with a low dose of stimulant medication ($1689), regardless of whether the initial treatment was intensified with a higher “dose” or if the other modality was added. Conclusions Outcome data from the parent study (Pelham et al., under review) found equivalent or superior outcomes for treatments beginning with low-intensity behavior modification compared to intervention beginning with medication. Combined with the present analyses, these findings document that initiating treatment with behavior modification rather than medication is the more cost-effective option for children with ADHD. PMID:26808137

  18. Comparative treatment-related adverse event cost burden in immune thrombocytopenic purpura.

    PubMed

    Donga, Prina Z; Bilir, Sara P; Little, Gregg; Babinchak, Tim; Munakata, Julie

    2017-09-08

    Real-world evidence on the safety profile and costs associated with immune thrombocytopenic purpura (ITP) treatment in adults is lacking. This study quantifies and compares adverse event (AE) crude rates and costs associated with ITP treatments as found in claims data. A retrospective claims-based analysis was conducted using IMS Pharmetrics Plus database. Included patients were ≥18 years old, with a diagnosis of ITP (2007-2012); an ITP-related claim for anti-D, intravenous immunoglobulin (IVIG), rituximab, romiplostim, or eltrombopag; and 1-year continuous enrollment (3-years for rituximab) during follow-up. AEs and event costs were identified during active treatment, defined from the first claim of each drug to a pre-defined treatment gap or end of study period. Descriptive statistics were reported with Wilcoxon rank-sum significance tests. A total of 2,518 patients were identified (mean age = 50.8 (±16.3 years); 55.8% male). Of all patients, 22.8% experienced any AE. Significantly fewer anti-D patients had any AE (13.8% vs IVIG: 21.1%, rituximab: 29.4%, romiplostim: 28.1%, eltrombopag: 22.4%). Nausea/vomiting and arthralgia/musculoskeletal pain were most common across treatments, and hemolytic events did not differ significantly across treatments. Most costly AEs were urinary tract infection, aseptic meningitis, and fever ($5000+/case); headache, nasal congestion, and hemolytic event were $4,000-5,000/case. Cost per AE did not differ by treatment. Although lower than trial-based AE rates, claims for ITP treatment-related AEs are common, with higher numbers for rituximab and lower numbers for anti-D. This disparity suggests a possible differential cost burden overall that future analysis should explore.

  19. The comparative effectiveness of oral versus subcutaneous methotrexate for the treatment of early rheumatoid arthritis.

    PubMed

    Hazlewood, Glen S; Thorne, J Carter; Pope, Janet E; Lin, Daming; Tin, Diane; Boire, Gilles; Haraoui, Boulos; Hitchon, Carol A; Keystone, Edward C; Jamal, Shahin; Bykerk, Vivian P

    2016-06-01

    To determine the comparative effectiveness of oral versus subcutaneous methotrexate (MTX) as initial therapy for patients with early rheumatoid arthritis (ERA). Patients with ERA (symptoms ≤1 year) initiating MTX therapy were included from a multicentre, prospective cohort study. We compared the effectiveness between starting with oral versus subcutaneous MTX over the first year. Longitudinal multivariable models, adjusted for potential baseline and time-varying confounders, were used to compare treatment changes due to inefficacy or toxicity and treatment efficacy (Disease Activity Score-28 (DAS-28), DAS-28 remission and Health Assessment Questionnaire-Disability Index (HAQ-DI)). 666 patients were included (417 oral MTX, 249 subcutaneous MTX). Patients prescribed subcutaneous MTX were prescribed a higher dose of MTX (mean dose over first three months 22.3 mg vs 17.2 mg/week). At 1 year, 49% of patients initially treated with subcutaneous MTX had changed treatment compared with 77% treated with oral MTX. After adjusting for potential confounders, subcutaneous MTX was associated with a lower rate of treatment failure ((HR (95% CI) 0.55 (0.39 to 0.79)). Most treatment failures were due to inefficacy with no difference in failure due to toxicity. In multivariable models, subcutaneous MTX was also associated with lower average DAS-28 scores (mean difference (-0.38 (95% CI -0.64 to -0.10)) and a small difference in DAS-28 remission (OR 1.2 (95% CI 1.1 to 1.3)). There was no significant difference in sustained remission or HAQ-DI (p values 0.43 and 0.75). Initial treatment with subcutaneous MTX was associated with lower rates of treatment changes, no difference in toxicity and some improvements in disease control versus oral MTX over the first year in patients with ERA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. In Vitro Comparative Assessment of Mechanical Blood Damage Induced by Different Hemodialysis Treatments

    PubMed Central

    Lodi, Carlo Alberto; Sconziano, Sara Antonia; Beck, Werner; Bosch, Juan P.

    2015-01-01

    Abstract Gradual deterioration of red blood cells (RBCs) due to mechanical stress (chronic hemolysis) is unavoidable during treatments that involve extracorporeal blood circulation, such as hemodialysis (HD). This effect is generally undetectable and does not generate any acute symptoms, but it leads to an increase in plasma free hemoglobin (fHb). There are no absolute safety levels for fHb increase, indicating the need for an empirical evaluation using comparative testing. The increase in fHb levels was investigated in vitro by applying double‐needle double‐pump HD (HD‐DNDP), a new modality in which arterial and venous pumps both run continuously. fHb was measured during typical and worst‐case simulated dialysis treatments (double‐needle single‐pump HD [HD‐DNSP], hemodiafiltration [HDF‐DN], single‐needle double‐pump HD [HD‐SNDP], and HD‐DNDP) performed in vitro using bovine blood for 4 h. Hemolysis‐related indices (fHb%; index of hemolysis, IH; and normalized IH) were calculated and used for comparison. The increase in fHb during either HDF‐DN or HD‐SNDP with Artis and AK200 dialysis machines was similar, while the fHb at the maximum real blood flow rate (Qbreal) at the completion of the HD‐DNDP treatment on Artis was higher than that for HD‐DNSP using a Phoenix dialysis machine (fHb % = 1.24 ± 0.13 and 0.92 ± 0.12 for the Artis machine with HD‐DNDP at Qbreal = 450 mL/min and Phoenix with HD‐DNSP at Qbreal = 500 mL/min, respectively). However, the fHb levels increased linearly, and no steep changes were observed. The increases observed during HD‐DNDP were the same order of magnitude as those for widely used bloodlines and treatment modes for delivering dialysis treatments. The observed results matched literature findings, and thus the measured fHb trends are not predicted to have clinical side effects. HD‐DNDP treatment with Artis does not merit any additional concern regarding mechanical stress

  1. Superior chronic tolerability of adjunctive modafinil compared to pramipexole in treatment-resistant bipolar disorder.

    PubMed

    Dell'osso, Bernardo; Timtim, Sara; Hooshmand, Farnaz; Miller, Shefali; Wang, Po W; Hill, Shelley J; Portillo, Natalie; Ketter, Terence A

    2013-08-15

    Suboptimal outcomes are common in bipolar disorder (BD) pharmacotherapy, and may be mitigated with novel adjunctive agents such as modafinil (a low-affinity dopamine transport inhibitor) and pramipexole (a dopamine D2/D3 receptor agonist). While uncontrolled long-term effectiveness data have been reported for these treatments, reports specifically assessing their comparative acute versus chronic tolerability in BD are lacking. Such information, particularly in relation to discontinuation causes, has substantial relevance, providing initial indications to clinicians which treatment may be better tolerated, and to researchers which agent ought to be assessed in longer-term controlled trials. BD outpatients assessed with the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Affective Disorders Evaluation, and followed with the STEP-BD Clinical Monitoring Form, were naturalistically prescribed adjunctive modafinil or pramipexole, and somatic/psychiatric intolerability discontinuation rates were compared. Among 63 BD outpatients (mean ± SD age 43.5 ± 14.3 years, 60.3% female, 42.9% type I, 44.4% type II, 12.7% type not otherwise specified), taking 3.5 ± 1.5 (median 3) concurrent prescription psychotropics, adjunctive modafinil (n=24) for 626.9 ± 863.9 (286) days versus pramipexole (n=39) for 473.7 ± 613.4 (214; p=0.51) days yielded a 26.0% lower somatic/psychiatric intolerability discontinuation rate (12.5% vs. 38.5%; p<0.05), with most of the difference accounted for by more pramipexole somatic intolerability discontinuations, due to nausea and sedation, after the first 12 weeks of treatment. No placebo comparison group. Small sample of predominantly female Caucasian insured outpatients, taking complex concurrent medication regimens. Further studies are warranted to assess our preliminary observation that modafinil, compared to pramipexole, may be better tolerated for longer-term BD treatment. Copyright © 2012 Elsevier B.V. All rights

  2. Comparative effectiveness of dynamic treatment regimes: an application of the parametric g-formula

    PubMed Central

    Young, Jessica G.; Cain, Lauren E.; Robins, James M.; O’Reilly, Eilis J.; Hernán, Miguel A.

    2013-01-01

    Ideally, randomized trials would be used to compare the long-term effectiveness of dynamic treatment regimes on clinically relevant outcomes. However, because randomized trials are not always feasible or timely, we often must rely on observational data to compare dynamic treatment regimes. An example of a dynamic treatment regime is “start combined antiretroviral therapy (cART) within 6 months of CD4 cell count first dropping below x cells/mm3 or diagnosis of an AIDS-defining illness, whichever happens first” where x can take values between 200 and 500. Recently, Cain et al (2011) used inverse probability (IP) weighting of dynamic marginal structural models to find the x that minimizes 5-year mortality risk under similar dynamic regimes using observational data. Unlike standard methods, IP weighting can appropriately adjust for measured time-varying confounders (e.g., CD4 cell count, viral load) that are affected by prior treatment. Here we describe an alternative method to IP weighting for comparing the effectiveness of dynamic cART regimes: the parametric g-formula. The parametric g-formula naturally handles dynamic regimes and, like IP weighting, can appropriately adjust for measured time-varying confounders. However, estimators based on the parametric g-formula are more efficient than IP weighted estimators. This is often at the expense of more parametric assumptions. Here we describe how to use the parametric g-formula to estimate risk by the end of a user-specified follow-up period under dynamic treatment regimes. We describe an application of this method to answer the “when to start” question using data from the HIV-CAUSAL Collaboration. PMID:24039638

  3. Comparison of the efficiency of combined extracorporeal shock-wave therapy and triple therapy versus triple therapy itself in Category III B chronic pelvic pain syndrome (CPPS).

    PubMed

    Pajovic, B; Radojevic, N; Dimitrovski, A; Vukovic, M

    2016-09-01

    The aim of this study is to determine the effect of combining extracorporeal shock-wave therapy (ESWT) and triple therapy versus triple therapy alone, when treating Category III B chronic prostatitis (CPPS). Study included 60 patients, classified as having CPPS, divided into two groups: the first group numbered 30 patients, who were treated with a combination of an α-blocker, an anti-inflammatory agent and a muscle relaxant; the second group consisted of 30 patients who received a combination of ESWT and the fore-mentioned triple therapy. Patients were treated for 12 weeks. The primary criterion of a response to therapy was scoring 2 or less on the NIH-CPSI quality of life item, while the secondary criterion of a response to therapy was a greater than a 50% reduction in NIH-CPSI pain score. Patients who received triple therapy did not show a significant change neither in post void residual urine (PVR) nor in maximum flow rate (QMAX), while the second group of patients exhibited significant improvement in both PVR and QMAX values. Both groups of patients showed statistically significant improvement in all items of the NIH-CPSI score after the treatment, with significantly better results in the second group.

  4. 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

  5. Cardiac shockwave therapy improves myocardial function in patients with refractory coronary artery disease by promoting VEGF and IL-8 secretion to mediate the proliferation of endothelial progenitor cells

    PubMed Central

    CAI, HONG-YAN; LI, LIN; GUO, TAO; WANG, YU; MA, TIE-KUN; XIAO, JIAN-MING; ZHAO, LING; FANG, YIN; YANG, PING; ZHAO, HU

    2015-01-01

    Cardiac shockwave therapy (CSWT) is a potential and effective remedy to promote revascularization in the ischemic myocardium of patients with refractory coronary heart disease (CHD). The technique is both safe and non-invasive; however, the underlying molecular mechanism remains unclear. The aim of this study was to evaluate the efficacy of CSWT in treating CHD patients and investigate a potential mechanism. A total of 26 patients with CHD were enrolled in the study, and CSWT was performed over a 3-month period. The efficacy of CSWT was assessed using several clinical parameters. Peripheral blood (PB) was collected prior to and following treatment. The number of circulating endothelial progenitor cells (EPCs) in the PB was counted using a flow cytometer, and the levels of vascular endothelial growth factor (VEGF), interleukin-8 (IL-8), stromal cell-derived factor 1 and matrix metalloproteinase 9 in the PB were analyzed. Mononuclear cells were isolated from the PB and cultured in vitro. The EPCs and EPC-colony forming units (EPC-CFUs) in the PB mononuclear cell culture were counted using an inverted phase contrast microscope. Following CSWT, the tested clinical parameters were significantly improved. The levels of circulating EPCs, VEGF and IL-8 in the PB were significantly increased, as were the EPCs and EPC-CFUs from the PB mononuclear cell culture. We suggest that EPC proliferation, mediated by VEGF and IL-8 secretion, may be among the potential mechanisms associated with CSWT. PMID:26668649

  6. 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.

  7. Comparing treatment-seeking codeine users and strong opioid users: Findings from a novel case series.

    PubMed

    Nielsen, Suzanne; Murnion, Bridin; Dunlop, Adrian; Degenhardt, Louisa; Demirkol, Apo; Muhleisen, Peter; Lintzeris, Nicholas

    2015-05-01

    Few studies have described those seeking treatment for codeine dependence. This study aimed to compare patients presenting for treatment where either codeine or a strong pharmaceutical opioid (oxycodone or morphine) was the principal drug of concern to understand if codeine users may have unique treatment needs. Retrospective case review of 135 patients from three geographical areas in New South Wales, Australia. Cases where the principal drug of concern was codeine (n = 53) or a strong pharmaceutical opioid (oxycodone or morphine, n = 82) were compared. Differences in demographic characteristics, pain history, mental health, substance use history and, subsequently, the treatment that was received were examined. People whose principal drug of concern was codeine were more likely to be female (66% vs. 37%, P < 0.001), employed (43% vs. 22%, P < 0.01) and use only one pharmaceutical opioid (91% vs. 49%, P < 0.001). There was no difference in age between the codeine group (mean 38.6 years) and the strong opioid group (39.3 years). Opioid substitution therapy was the most common treatment received by both groups although codeine patients were more likely to be treated with buprenorphine than methadone (odds ratio = 7.7, 95% confidence interval 2.2-27.2, P < 0.001) and more likely to attempt withdrawal (odds ratio = 2.6, 95% confidence interval 1.2-5.3, P = 0.010). There are important differences between codeine-dependent patients and strong prescription opioid-dependent patients. Further work should explore the outcomes of withdrawal versus maintenance treatment for codeine users. © 2014 Australasian Professional Society on Alcohol and other Drugs.

  8. Effects of an occlusal splint compared with cognitive-behavioral treatment on sleep bruxism activity.

    PubMed

    Ommerborn, Michelle A; Schneider, Christine; Giraki, Maria; Schäfer, Ralf; Handschel, Jörg; Franz, Matthias; Raab, Wolfgang H-M

    2007-02-01

    The impact of an occlusal splint (OS) compared with cognitive-behavioral treatment (CBT) on the management of sleep bruxism (SB) has been poorly investigated. The aim of this study was to evaluate the efficacy of an OS with CBT in SB patients. Following a randomized assignment, the OS group consisted of 29, and the CBT group of 28, SB patients. The CBT comprised problem-solving, progressive muscle relaxation, nocturnal biofeedback, and training of recreation and enjoyment. The treatment took place over a period of 12 wk, and the OS group received an OS over the same time period. Both groups were examined pretreatment, post-treatment, and at 6 months of follow-up for SB activity, self-assessment of SB activity and associated symptoms, psychological impairment, and individual stress-coping strategies. The analyses demonstrated a significant reduction in SB activity, self-assessment of SB activity, and psychological impairment, as well as an increase of positive stress-coping strategies in both groups. However, the effects were small and no group-specific differences were seen in any dependent variable. This is an initial attempt to compare CBT and OS in SB patients, and the data collected substantiate the need for further controlled evaluations, using a three-group randomized design with repeated measures to verify treatment effects.

  9. A computational model of drug delivery through microcirculation to compare different tumor treatments.

    PubMed

    Cattaneo, L; Zunino, P

    2014-11-01

    Starting from the fundamental laws of filtration and transport in biological tissues, we develop a computational model to capture the interplay between blood perfusion, fluid exchange with the interstitial volume, mass transport in the capillary bed, through the capillary walls and into the surrounding tissue. These phenomena are accounted at the microscale level, where capillaries and interstitial volume are viewed as two separate regions. The capillaries are described as a network of vessels carrying blood flow. We apply the model to study drug delivery to tumors. The model can be adapted to compare various treatment options. In particular, we consider delivery using drug bolus injection and nanoparticle injection into the blood stream. The computational approach is suitable for a systematic quantification of the treatment performance, enabling the analysis of interstitial drug concentration levels, metabolization rates and cell surviving fractions. Our study suggests that for the treatment based on bolus injection, the drug dose is not optimally delivered to the tumor interstitial volume. Using nanoparticles as intermediate drug carriers overrides the shortcomings of the previous delivery approach. This work shows that the