A computational study of combination HIFU-chemotherapy as a potential means of overcoming cancer drug resistance.

The application of local hyperthermia, particularly in conjunction with other treatment strategies (like chemotherapy and radiotherapy) has been known to be a useful means of enhancing tumor treatment outcomes. However, to our knowledge, there has been no mathematical model designed to capture the impact of the combination of hyperthermia and chemotherapies on tumor growth and control. In this study, we propose a nonlinear Partial Differential Equation (PDE) model which describes the tumor response to chemotherapy, and use the model to study the effects of hyperthermia on the response of prototypical tumor to the generic chemotherapeutic agent. Ultrasound energy is delivered to the tumor through High Intensity Focused Ultrasound (HIFU), as a noninvasive technique to elevate the tumor temperature in a controlled manner. The proposed tumor growth model is coupled with the nonlinear density dependent Westervelt and Penne's bio-heat equations, used to calculate the net delivered energy and temperature of the tumor and its surrounding normal tissue. The tumor is assumed to be composed of two species: drug-sensitive and drug-resistant. The central assumption underlying our model is that the drug-resistant species is converted to a drug-sensitive type when the tumor temperature is elevated above a certain threshold temperature. The "in silico" results obtained, confirm that hyperthermia can result in less aggressive tumor development and emphasize the importance of designing an optimized thermal dose strategy. Furthermore, our results suggest that increasing the length of the on/off cycle of the transducer is an efficient approach to treatment scheduling in the sense of optimizing tumor eradication.

Method to optimize the placement of a single-element transducer for transcranial focused ultrasound.

BACKGROUND AND OBJECTIVE: Transcranial focused ultrasound (tFUS) is a promising neuromodulation technique because of its non-invasiveness and high spatial resolution (within millimeter scale). However, the presence of the skull can lead to disrupting and shifting the acoustic focus in the brain. In this study, we propose a computationally efficient way to determine the optimal position of a single-element focused ultrasound transducer which can effectively deliver acoustic energy to the brain target. We hypothesized that the placement of a single element transducer with the lowest average reflection coefficient would be the optimal position. METHODS: The reflection coefficient is defined by the ratio of the amplitude of the reflected wave to the incident wave. To calculate the reflection coefficient, we assumed ultrasound waves as straight lines (beam lines). At each beam line, the reflection coefficient was calculated from the incidence angle at the skull interface (outer/inner skull surfaces). The average reflection coefficient (ARC) was calculated at each possible placement of the transducer using a custom-built software. For comparison purposes, acoustic simulations (k-Wave MATLAB toolbox) which numerically solved the linear wave equation were performed with the same transducer positions used in the ARC calculation. In addition, the experimental validation of our proposed method was also performed by measuring acoustic wave propagation through the calvaria skull phantom in water. The accuracy of our method was defined as the distance between the two optimal transducer placements which were determined from the acoustic simulations and from the ARC method. RESULT: Simulated acoustic pressure distribution corresponding to each ARC showed an inverse relationship with peak acoustic pressures produced in the brain. In comparison to the acoustic simulations, the accuracy of our method was 5.07 ± 4.27 mm when targeting the cortical region in the brain. The computing time of ARC calculations were 0.08% of the time required for acoustic pressure simulations. CONCLUSION: We calculated the ARC to find the optimal position of the tFUS transducer used in the present study. The optimal placement of the transducer was found when the ARC was the lowest. Our numerical and experimental results showed that the proposed ARC method can effectively be used to find the optimal position of a single-element tFUS transducer for targeting the cortex region of the brain in a computationally inexpensive way.

Survey of ultrasound practice amongst podiatrists in the UK.

BACKGROUND: Ultrasound in podiatry practice encompasses musculoskeletal ultrasound imaging, vascular hand-held Doppler ultrasound and therapeutic ultrasound. Sonography practice is not regulated by the Health and Care Professions Council (HCPC), with no requirement to hold a formal qualification. The College of Podiatry does not currently define ultrasound training and competencies.This study aimed to determine the current use of ultrasound, training received and mentorship received and/or provided by podiatrists using ultrasound. METHODS: A quantitative study utilising a cross-sectional, on-line, single-event survey was undertaken within the UK. RESULTS: Completed surveys were received from 284 podiatrists; 173 (70%) use ultrasound as part of their general practice, 139 (49%) for musculoskeletal problems, 131 (46%) for vascular assessment and 39 (14%) to support their surgical practice. Almost a quarter (n = 62) worked for more than one organisation; 202 (71%) were employed by the NHS and/or private sector (n = 118, 41%).Nearly all (93%) respondents report using a hand-held vascular Doppler in their daily practice; 216 (82%) to support decisions regarding treatment options, 102 (39%) to provide diagnostic reports for other health professionals, and 34 (13%) to guide nerve blocks.Ultrasound imaging was used by 104 (37%) respondents primarily to aid clinical decision making (n = 81) and guide interventions (steroid injections n = 67; nerve blocks n = 39). Ninety-three percent stated they use ultrasound imaging to treat their own patients, while others scan at the request of other podiatrists (n = 28) or health professionals (n = 18). Few use ultrasound imaging for research (n = 7) or education (n = 2).Only 32 (11%) respondents (n = 20 private sector) use therapeutic ultrasound to treat patients presenting with musculoskeletal complaints, namely tendon pathologies.Few respondents (18%) had completed formal post-graduate CASE (Consortium for the Accreditation of Sonographic Education) accredited ultrasound courses.Forty (14%) respondents receive ultrasound mentorship; the majority from fellow podiatrists (n = 17) or medical colleagues (n = 15). Over half (n = 127) who do not have ultrasound mentorship indicated they would like a mentor predominantly for ultrasound imaging. Fifty-five (19%) report they currently provide ultrasound mentorship for others. CONCLUSIONS: Understanding the scope of ultrasound practice, the training undertaken and the requirements for mentorship will underpin the development of competencies and recommendations defined by the College of Podiatry to support professional development and ensure safe practice.

Uso de ultrassom e laser na descontaminação do sistema de canais radiculares: revisão de literatura / Use of ultrasound and laser in root canal decontamination: literature review

O maior obstáculo para o sucesso do tratamento endodôntico é a eliminação da microbiota instalada. A instrumentação mecânica, bem como as substâncias químicas auxiliares, é utilizada para eliminação dessa microbiota. Além das soluções irrigantes, outras técnicas complementares, como a agitação ultrassônica passiva (PUI) e o laser, estão sendo utilizadas para otimizar a eliminação dos microrganismos. Desse modo, o presente estudo objetivou o levantamento bibliográfico de diferentes tipos de agitação dos irrigantes no tratamento endodôntico. A PUI tem sido sugerida como um meio para melhorar o desbridamento do canal. Já o laser tem sido utilizado por apresentar vantagens terapêuticas ao tratamento. Todas as técnicas citadas para melhorar a limpeza dos canais radiculares mostraram alguma melhora. A técnica mais empregada ainda é a agitação ultrassônica, por apresentar eficiência e praticidade no procedimento. Pôde-se concluir que a diminuição da microbiota é mais eficiente quando se utiliza uma maior concentração da solução irrigadora, independentemente da agitação final de escolha.

Use of Noncontact Low-Frequency Ultrasound in Deep Tissue Pressure Injury: A Retrospective Analysis.

PURPOSE: The purpose of this study was to examine the effect of noncontact low-frequency ultrasound (NLFU) on deep tissue pressure injury (DTPI), both hospital-acquired and those present on admission (POA). DESIGN: Retrospective, descriptive study. SAMPLE AND SETTING: Medical records from 44 adult patients with a DTPI treated with NLFU were reviewed; 22 had a hospital-acquired DTPI (HADTPI) and 22 had DTPI POA. Their mean age was 71.3 ± 16.3 years (mean ± SD); 52% were male. The study setting was a 318-bed community hospital in the Mid-Atlantic region of the United States. METHODS: Data were collected from the medical records including demographic and relevant clinical characteristics, DTPI measurements, and DTPI evolution/resolution. Data were summarized and examined using descriptive statistics (eg, frequencies and percentages and means and standard deviations). Differences between groups were examined using paired t tests or the Mann-Whitney U test and the chi-square test as appropriate. In addition, the heel DTPI subgroup (N = 8) was examined separately due to the small sample size. RESULTS: All patients with HADTPI and DTPI POA treated with NLFU exhibited a statistically significant decrease in injury size from initiation to discontinuation of NLFU therapy (24.6 cm vs 14.4 cm, P = .02). No statistically significant difference in wound resolution was found between HADTPI versus DTPI POA (27% vs 18%, P = .47). Mean size of both HADTPI and DTPI POA decreased significantly from 15.9 to 13.4 cm (P = .045) by NLFU therapy. Wounds were classified as resolved at completion of treatment in 23% (10 out of 44) of all treated patients. Of all patients with the potential to be resolved (not discharged early or expired) 63% (10 out of 16) had wounds classified as resolved. CONCLUSION: Study findings suggest that NLFU is a viable and promising treatment option for both HADTPI and DTPI POA. Future studies are needed to confirm these results and to examine efficacy and feasibility of DTPI across care settings.

Hearing Difficulties Among Experienced Dental Hygienists: A Survey.

PURPOSE: Assess prevalence of self-reported hearing difficulties among experienced dental hygienists who have been practicing for a minimum of 20 years and explore the relationship between hearing difficulties and occupational noise exposure from ultrasonic scalers. METHODS: A 19-item survey was mailed to a random sample of 1,067 dental hygienists who had obtained their California licenses between 1972 and 1992. To estimate the prevalence of hearing difficulty, binomial proportion and associated 95% confidence interval are presented. Logistic regression model of hearing difficulty was used to assess an association with ultrasonic scaler use. RESULTS: Response rate was 35% (n=372/1,067). The prevalence of self-reported hearing difficulty was 40% (95% confidence interval, 35 to 44%). Of the 17% (95% confidence interval, 14 to 21%) of respondents that reported hearing difficulty due to ultrasonic scalers, most (91%) reported that their hearing difficulty was confirmed by an audiologist. Respondents with hearing difficulty due to scalers were 2-times (odds ratio: 2.0, 95% confidence interval, 1.1 to 3.6, p=0.03) more likely to report significantly higher scaler use than those who did not have hearing difficulty after adjusting for age and other potential causes of hearing difficulties. CONCLUSION: The prevalence of hearing difficulty at 40% among dental hygienists with an average age of 56 years was considerably higher than the reported national average at 17% for adults 70 years or older. Long-term noise exposure to dental equipment, such as ultrasonic scalers, may contribute to hearing difficulties among experienced dental hygienists. Ear protection is suggested as a preventive measure while using noisy dental equipment.

Point-of-care ultrasound in intensive care units: assessment of 1073 procedures in a multicentric, prospective, observational study.

OBJECTIVE: To describe current use and diagnostic and therapeutic impacts of point-of-care ultrasound (POCUS) in the intensive care unit (ICU). BACKGROUND: POCUS is of growing importance in the ICU. Several guidelines recommend its use for procedural guidance and diagnostic assessment. Nevertheless, its current use and clinical impact remain unknown. METHODS: Prospective multicentric study in 142 ICUs in France, Belgium, and Switzerland. All the POCUS procedures performed during a 24-h period were prospectively analyzed. Data regarding patient condition and the POCUS procedures were collected. Factors associated with diagnostic and therapeutic impacts were identified. RESULTS: Among 1954 patients hospitalized during the study period, 1073 (55%) POCUS/day were performed in 709 (36%) patients. POCUS served for diagnostic assessment in 932 (87%) cases and procedural guidance in 141 (13%) cases. Transthoracic echocardiography, lung ultrasound, and transcranial Doppler accounted for 51, 17, and 16% of procedures, respectively. Diagnostic and therapeutic impacts of diagnostic POCUS examinations were 84 and 69%, respectively. Ultrasound guidance was used in 54 and 15% of cases for central venous line and arterial catheter placement, respectively. Hemodynamic instability, emergency conditions, transthoracic echocardiography, and ultrasounds performed by certified intensivists themselves were independent factors affecting diagnostic or therapeutic impacts. CONCLUSIONS: With regard to guidelines, POCUS utilization for procedural guidance remains insufficient. In contrast, POCUS for diagnostic assessment is of extensive use. Its impact on both diagnosis and treatment of ICU patients seems critical. This study identified factors associated with an improved clinical value of POCUS.

The potential utility of high-intensity ultrasound to treat osteoarthritis.

Osteoarthritis (OA) is a widespread musculoskeletal disease that reduces quality of life and for which there is no cure. The treatment of OA is challenging since cartilage impedes the local and systemic delivery of therapeutic compounds (TCs). This review identifies high-intensity ultrasound (HIU) as a non-contact technique to modify articular cartilage and subchondral bone. HIU enables new approaches to overcome challenges associated with drug delivery to cartilage and new non-invasive approaches for the treatment of joint disease. Specifically, HIU has the potential to facilitate targeted drug delivery and release deep within cartilage, to repair soft tissue damage, and to physically alter tissue structures including cartilage and bone. The localized, non-invasive ultrasonic delivery of TCs to articular cartilage and subchondral bone appears to be a promising technique in the immediate future.

Use of ultrasonography as a diagnostic and therapeutic tool in sports medicine.

Ultrasonography has many important advantages over other imaging modalities and many important applications in sports medicine. This article presents an evidence-based discussion of the use of ultrasound technology to diagnose and treat common musculoskeletal disorders, with emphasis on the shoulder, elbow, hip, knee, and foot and ankle. Topics include basic principles, scan artifacts, the appearance of musculoskeletal structure characteristics and pathologies, and various diagnostic and therapeutic applications in sports medicine.

The role of sonolysis and sonothrombolysis in acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials and case-control studies.

OBJECTIVES: To assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke. SEARCH METHODS: Electronic databases and grey literature were searched under different MeSH terms from 1970 to present. SELECTION CRITERIA: Randomized control trials (RCTs) and case control studies (CCSs) on sonolysis and sonothrombolysis alone or with microsphere in acute stroke patients (>18 old). Outcome measures included complete recanalization (CR) at 1-2 and 24 hours, 3 months modified Rankin Scale (mRS), and symptomatic intracerebral hemorrhage (sICH). Data was extracted to Review Manager software. RESULTS: Fifty-seven studies were retrieved and analyzed. Ten studies (7 RCTs and 3 CCSs) were included in our meta-analysis, which revealed that sonolysis and sonothrombolysis are safe (OR of sICH: 1.14; 95% confidence interval (CI): 0.56- 2.34;P=0.71) and effective (OR of CR at 1-2 hours: 2.95;95% CI: 1.81-4.81;P<0.00001) and have more than two-fold higher likelihood of favourable long-term outcome (3-month mRS 0-2; OR: 2.20; CI:1.52-3.19;P<0.0001). Further subgroup analysis based on the presence of microsphere revealed that it is safe (OR of sICH: 1.18; CI:0.433.24;P=0.75) and effective (OR of CR: 2.61; CI: 1.36-4.99;P=0.004). Subgroup analysis based on sonolysis revealed to be safe and effective. CONCLUSIONS: This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.

Physical therapists in primary care are interested in high quality evidence regarding efficacy of therapeutic ultrasound for knee osteoarthritis: a provincial survey.

Recent high-level evidence favours therapeutic ultrasound (US) for reducing pain in people with knee osteoarthritis (OA). It is unknown how current practice patterns align with current evidence regarding US efficacy and whether physical therapists perceive a need for further high-level evidence. We conducted a descriptive electronic survey to characterize the beliefs and use of US among physical therapists in Ontario treating people with nonsurgical knee OA. Most of the 123 respondents (81%) reported at least some use of US with 45% using it often or sometimes. The main goal for using US was to reduce pain in the surrounding soft tissue (n = 66) and/or the knee joint (n = 43). Almost half (46%) endorsed the belief that US is likely to be beneficial for clients with nonsurgical knee OA. Most respondents (85%) expressed interest in the results of a randomized controlled trial evaluating the effectiveness of US on pain and physical function. Patterns of use reflect the respondents' belief that US is likely to be beneficial for knee OA pain.

[Orthogonal analysis of physical parameters optimization of microbubble-enhanced sono-thrombolysis].

OBJECTIVE: To investigate the main influence factors of microbubble-enhanced sono-thrombolysis by an orthogonal array experimental design (OAD) and to confirm the optimal parameters of microbubble-enhanced sono-thrombolysis in vitro. METHODS: The peripheral blood was collected from 50 female Sprague Dawley rats to prepare the standard plasma, and then 100 microL standard plasma and 25 microL thrombin (0.15 U/microL) were mixed and incubated in 37 degrees C water bath for 3, 6, 12, and 24 hours respectively to prepare corresponding standardized thrombus. The physical parameters for the designed experiments included transmit powers of ultrasound (factor A: 5%, 25%, 50%, and 100%), microbubble volume (factor B: 50, 100, 200, and 400 microL), urokinase (UK) concentration (factor C: 100, 200, 400, and 800 U/mL), and thrombolysis time (factor D: 10, 20, 30, and 40 minutes), respectively. Then an OAD based on four parameters and four levels [L16(4(5))] was employed to optimize the thrombolysis conditions. The ultrasound frequency was 1.82 MHz. HE staining and scanning electron microscope (SEM) were used to observe the clots before and after thrombolysis. The thrombolysis rate was measured. RESULTS: HE staining and SEM observation showed that the fibrin was dissolved after thrombolysis. According to the OAD, the optimal parameter combination was C4-D4-A1-B4, indicating UK concentration 800 U/mL, thrombolysis time 40 minutes, transmit power of ultrasound 5%, and microbubble volume 400 microL, respectively. The four factors above had significant influence on thrombolysis (P < 0.05), and UK concentration was the most significant. There were significant differences in thrombolysis between different thrombolysis time (P < 0.05). CONCLUSION: Under the condition of fixed ultrasound frequency, microbubble-enhanced sono-thrombolysis efficiency is better in lower transmit power of ultrasound, higher UK concentration, longer thrombolysis time, higher microbubble volume, and shorter thrombolysis time.

Phase estimation for a phased array therapeutic interstitial ultrasound probe.

This paper deals about high intensity ultrasound interstitial therapy simulation. The simulated phased array ultrasound probe allows a dynamic electronic focusing of the therapeutic beam. In order to maximize the power deposit at the focal point we propose a method which allows to optimally defining the phase shift of the electrical control signal for each individual element.

Improved healing response in delayed unions of the tibia with low-intensity pulsed ultrasound: results of a randomized sham-controlled trial.

BACKGROUND: We compared the healing response of tibial delayed unions between subjects treated with low-intensity pulsed ultrasound (LIPUS) (n = 51) and subjects treated with a sham device (n = 50). Fracture age was ≥ 4 months in all cases. Study personnel and participants were blinded to random treatment assignment throughout the study. METHODS: This multi-center randomized sham-controlled trial was undertaken at six hospitals in Germany. Adult patients who had sustained a tibial shaft fracture that subsequently showed inadequate progress toward healing (i.e., delayed union) were enrolled and randomized to receive either LIPUS (Exogen 2000/2000+, Smith & Nephew GmbH, Schenefeld, Germany) or an identical nonoperative sham device. The daily treatment duration was 20 minutes, for a period of 16 weeks. Subjects randomly assigned to active treatment had the ultrasound pressure wave signal set at the following parameters: 1.5 MHz frequency, 1 kHz repetition rate, 200 µs pulse duration, 30 mW/cm2 spatial intensity. Progress toward healing was estimated from changes in bone mineral density (BMD) and gap area as determined from computed tomography scans. Intention-to-treat analysis was conducted using a multiple imputation methodology. RESULTS: Based on log-transformed data, mean improvement in BMD was 1.34 (90% confidence interval (CI) 1.14 to 1.57) times greater for LIPUS-treated subjects compared to sham (p = 0.002). A mean reduction in bone gap area also favored LIPUS treatment (p = 0.014). CONCLUSIONS: These findings demonstrate significantly greater progress toward bone healing after LIPUS treatment compared to no LIPUS treatment in subjects with established delayed unions of the tibia.

Safety and efficacy of ultrasound-enhanced thrombolysis: a comprehensive review and meta-analysis of randomized and nonrandomized studies.

BACKGROUND AND PURPOSE: Ultrasound-enhanced thrombolysis is a promising new approach to facilitate reperfusion therapies for acute ischemic stroke. So far, 3 different ultrasound technologies were used to increase the thrombolytic activity of tissue plasminogen activator (tPA), including transcranial Doppler (TCD), transcranial color-coded duplex (TCCD), and low-frequency ultrasound. We performed a meta-analysis to evaluate the safety and efficacy of ultrasound-enhanced thrombolysis compared to the current standard of care (intravenous tPA). SUBJECTS AND METHODS: Through Medline, Embase, and Cochrane database search, we identified and abstracted all studies of ultrasound-enhanced thrombolysis in acute cerebral ischemia. Principal investigators were contacted if data not available through peer-reviewed publication were needed. Symptomatic intracerebral hemorrhage (sICH) and recanalization rates were compared between tPA, tPA+TCD+/-microspheres (microS), tPA+TCCD+/-microS, and tPA+low-frequency ultrasound. RESULTS: A total of 6 randomized (n=224) and 3 nonrandomized (n=192) studies were identified. The rates of symptomatic intracerebral hemorrhage in randomized studies were as follows: tPA+TCD, 3.8% (95% CI, 0%-11.2%); tPA+TCCD, 11.1% (95% CI, 0%-28.9%); tPA+low-frequency ultrasound, 35.7% (95% CI, 16.2%- 61.4%); and tPA alone, 2.9% (95% CI, 0%-8.4%). Complete recanalization rates were higher in patients receiving combination of TCD with tPA 37.2% (95% CI, 26.5%- 47.9%) compared with patients treated with tPA alone 17.2% (95% CI, 9.5%-24.9%). In 8 trials of high-frequency (TCD/TCCD) ultrasound-enhanced thrombolysis, tPA+TCD/TCCD+/-microS was associated with a higher likelihood of complete recanalization (pooled OR, 2.99; 95% CI, 1.70-5.25; P=0.0001) when compared to tPA alone. High-frequency ultrasound-enhanced thrombolysis was not associated with an increased risk of symptomatic intracerebral hemorrhage (pooled OR, 1.26; 95% CI, 0.44-3.60; P=0.67). CONCLUSIONS: The present safety and signal-of-efficacy data of high-frequency ultrasound-enhanced thrombolysis should be taken into account in the design of future randomized controlled trials.

Eligibility and accessibility of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of uterine leiomyomas.

OBJECTIVE: To evaluate patient eligibility and accessibility of magnetic resonance-guided focused ultrasound (MRgFUS) for women with symptomatic uterine leiomyomas who desire conservative therapy. DESIGN: Retrospective analysis of 169 patients referred for minimally invasive treatment of leiomyomas between November 2007 and February 2009. Clinical eligibility for MRgFUS was determined by Food and Drug Administration-based treatment guidelines. All patients underwent pretreatment pelvic imaging to determine candidacy for the procedure. PATIENT(S): Premenopausal women with symptomatic uterine leiomyomas. SETTING: Academic medical center. MAIN OUTCOME MEASURE(S): Eligibility for MRgFUS based on clinical and anatomic patient criteria. RESULT(S): Forty-seven percent of patients (80/169) were determined clinically eligible for the procedure. Of these, 16% of patients (27/169) were found to be eligible for MRgFUS based on imaging results. Overall, the main reasons for ineligibility were very large leiomyomas (8%; 14/169), cost (12%; 21/169), and desired fertility (14%; 23/169). An additional 48% of patients declined MRgFUS for unstated reasons, often after obtaining financial and insurance coverage information. CONCLUSION(S): Currently, many women with leiomyomas are unable to obtain MRgFUS treatment for multiple reasons, including uterine size, desire for fertility, and, most commonly, financial limitations. With increasing clinical experience, further research, and broadened insurance coverage, it may be possible to increase accessibility and expand eligibility criteria for this minimally invasive therapy.

Effects of therapeutic ultrasound and electrical stimulation program on pain, trunk muscle strength, disability, walking performance, quality of life, and depression in patients with low back pain: a randomized-controlled trial.

The aim of this trial is to investigate and compare the effects of electrical stimulation (ES) program and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 59 patients with definite CLBP were enrolled in this study. These patients were randomized into three groups. Group 1 (n = 20) was given an ES program and exercises. Group 2 (n = 19) was given an US treatment and exercises. Group 3 (n = 20) was accepted as the control group and was given only exercises. All of the programs were performed 3 days a week, for 6 weeks. The patients were evaluated according to pain, disability, walking performance, endurance, mobility, QOL, depression. The trunk muscle strength was measured with a hand-held dynamometer. All of the groups showed stastically significant improvements in pain, disability, muscle strength, endurance, walking performance, mobility, sub-scores of SF 36, and depression when compared with their initial status. The intergroup comparison showed significant difference in physical function, energy and social function sub-groups of SF-36, VAS pain, extensor muscle strength, between three groups. This difference was statistically significant in the groups 1 and 2 compared to the control group. There was also no significant difference between the groups 1 and 2. We observed that US treatment and ES treatment were effective in improving pain, isometric extensor muscle strength, and QOL in patients with CLBP.

The management of neuropathic ulcers of the foot in diabetes by shock wave therapy.

BACKGROUND: Diabetes is becoming one of the most common chronic diseases, and ulcers are its most serious complication. Beginning with neuropathy, the subsequent foot wounds frequently lead to lower extremity amputation, even in the absence of critical limb ischemia. In recent years, some researchers have studied external shock wave therapy (ESWT) as a new approach to soft tissue wound healing. The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers. METHODS: We designed a randomized, prospective, controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies. One group was treated with standard care and shock wave therapy. The other group was treated with only standard care. The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization. RESULTS: After 20 weeks of treatment, 53.33% of the ESWT-treated patients had complete wound closure compared with 33.33% of the control patients, and the healing times were 60.8 and 82.2 days, respectively (p < 0.001). Significant differences in the index of the re-epithelization were observed between the two groups, with values of 2.97 mm2/die in the ESWT-group and 1.30 mm2/die in the control group (p < 0.001). CONCLUSION: Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration.

A national study of the availability and use of electrophysical agents by Australian physiotherapists.

Electrophysical agents (EPAs) are a core part of physiotherapy practice and entry level education. With the increase in the number of EPAs over time, their availability and use in contemporary physiotherapy practice is an important consideration when determining entry level curricula. Thus, the aim of the study was to ascertain the current availability and usage of EPAs in Australian physiotherapy practice. A purpose-designed questionnaire was mailed to all registered physiotherapists in Australia. A response rate of 27% was obtained (n=3,538). Nonresponder analyses indicated that the results were representative of the total population of Australian physiotherapists. Over 70% of respondents had access to ultrasound, cold packs/ice, heat packs, electrical stimulation for sensory stimulation, and interferential therapy. Two main groups of EPAs were used relatively frequently. The first group was used daily or monthly by 60% of respondents (ultrasound, hot packs, and cold packs/ice), and a second group (electromyographic and pressure biofeedback, interferential therapy, and electrical stimulation for sensory stimulation) was used on a daily or monthly basis by between 30% and 45% of the sample. A group of EPAs, including ultraviolet light, microwave, and shortwave diathermy, was not used by over 90% of the sample. The study has provided contemporary national data on EPA availability and use in Australia.