Finite element modelling of radial shock wave therapy for chronic plantar fasciitis

Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression–rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot.     

Treatment of long bone defects and non-unions: from research to clinical practice

The treatment of long bone defects and non-unions is still a major clinical and socio-economical problem. In addition to the non-operative therapeutic options, such as the application of various forms of electricity, extracorporeal shock wave therapy and ultrasound therapy, which are still in clinical use, several operative treatment methods are available. No consensus guidelines are available and the treatments of such defects differ greatly. Therefore, clinicians and researchers are presently investigating ways to treat large bone defects based on tissue engineering approaches. Tissue engineering strategies for bone regeneration seem to be a promising option in regenerative medicine. Several in vitro and in vivo studies in small and large animal models have been conducted to establish the efficiency of various tissue engineering approaches. Neverthelsss, the literature still lacks controlled studies that compare the different clinical treatment strategies currently in use. However, based on the results obtained so far in diverse animal studies, bone tissue engineering approaches need further validation in more clinically relevant animal models and in clinical pilot studies for the translation of bone tissue engineering approaches into clinical practice.     

超声空化强度测量的研究进展

近几十年来,超声波已经广泛应用于生物学和医学领域,在医学领域中超声波可以作为信息载体用于探测人体的病变信息,并且可以用一定剂量的超声波作用于人体病变组织,并通过它对组织的作用达到一定的治疗目的。作为一种无创、非介入性外科技术,它的疗效和安全性越来越被人们所关注。超声波与人体组织的相互作用有三种,分别是机械机制,热学机制,和空化机制。对于机械机制和热机制人们比较熟悉,而对于空化机制则相对陌生。随着超声空化在医学中的应用越来越广泛,其安全性越来越受到人们的关心。要么是其强度迭不到治疗效果,要么是其强度过大损伤人体,因此其强度已成为人们关心的主要主题。本文主要介绍超声空化的主要探讨了几种测量方法及对超声空化有影响的几种参量,并对超声空化的发展进行了展望。     

Formation of shock waves in a discharge plasma in the presence of a magnetic field

The effect of an external magnetic field on the dynamics of shock waves generated in an argon plasma due to both explosive processes on the cathode and expansion of the spark channel has been studied experimentally. It is shown that the expanding plasma of the cathode spot forms a shock wave and that the application of a longitudinal magnetic field decelerates the radial expansion of the cathode plasma. It is found that the intensities of some argon spectral lines increase in the presence of a magnetic field.     

Prey capture in lizards: differences in jaw–neck–forelimb coordination

Fish body muscles are arranged along the vertebral column in three‐dimensional W‐shaped blocks, called myomeres. Each myomere is separated from its neighbours by a collagenous sheet, the myoseptum, and embedded in these myosepta and in positions that are conserved throughout gnathostome evolution are distinct tendons. Within teleosts these tendons often ossify. Ossification is usually intramembranous but cartilaginous structures within the tendons have also been reported. Ossified myoseptal tendons are homologous to intermuscular bones and appear only in teleosts. The phylogenetic signal of myoseptal tendon ossfication has not been tested previously, although the presence and morphology of intermuscular bones have been used to infer phylogenetic relationships. We sample over a broad phylogenetic range of teleost fishes to test for (1) the effects of phylogenetic history on the presence of intermuscular bones and (2) morphological correlations with the presence of intermuscular bones. Body shape and fin position as well as vertebral number and aspect ratio are characters that are likely to affect the distribution of stresses along myoseptal tendons, and are therefore good functional predictors of myoseptal tendon ossification. We use the summary information by Patterson & Johnson for a list of species with intermuscular bones and reanalyse the homology of intermuscular bones to myoseptal tendons. We find that there is a phylogenetic signal in the distribution of four out of six ossified tendons, but that after correcting for phylogenetic relationships there are still morphological predictors for the presence of all ossified tendons. © 2012 The Linnean Society of London, Biological Journal of the Linnean Society, 2012, 106 , 607–622.     

Small disturbance in arterial blood flow

The behaviour of a small disturbance in an arterial blood flow has been studied analytically. The growth equation governing growth or decay of a disturbance has been obtained and solved. The behaviour of wave amplitude has been investigated as the wave propagates in time. The application of results to the human arterial system shows that the shock waves are not expected under normal physiological conditions. In the case of a pathologically increased pressure rise at the root of aorta, shock-like transitions may develop in the periphery. It is observed that the friction effects are to resist the tendency of shock formation in arteries.     

Low Energy Shock Wave Therapy Induces Angiogenesis in Acute Hind-Limb Ischemia via VEGF Receptor 2 Phosphorylation

Objectives

Low energy shock waves have been shown to induce angiogenesis, improve left ventricular ejection fraction and decrease angina symptoms in patients suffering from chronic ischemic heart disease. Whether there is as well an effect in acute ischemia was not yet investigated.

Methods

Hind-limb ischemia was induced in 10–12 weeks old male C57/Bl6 wild-type mice by excision of the left femoral artery. Animals were randomly divided in a treatment group (SWT, 300 shock waves at 0.1 mJ/mm², 5 Hz) and untreated controls (CTR), n = 10 per group. The treatment group received shock wave therapy immediately after surgery.

Results

Higher gene expression and protein levels of angiogenic factors VEGF-A and PlGF, as well as their receptors Flt-1 and KDR have been found. This resulted in significantly more vessels per high-power field in SWT compared to controls. Improvement of blood perfusion in treatment animals was confirmed by laser Doppler perfusion imaging. Receptor tyrosine kinase profiler revealed significant phosphorylation of VEGF receptor 2 as an underlying mechanism of action. The effect of VEGF signaling was abolished upon incubation with a VEGFR2 inhibitor indicating that the effect is indeed VEGFR 2 dependent.

Conclusions

Low energy shock wave treatment induces angiogenesis in acute ischemia via VEGF receptor 2 stimulation and shows the same promising effects as known from chronic myocardial ischemia. It may therefore develop as an adjunct to the treatment armentarium of acute muscle ischemia in limbs and myocardium.     

Adipose-derived stromal cell in regenerative medicine: A review

The application of appropriate cell origin for utilizing inregenerative medicine is the major issue. Various kinds of stem cells have been used for the tissue engineering and regenerative medicine. Such as, several stromal cells have been employed as treat option for regenerative medicine. For example, human bone marrow-derived stromal cells and adipose-derived stromal cells(ADSCs) are used in cell-based therapy. Data relating to the stem cell therapy and processes associated with ADSC has developed remarkably in the past 10 years. As medical options, both the stromal vascular and ADSC suggests good opportunity as marvelous cell-based therapeutics. The some biological features are the main factors that impact the regenerative activity of ADSCs, including the modulation of the cellular immune system properties and secretion of bioactive proteins such as cytokines, chemokines and growth factors, as well as their intrinsic anti-ulcer and anti-inflammatory potential. A variety of diseases have been treated by ADSCs, and it is not surprising that there has been great interest in the possibility that ADSCs might be used as therapeutic strategy to improve a wider range of diseases. This is especially important when it is remembered that routine therapeutic methods are not completely effective in treat of diseases. Here, it was discuss about applications of ADSC to colitis, liver failure, diabetes mellitus, multiple sclerosis, orthopaedic disorders, hair loss, fertility problems, and salivary gland damage.     

Human amniotic membrane as an alternative source of stem cells for regenerative medicine

The human amniotic membrane (HAM) is a highly abundant and readily available tissue. This amniotic tissue has considerable advantageous characteristics to be considered as an attractive material in the field of regenerative medicine. It has low immunogenicity, anti-inflammatory properties and their cells can be isolated without the sacrifice of human embryos. Since it is discarded post-partum it may be useful for regenerative medicine and cell therapy. Amniotic membranes have already been used extensively as biologic dressings in ophthalmic, abdominal and plastic surgery. HAM contains two cell types, from different embryological origins, which display some characteristic properties of stem cells. Human amnion epithelial cells (hAECs) are derived from the embryonic ectoderm, while human amnion mesenchymal stromal cells (hAMSCs) are derived from the embryonic mesoderm. Both populations have similar immunophenotype and multipotential for in vitro differentiation into the major mesodermal lineages, however they differ in cell yield. Therefore, HAM has been proposed as a good candidate to be used in cell therapy or regenerative medicine to treat damaged or diseased tissues.     

Shock Wave Treatment Enhances Cell Proliferation and Improves Wound Healing by ATP Release-coupled Extracellular Signal-regulated Kinase (ERK) Activation

Shock wave treatment accelerates impaired wound healing in diverse clinical situations. However, the mechanisms underlying the beneficial effects of shock waves have not yet been fully revealed. Because cell proliferation is a major requirement in the wound healing cascade, we used in vitro studies and an in vivo wound healing model to study whether shock wave treatment influences proliferation by altering major extracellular factors and signaling pathways involved in cell proliferation. We identified extracellular ATP, released in an energy- and pulse number-dependent manner, as a trigger of the biological effects of shock wave treatment. Shock wave treatment induced ATP release, increased Erk1/2 and p38 MAPK activation, and enhanced proliferation in three different cell types (C3H10T1/2 murine mesenchymal progenitor cells, primary human adipose tissue-derived stem cells, and a human Jurkat T cell line) in vitro. Purinergic signaling-induced Erk1/2 activation was found to be essential for this proliferative effect, which was further confirmed by in vivo studies in a rat wound healing model where shock wave treatment induced proliferation and increased wound healing in an Erk1/2-dependent fashion. In summary, this report demonstrates that shock wave treatment triggers release of cellular ATP, which subsequently activates purinergic receptors and finally enhances proliferation in vitro and in vivo via downstream Erk1/2 signaling. In conclusion, our findings shed further light on the molecular mechanisms by which shock wave treatment exerts its beneficial effects. These findings could help to improve the clinical use of shock wave treatment for wound healing.     

Extensive burns in children; treatment of the early phase

The water, electrolyte and colloid losses and shifts which occur after a severe burning are complex, and variable from patient to patient. No available clinical method allows for accurate prediction of the volume and composition of the fluid losses. The method here described assumes that parenteral therapy which produces a normal urinary output and maintains the child free of signs and symptoms of shock is good therapy and at least approximates his needs. On the whole this assumption has been verified by clinical experience. Once again it is necessary to stress the importance of treatment that anticipates needs rather than treatment which comes after unmet needs are obvious. Methods used to assess and treat burned adults need modification before application to infants and children.     

An alternative ultrasonic method for measuring the elastic properties of cortical bone

We studied the elastic properties of bone to analyze its mechanical behavior. The basic principles of ultrasonic methods are now well established for varying isotropic media, particularly in the field of biomedical engineering. However, little progress has been made in its application to anisotropic materials. This is largely due to the complex nature of wave propagation in these media. In the present study, the theory of elastic waves is essential because it relates the elastic moduli of a material to the velocity of propagation of these waves along arbitrary directions in a solid. Transducers are generally placed in contact with the samples which are often cubes with parallel faces that are difficult to prepare. The ultrasonic method used here is original, a rough preparation of the bone is sufficient and the sample is rotated. Moreover, to analyze heterogeneity of the structure we measure velocities in different points on the sample. The aim of the present study was to determine in vitro the anisotropic elastic properties of cortical bones. For this purpose, our method allowed measurement of longitudinal and transverse velocities (C(L) and C(T)) in longitudinal (fiber direction) and the radial directions (orthogonal to the fiber direction) of compact bones. Young's modulus E and Poisson's ratio nu, were then deduced from the velocities measured considering the compact bone as transversely isotropic or orthotropic. The results are in line with those of other methods.     

Application of hydroelastic waves of the Chinese traditional medicine solution to the traumatotherapy

We have used hydroelastic waves to treat the closed trauma of the soft tissue. The Shu Huo Jiu (S. H. J.) which is the Chinese traditional medicine alcohol, was used as the fluid medium for generating the pressure waves. The biomechanical model was established and analysed. Both animal and human tests have been made. A practical system was designed, constructed and clinically tested to treat the closed trauma, such as the bruise, contusion, sprain etc.. This system was found to be effective.     

Shock wave therapy for femoral head necrosis—Pressure measurements inside the femoral head

There is a persisting need for effective therapies of femoral head necrosis, a common bone disease. Promising clinical results have been stated for the treatment with extracorporeal shock waves (ESW). However, the effective remaining pressure in the target region inside the femoral head has never been determined. Aim of this study was to investigate whether ESW are able to propagate through bone without an excessive loss of pressure. The remaining ESW pressure generated by an electromagnetic device after passing a certain intraosseous distance within the femoral head was measured. Standardized holes were drilled in porcine femora and the absorption in relation to reference measurements in degassed water was determined. The results showed continuous attenuation of shock waves in bone. After a clinical relevant intraosseous distance of 10 mm an ESW pressure of ～50% remained.In conclusion, ESW have the potential to reach necrotic regions with therapeutic pressure levels and to effectively treat femoral head necrosis.     

Ozone as Janus: this controversial gas can be either toxic or medically useful

Ozone is an intrinsically toxic gas and its hazardous employment has led to a poor consideration of ozone therapy. The aim of this review is to indicate that a wrong dogma and several misconceptions thwart progress: in reality, properly performed ozone therapy, carried out by expert physicians, can be very useful when orthodox medicine appears inadequate. The unbelievable versatility of ozone therapy is due to the cascade of ozone-derived compounds able to act on several targets leading to a multifactorial correction of a pathological state. During the past decade, contrary to all expectations, it has been demonstrated that the judicious application of ozone in chronic infectious diseases, vasculopathies, orthopedics and even dentistry has yielded such striking results that it is deplorable that the medical establishment continues to ignore ozone therapy.     

Tumor cytotoxicity in vivo and radical formation in vitro depend on the shock wave-induced cavitation dose

Local tumor therapy using focused ultrasonic waves may become an important treatment option. This technique exploits the ability of mechanical waves to induce thermal and nonthermal effects noninvasively. The cytotoxicity to cultured cells and biological tissues in vivo that results from exposure to ultrasonic shock waves is considered to be a nonthermal effect that is partly a consequence of ultrasound-induced cavitation. Cavitation is defined as the formation of bubbles during the negative wave cycle; their subsequent oscillation and/or violent implosion can affect surrounding structures. To investigate cavitational effects in cells and tissues, defined cavitation doses must be applied while ideally holding all other potential ultrasound parameters constant. The application of independent cavitation doses has been difficult and has yielded little knowledge about quantitative cavitation-tissue interactions. By using a special shock-wave pulse regimen and laser optical calibration in this study, we were able to control the cavitation dose independently of other physical parameters such as the pressure amplitudes, and averaged acoustic intensity. We treated Dunning prostate tumors (subline R3327-AT1) transplanted into Copenhagen rats with shock waves at three cavitation dose levels and then determined the tumor growth delay and the histopathological changes. All of the treated animals exhibited a significant tumor growth delay compared to the controls. Higher cavitation doses were associated with a greater delay in the growth of the tumor and more severe effects on tumor histopathology, such as hemorrhaging, tissue disruption, and necrosis. In vitro, the cavitation dose level correlated with the amount of radical formation. We concluded that the process of acoustic cavitation was responsible; higher cavitation doses caused greater effects in tumors both in vivo and in vitro. These findings may prove important in local tumor therapy and other applications of ultrasound such as ultrasound-mediated drug delivery.     

Emerging technologies in therapeutic ultrasound: Thermal ablation to gene delivery

Ultrasound is used today in medicine as a modality for diagnostic imaging. Recently, there have been numerous reports on the application of thermal and nonthermal ultrasound energy for treating various diseases. In addition to thermal ablation of tumors, non-thermal ultrasound combined with drugs and genes have led to much excitement especially for cancer treatment, vascular diseases, and regenerative medicine. Ultrasound energy can enhance the effects of thrombolytic agents such as urokinase for treatment of stroke and acute myocardial infarction. New ultrasound technologies have resulted in advanced devices such as a) ultrasound catheters, b) Non-invasive methods as high intensity focused ultrasound (HIFU) in conjunction with MRI and CT is already being applied in the clinical field, c) Chemical activation of drugs by ultrasound energy for treatment of tumors is another new field recently termed “Sonodynamic Thew”, and d) Combination of genes and microbubble have induced great hopes for ideal gene therapy (sonoporation). Various examples of ultrasound combined modalities are under investigation which could lead to revolutionary therapy.     

生物标记物与精准医疗研究进展

自2015年精准医疗理念提出后,生物标记物与精准医疗愈加被人们重视。并被广泛应用于病毒、癌症等重大疾病的筛查与治疗研究中。新兴循环生物标记物的应用与开发,在HBV、HPV的检测和肿瘤的靶向药物治疗、细胞治疗、免疫抑制剂、癌症疫苗开发方向上都取得了重大成果。与传统的医疗方法相比,生物标记物为辅助精准医疗的检测治疗模式,无论是在研发还是治疗上都有着显著的优势。因此,综述了生物标记物与精准医疗的应用,并就最近的研究报告重点综述了生物标记物与精准医疗的最新研究进展。     

Recent advances in gene therapy and future prospects

Gene therapy, which is treatment of diseases by introducing normal genes into the body, is becoming feasible as the result of advances in genetic engineering. The hematopoietic stem cells have been considered as the appropriate target for gene transfer in many genetic diseases for which allogeneic bone marrow transplantation has been employed successfully. However, there are still many problems to be solved. In particular, expression from retrovirally transduced genes in bone marrow cells has been transient and unstable. On the other hand, an alternative approach to somatic cell gene therapy using nonhematopoietic cells, including skin fibroblasts, endothelial cells, keratinocytes, and lymphocytes, has been shown to possess several advantages. This kind of approach is usually applied to supplementation therapy in not only hereditary disorders but also various acquired diseases, such as cancer or infectious diseases. Recently, clinical application of gene transfer into lymphocytes to treat cancer and immunodeficiency have been approved at NIH (USA). The trial could represent the start of a new era in molecular medicine.     

New insights into and novel applications for platelet-rich fibrin therapies

The therapeutic use of autologous platelet-rich plasma constitutes a relatively new biotechnology that has been a breakthrough in the stimulation and acceleration of soft-tissue and bone healing. The efficiency of this process lies in the local and continuous delivery of a wide range of growth factors and proteins, mimicking the needs of the physiological wound healing and reparative tissue processes. Consequently, the application of platelet-rich plasma has been extended to many different fields, including orthopedics, sports medicine, dentistry, cosmetic and periodontal medicine and cosmetic, plastic and maxillofacial surgery. This article highlights the use of this technology and discusses some of the obstacles and challenges that need to be addressed to maintain progress in this field.