Test-Retest Reliability of Measuring the Vertebral Arterial Blood Flow Velocity in People With Cervicogenic Dizziness.

OBJECTIVES: The purpose of this study was to determine the within-session and between-sessions reliability of measuring the vertebral artery blood flow velocities in people with cervicogenic dizziness using Doppler ultrasound at both upper and lower cervical levels. METHODS: Outcome measures were taken on 2 occasions 3 weeks apart with no active treatment provided in between the assessments on 12 participants. Pulsed-wave Doppler ultrasound was used to quantify time-averaged mean velocities through the vertebral artery at upper cervical (C0-1) and lower cervical vertebrae (C5-6). The clinical outcome measures were also recorded in people with cervicogenic dizziness. The intraclass correlation coefficient (ICC) was used to determine the within-session and between-session repeatability. Paired t test was used to determine the differences in the time-averaged mean velocities of blood flow at the same site of the vertebral artery and the clinical outcome measures in 2 sessions 3 weeks apart. RESULTS: In people with cervicogenic dizziness, there was no significant change in both clinical outcome measures and the time-averaged mean velocities when the patients were measured 3 weeks apart (P > .05). This study identified good within-session (ICC: 0.903-0.967) and between-session (ICC: 0.922-0.984) repeatability in measuring the vertical blood flow velocities in patients with cervicogenic dizziness when the clinical outcome measures were unchanged. CONCLUSIONS: This study supports the use of Doppler ultrasound to identify changes in mean vertebral arterial blood flow velocities before and after intervention in people with cervicogenic dizziness in future studies.

Effects of low-intensity pulsed ultrasound and hyperbaric oxygen on human osteoarthritic chondrocytes.

BACKGROUND: Although the individual effects of hyperbaric oxygen (HBO) and low-intensity pulsed ultrasound (LIPUS) on osteoarthritic (OA) chondrocytes have been reported, the effects of HBO combined with LIPUS treatment are unknown. METHODS: OA chondrocytes were obtained from patients undergoing knee replacement surgery. RNA was isolated for real-time polymerase chain reaction (PCR) analysis of inducible nitric oxide synthase (iNOS), type-II collagen, and aggrecan gene expression. The protein levels of MMP-3 and TIMP-1 were quantified by enzyme-linked immunosorbent assay (ELISA) after LIPUS or HBO treatment. The data are given as mean ± standard deviation (SD) of the results from three independent experiments. A p value less than 0.05 was defined as statistically significant. RESULTS: Our data suggested that ultrasound and HBO treatment increased cell bioactivity of OA chondrocytes. Real-time PCR analysis showed that HBO treatment increased the mRNA of type-II collagen, aggrecan, and TIMP-1 but suppressed the iNOS expression of OA chondrocytes. LIPUS treatment increased the type-II collagen and iNOS expression of OA chondrocytes. ELISA data showed that HBO or LIPUS treatment increased TIMP-1 production of OA chondrocyte. MMP-3 production was suppressed by HBO treatment. HBO combined with LIPUS treatments resulted in additive effect in TIMP-1 production and compensatory effect in iNOS expression. CONCLUSION: HBO combined with LIPUS treatment-induced increase of the anabolic factor (TIMP-1)/catabolic factor (MMP-3) ratio may provide an additive therapeutic approach to slow the course of OA degeneration.

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

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

The effect of low-intensity pulsed ultrasound on repair of epithelial cell monolayers in vitro.

Low intensity pulsed ultrasound (LIPUS) is widely used to accelerate tissue regeneration following injury, but the biological mechanisms of this effect are poorly understood. An in vitro model of epithelial wound healing was used to investigate the effect of LIPUS on the reepithelialization of scrape wounds in normal human urothelial (NHU) cell monolayers. The effects of clinical doses of ultrasound treatment on NHU cell growth and migration were investigated in cells grown under optimal conditions, without growth supplements and in media containing low vs. physiological calcium concentrations. No differences in cell growth or migration were observed. We conclude that there is no direct effect upon uro-epithelial regeneration by therapeutic ultrasound in vitro and suggest that any stimulation of epithelial wound repair in vivo may occur indirectly, for example by modulating the extracellular matrix composition and/or production of paracrine factors by the stroma.

Effect of low- and high-intensity pulsed ultrasound on collagen post-translational modifications in MC3T3-E1 osteoblasts.

Different intensities of pulsed ultrasound have distinct biological effects on bone mineralization in the process of bone fracture repair, even across a narrow range (e.g., 30-120 mW/cm(2)). The aim of our study was to elucidate the effect of low-intensity (30 mW/cm(2)) and high-intensity (120 mW/cm(2)) pulsed ultrasound on collagen metabolism by using MC3T3-E1 osteoblasts. Of special interest was the relationship between posttranslational collagen quality and prostaglandin E(2) activity. Cells with or without a cyclooxygenase-2 inhibitor, NS398, were exposed every day for four consecutive days to high-level or low-level intensities of pulsed ultrasound. We examined the, expression patterns of cyclooxygenase-2, lysyl oxidase, telopeptidyl lysyl hydroxylase (TLH), and helical lysyl hydroxylase by real-time polymerase chain reaction analysis. Quantitative analyses of reducible immature and nonreducible mature cross-links were also performed. Ultrasound at 30 mW/cm(2) upregulated TLH messenger RNA (mRNA) expression and enzyme activity compared to the control and resulted in increased relative concentrations of telopeptidyl hydroxylysine-derived cross-links. In addition to upregulated lysyl oxidase mRNA expression, increased total reducible and nonreducible cross-links were observed by 30 mW/cm(2) exposure compared to the control. In contrast, ultrasound at 120 mW/cm(2) had no obvious effect on collagen metabolism owing to high levels of endogenous prostaglandin E(2) induced by ultrasound. Our results showed that (1) low-intensity, but not high-intensity, ultrasound may accelerate the formation of the unique molecular packing of collagen fibers conducive to bone mineralization and that (2) the high dose of endogenous prostaglandin E(2) induced by pulsed ultrasound may be detrimental to calcifiable cross-link formation.

Time-reversal acoustics in biomedical engineering.

Time reversal is a very powerful method for focusing through complex and heterogeneous media and shows very promising results in biomedical applications. In this paper, we review some of the main applications investigated during the past decade. An iterative implementation of the time-reversal process allows tracking gallstones in real time during lithotripsy treatments. In this application domain, a smart exploitation of the reverberations in solid waveguides permits the focusing of high-amplitude ultrasonic shock waves with a small number of transducers. Finally, because time reversal is able to correct the strong distortions induced by the skull bone on ultrasonic propagation, this adaptive focusing technique is very promising for ultrasonic hyperthermia brain therapy.