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Photo-sono therapy (PST) is an innovative anti-vascular approach based on cavitation-induced spallation. Currently, passive cavitation detection (PCD) is the prevalent technique for cavitation monitoring during treatment. However, the limitations of PCD are the lack of spatial information of bubbles and the difficulty of integration with the PST system. To address this, we proposed a new, to the best of our knowledge, cavitation mapping method that integrates Doppler optical coherence tomography (OCT) with PST to visualize bubble dynamics in real time. The feasibility of the proposed system has been confirmed through experiments on vascular-mimicking phantoms and in vivo rabbit ear vessels, and the results are compared to high-speed camera observations and PCD data. The findings demonstrate that Doppler OCT effectively maps cavitation in real time and holds promise for guiding PST treatments and other cavitation-related clinical applications.

Fenugreek (Trigonella foenum-graecum L.) is a pharmaceutically significant aromatic crop with health benefits linked to its phytochemicals. This article aims to overview progress in using emerging technologies to extract its bioactive compounds and extraction mechanisms. Also, the trends in the applications of this herb in the food industry and its therapeutical effects were explained. Fenugreek's flavor is the primary reason for its applications in the food industry. At the same time, it has antimicrobial, antibacterial, hepatoprotection, anticancer, lactation, and antidiabetic effects. Phytochemicals responsible for these effects include galactomannans, saponins, alkaloids, and polyphenols. Besides, data showed that emerging technologies boost fenugreek extracts' yield and biological activity. Among these, ultrasound (55.6%) is the most studied technology, followed by microwave (37.0%), cold plasma (3.7%), and combined approaches (3.7%). Processing conditions (e.g., treatment time and intensity) and solvent (type, ratio, and concentration) are significant parameters that affect the performance of these novel extraction technologies. Extracts obtained by sustainable energy-saving emerging technologies can be used to develop value-added health-promoting products. HIGHLIGHTS: Fenugreek's phytochemicals (e.g., galactomannans and polyphenols) have therapeutic effects Ultrasound and microwave are major emerging technologies for fenugreek's bioactive compound extraction Emerging technologies enhance the yield and biological activities of fenugreek extracts Emerging extraction technologies can develop fenugreek-based products with health benefits [ABSTRACT FROM AUTHOR]

Background: While the benefits of sonication for improving periprosthetic joint infection (PJI) are well-documented, its potential therapeutic effect against bacterial biofilm remains unstudied. This study aimed to investigate the safety and efficacy of a novel nanoparticle ultrasonication process on methicillin-resistant Staphylococcus aureus (MRSA) bacterial biofilm formation in a PJI rat model. Methods: This novel ultrasonication process was designed to remove attached bacterial biofilm from implant and peri-articular tissues, without damaging native tissues or compromising implant integrity. Twenty-five adult Sprague–Dawley rats underwent a surgical procedure and were colonized with intra-articular MRSA, followed by the insertion of a titanium screw. Three weeks after the index surgery, the animals received a second procedure during which the screws were explanted, and soft tissue was sampled. The intraoperative use of the nanoparticle sonication treatment was employed to assess the device's safety, while ex vivo treatment on the retrieved tissue and implants was used to evaluate its efficacy. Results: Clinical and histological assessments did not indicate any macro- or micro-damage to the host tissue. Sonication of the retrieved tissues demonstrated an average bacterial removal of 2 × 103 CFU/mL and 1 × 104 CFU/gram of tissue. Compared to the standard-of-care group (n = 10), implants treated with sonication (n = 15) had significantly lower remaining bacteria, as indicated by crystal violet absorbance measurements (P = 0.012). Conclusions: This study suggests that nanoparticle sonication technology can successfully remove attached bacterial biofilms from explanted orthopedic hardware and the joint capsule, without negatively affecting native tissue. The study provides initial results supporting the potential of nanoparticle sonication as an adjuvant treatment option during a DAIR (debridement, antibiotics, and implant retention) procedure for PJI, paving the way for future clinical trials. [ABSTRACT FROM AUTHOR]

The management of adenomyosis has undergone significant evolution, moving from traditional surgical interventions like hysterectomy to more conservative methods aimed at preserving fertility. Essential roles have been played by uterine-sparing surgeries and uterine artery embolization. Despite these advancements, there is a growing interest in less invasive alternatives. This review delves into the potential of high-intensity focused ultrasound (HIFU). HIFU employs focused ultrasound waves for precise ablation of adenomyotic lesions. The review conducts a thorough analysis of HIFU principles, safety, efficacy, and its possible synergies with other therapies. HIFU seems to be effective for adenomyosis treatment, demonstrating a favorable adverse effect profile and suitability for fertility preservation. Combining HIFU with hormonal treatment appears to enhance long-term symptom control, presenting a promising and comprehensive approach for managing adenomyosis. The goal of this article is to develop a comprehensive understanding of HIFU's role in contemporary adenomyosis management and to explore areas requiring further research. [ABSTRACT FROM AUTHOR]

Background and Purpose: Sonothrombolysis is a potential adjunctive therapy for large vessel occlusion (LVO) stroke. Bedside ultrasound image‐guided high‐intensity focused ultrasound (HIFU) therapy could deliver higher energy therapeutic ultrasound to the thrombus with higher precision than what was previously accomplished in human trials. The aim is to test the feasibility of diagnostic transcranial contrast‐enhanced ultrasound (CEUS) to image the occlusion site and continuously maintain the guidance image on‐target for a sufficient exposure time for HIFU to be effective during LVO stroke evaluation and treatment. Methods: This prospective, single center, observational cohort study included adult patients, presenting within 6 hours of stroke symptom onset, with LVO identified on computed tomography angiography (CTA). A hand‐held CEUS imaging study was initiated following CTA and lasted up to 30 minutes. The primary outcome is the proportion of patients where a guidance CEUS image of the occlusion was achieved. Results: A CEUS image of the occluded artery was obtained in 32/35 of the included patients. The median total imaging time was 23 minutes (interquartile range 15‐30). Patients undergoing thrombectomy had a lower total imaging time (17 vs. 29.5 minutes, p =.002). When imaging was successful, on‐target image was maintained for only 58% (standard deviation 23.8%) of total imaging time. No complications related to CEUS were observed. Conclusions: This feasibility study explored the use of diagnostic transcranial CEUS for continuous imaging of occlusion sites in LVO strokes. Challenges in maintaining target image during HIFU were identified, highlighting the need for technical advances for clinical application. [ABSTRACT FROM AUTHOR]

Simple Summary: STING agonists face challenges in breast cancer treatment due to their lower accumulation in tumors and rapid clearance from the body, resulting in a short duration of therapeutic effect. Novel phase-transitional liposomes loaded with STING agonists have been developed to overcome these limitations and are specifically designed for low-intensity focused ultrasound (LIFU)-assisted molecular imaging and precise treatment of breast cancer. With the assistance of LIFU, iRGD-modified liposomes (a targeting peptide) undergo a phase transition into microbubbles, leading to enhanced ultrasound molecular imaging of tumors and facilitating breast cancer immunotherapy by releasing STING agonists from the ultrasound-targeted liposomes. Background: Pharmacologically targeting the STING pathway offers a novel approach to cancer immunotherapy. However, small-molecule STING agonists face challenges such as poor tumor accumulation, rapid clearance, and short-lived effects within the tumor microenvironment, thus limiting their therapeutic potential. To address the challenges of poor specificity and inadequate targeting of STING in breast cancer treatment, herein, we report the design and development of a targeted liposomal delivery system modified with the tumor-targeting peptide iRGD (iRGD-STING-PFP@liposomes). With LIFU irradiation, the liposomal system exploits acoustic cavitation, where gas nuclei form and collapse within the hydrophobic region of the liposome lipid bilayer (transient pore formation), which leads to significantly enhanced drug release. Methods: Transmission electron microscopy (TEM) was used to investigate the physicochemical properties of the targeted liposomes. Encapsulation efficiency and in vitro release were assessed using the dialysis bag method, while the effects of iRGD on liposome targeting were evaluated through laser confocal microscopy. The CCK-8 assay was used to investigate the toxicity and cell growth effects of this system on 4T1 breast cancer cells and HUVEC vascular endothelial cells. A subcutaneous breast cancer tumor model was established to evaluate the tumor-killing effects and therapeutic mechanism of the newly developed liposomes. Results: The liposome carrier exhibited a regular morphology, with a particle size of 232.16 ± 19.82 nm, as indicated by dynamic light scattering (DLS), and demonstrated low toxicity to both HUVEC and 4T1 cells. With an encapsulation efficiency of 41.82 ± 5.67%, the carrier exhibited a slow release pattern in vitro after STING loading. Targeting results indicated that iRGD modification enhanced the system's ability to target 4T1 cells. The iRGD-STING-PFP@liposomes group demonstrated significant tumor growth inhibition in the subcutaneous breast cancer mouse model with effective activation of the immune system, resulting in the highest populations of matured dendritic cells (71.2 ± 5.4%), increased presentation of tumor-related antigens, promoted CD8+ T cell infiltration at the tumor site, and enhanced NK cell activity. Conclusions: The iRGD-STING-PFP@liposomes targeted drug delivery system effectively targets breast cancer cells, providing a new strategy for breast cancer immunotherapy. These findings indicate that iRGD-STING-PFP@liposomes could successfully deliver STING agonists to tumor tissue, trigger the innate immune response, and may serve as a potential platform for targeted immunotherapy. [ABSTRACT FROM AUTHOR]

This study assessed whether symptoms of muscle damage could be reduced by a combination of therapeutic ultrasound and electrical stimulations, and whether this could be enhanced by blood flow restriction. Before and 48 h after performing eccentric elbow flexion exercises, individuals completed assessments of muscle damage. A 10-min therapeutic ultrasound and electrical stimulation treatment was then applied with and without blood flow restriction to assess short (5 min) and long-term (24 h) improvements. Twenty-three individuals completed the study (11 females). Data were analysed using Bayesian repeated measures ANOVAs. The damaging exercise increased discomfort (BF10 = 2.93e14) and relaxed joint angle (BF10 = 2425.90) while decreasing pain pressure threshold (BF10 = 289.71). Each of these variables was acutely improved with the combination treatment protocol (all BF10 ≥ 74) with no added effect of blood flow restriction. A combination of therapeutic ultrasound and interferential electrical stimulations appeared effective at acutely alleviating symptoms of muscle damage with no additive effect of blood flow restriction. [ABSTRACT FROM AUTHOR]

Objective: A recent study was designed to ascertain the impact of extracorporeal shock wave therapy on upper trapezius trigger points in cervicogenic headaches patients. Design: A double-blinded randomized controlled trial study, in which 50 participants (11 male and 39 female) aged between 20–40 with cervicogenic headache were subdivided with randomization to group (A), which received traditional physical therapy and sham shock wave therapy, and group (B), which received traditional physical therapy and actual shock wave therapy. All assessments were performed by a therapist before and after the treatment program (4 wks). Results: There was a significant difference of headache disability index, visual analog scale scores, and upper trapezius electromyographic characteristics with P value <0.05 in both groups, in favor of the shock wave group. Conclusions: Extracorporeal shock wave therapy could be used for clinical and research concerns because its positive effects on pain suppression, reduction of headache intensity, and restoration of muscle regular activity in cervicogenic headache patients. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound demonstrates significant potential in biomedical research due to its noninvasive, real-time visualization, cost-effectiveness, and other biological benefits. Ultrasound irradiation can precisely control the mechanical and physicochemical effects on pathogenic lesions, enabling real-time visualization, tunable tissue penetration depth, and therapeutic applications. This review summarizes recent advancements in ultrasound-enabled diagnostics and therapeutics, focusing on mechanochemical effects that can be directly integrated into biomedical applications. Additionally, the structure-functionality relationships of sonotheranostic nanoplatforms are systematically discussed, providing insights into the underlying biological effects. Finally, the limitations of current ultrasonic medicine are discussed, along with potential expansions to facilitate patient-centered translations. This review summarizes the recent progress in the development of ultrasound-derived systems for ultrasonic molecular bioimaging and ultrasound-activatable therapy, with deep insights into the action mechanism, clinical challenges, and corresponding remedies. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To assess the reduction in pain, muscle tenderness, joint clicking, and improvement in mouth opening (MO) after low-level laser therapy (LLLT) compared to transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) among temporomandibular joint disorder (TMD) patients. Methods: A systematic search of online sources of electronic databases was undertaken. The quality of the study was assessed using the Cochrane risk of bias assessment tool for randomized controlled trials (RCTs). Results: Twelve RCTs were included in the systematic review, and 9 were included in the meta-analysis. For reduction in pain between LLLT and TENS, LLLT was found to be better than TENS, at 95% CI. LLLT was also proven to be better in reducing pain than therapeutic US, at 81% CI. Conclusion: This systematic review and meta-analysis compared the effectiveness of LLLT, TENS, and therapeutic US in TMD. LLLT provided relatively more effective pain relief and improvement in MO. [ABSTRACT FROM AUTHOR]

Introduction: Through a network meta-analysis, we compared different treatment measures for patients with diabetic foot ulcers (DFU), assessing their impact on the healing of DFU and ranking them accordingly. Methods: We searched the PubMed, the China National Knowledge Infrastructure (CNKI), Embase, the WanFang and the WeiPu database. The retrieval time was from database establishment to January 2024, and retrieval entailed subject and free words. Randomized controlled trials (RCTs) with different treatment measures for DFU were included. Data extraction and evaluation were based on the PRISMA guidelines. Meta-analyses using pairwise and network methods were employed to compare and rank the effectiveness of different treatments for DFU. Results: Ultimately, we included 57 RCTs involving a total of 4,826 patients with DFU. When it comes to ulcer healing rates, compared to standard of care(SOC), platelet-rich plasma(PRP), hyperbaric oxygen therapy(HBOT), topical oxygen therapy(TOT), acellular dermal matrix(ADM), and stem cells(SCs) in both direct meta-analysis(DMA) and network meta-analysis(NMA) can effectively increase the complete healing rate. For Scs+PRP, a statistically significant improvement was only observed in the NMA. Moreover, when compared to the negative pressure wound therapy(NPWT) group, the PRP+NPWT group was more effective in promoting the complete healing of ulcers. In terms of promoting the reduction of ulcer area, no statistical differences were observed among various treatment measures. When it comes to ulcer healing time, both PRP and NPWT can effectively shorten the healing time compared to SOC. Furthermore, when compared to the NPWT group, the combined treatment of PRP and ultrasonic debridement(UD) with NPWT is more effective in reducing healing time. In terms of amputation rates and adverse reactions, the PRP group effectively reduced the amputation rate and adverse reactions for patients with DFU. Additionally, compared to the NPWT group, the combined treatment of PRP and UD with NPWT reduced the incidence of adverse reactions. However, no significant differences were observed among other treatment measures in terms of amputation rates and adverse reactions. The ranking results showed that the efficacy of PRP+NPWT and UD+NPWT in promoting ulcer healing, reducing ulcer area, shortening healing time, decreasing amputation rates and adverse reactions is superior to that of the alone PRP group, NPWT group, and UD group. Conversely, the SOC group demonstrates the least effective performance in all aspects. Conclusion: Due to the particularity of the wound of DFU, the standard of care is not effective, but the new treatment scheme has a remarkable effect in many aspects. And the treatment of DFU is not a single choice, combined with a variety of methods often achieve better efficacy, and will not bring more adverse reactions. [ABSTRACT FROM AUTHOR]

The basal ganglia are involved in motor control and action selection, and their impairment manifests in movement disorders such as Parkinson's disease (PD) and dystonia, among others. The complex neuronal circuitry of the basal ganglia is located deep inside the brain and presents significant treatment challenges. Conventional treatment strategies, such as invasive surgeries and medications, may have limited effectiveness and may result in considerable side effects. Non-invasive ultrasound (US) treatment approaches are becoming increasingly recognized for their therapeutic potential for reversibly permeabilizing the blood-brain barrier (BBB), targeting therapeutic delivery deep into the brain, and neuromodulation. Studies conducted on animals and early clinical trials using ultrasound as a therapeutic modality have demonstrated promising outcomes for controlling symptom severity while preserving neural tissue. These results could improve the quality of life for patients living with basal ganglia impairments. This review article explores the therapeutic frontiers of ultrasound technology, describing the brain mechanisms that are triggered and engaged by ultrasound. We demonstrate that this cutting-edge method could transform the way neurological disorders associated with the basal ganglia are managed, opening the door to less invasive and more effective treatments. [ABSTRACT FROM AUTHOR]

Transalveolar sinus elevation is a minimally invasive technique aimed at augmenting the vertical bone height in the posterior maxilla, facilitating successful implant placement in areas with insufficient bone volume. This study compares the efficacy of osseodensification and piezoelectric internal sinus elevation (PISE) techniques in delayed implant placement. The primary objective was to radiographically assess vertical bone gain and bone density, while secondary objectives included clinical assessment of primary implant stability and post-operative satisfaction of both patients and operators. The study population of a total of 16 patients was randomly divided into two groups. Group 1 underwent osseodensification sinus lift using sticky bone as a graft material, whereas Group 2 received PISE with the same graft material. Results indicated that the osseodensification technique led to greater bone gain, improved bone density, and shorter surgical duration. Additionally, osseodensification was associated with enhanced rapid healing and higher patient satisfaction. Conversely, the PISE technique demonstrated superior primary stability of implants on the day of surgery. These findings suggest that while both techniques are effective, osseodensification may offer advantages in terms of bone gain, density, and patient satisfaction, making it a reliable method for enhancing rapid healing in delayed implant placement. the study was registered on clinicaltrials.gov at 26th September 2023 and clinical trials ID is NCT06055127. [ABSTRACT FROM AUTHOR]

Background: Patellar tendinopathy (PT) is a common sport injury prone to recurrence. Heavy Slow Resistance Training (HSR) and High-Dose Therapeutic Ultrasound (TUS) are frequently used interventions for PT. However, the combined effectiveness of these therapies remains unclear. This study investigated the impact of combination therapy on functional outcomes in patients with PT. Methods: Fifty-one college students aged 18–25, diagnosed with PT via musculoskeletal ultrasound, were randomly assigned to one of three groups (n = 17 per group): combined HSR and high-dose TUS, HSR training alone, or high-dose TUS alone. The eight-week intervention included assessments using the Victorian Institute of Sport Assessment-Patella (VISA-P), Visual Analogue Scale (VAS), Y-balance Test (YBT), Modified Thomas Test (MTT), Horizontal Jumping Distance, Maximum Isometric Muscle Strength Test, and musculoskeletal ultrasound for patellar tendon thickness and blood flow. Assessments were conducted at baseline and post-intervention, with a follow-up VISA-P assessment at week 16. This randomized, single-blind controlled trial was registered on ISRCTN11447397 (www.ISRCTN.com) on February 17, 2024 (retrospectively registered). Results: All groups demonstrated significant improvements in VISA-P scores at the end of the intervention compared to baseline (p < 0.01), with the combined group showing the greatest improvement (21 points). Follow-up at week 16 revealed continued improvement in VISA-P scores for the combined and HSR groups, while the TUS group showed a slight decrease (from 74 to 70). All groups displayed significantly reduced VAS scores post-intervention (p < 0.01) compared to baseline, indicating decreased pain. While no significant between-group differences were observed in pre-intervention VAS scores, post-intervention results revealed significant differences between the combined and HSR groups (p < 0.05), as well as between the combined and TUS groups (p < 0.01). Conclusion: Both exercise intervention and high-dose TUS appear effective in reducing pain and improving motor function in individuals with PT. However, the therapeutic effect of high-dose TUS alone seems limited compared to exercise intervention. The combined application of both methods yielded the most significant improvements in pain relief and motor function enhancement. [ABSTRACT FROM AUTHOR]

Previous studies assessed the effect of extracorporeal shockwave therapy (ESWT) for knee osteoarthritis (OA) among different situations. Thus, results from a meta-analysis regarding this topic may not be reliable due to heterogeneity. A systematic review was conducted on three internet databases, namely Cochrane Library, PubMed, and Embase, gathering pertinent papers from their establishment to March 2024. The search phrases were as follows: "shockwave" OR "shock wave" OR "extracorporeal shockwave" OR "Extracorporeal Shockwave Therapy [MeSH Term]" AND "knee" AND ("osteoarthritis" OR "arthritis" OR "arthritic" OR "osteoarthritis [MeSH term]"). Twenty-four articles (n = 888) were included, with the resulting conclusions demonstrating that ESWT was effective for knee OA compared with sham ESWT; however, ESWT was not effective for patients with severe knee OA. Patients receiving higher energy or higher shock number had significant improvement than those receiving lower energy or less shock number, respectively. Adding ESWT in isokinetic muscular strengthening exercises (IMSE) was more effective than IMSE alone. The efficacy of ESWT was better than other therapies, including intravenously applied prostacyclin and bisphosphonate, corticosteroid injection, kinesiotherapy, hyaluronic acid injection, platelet-rich plasma injection, and physiotherapy. This review demonstrated that ESWT was effective for knee OA. Higher energy and more shock numbers could obtain better efficacy. ESWT could be used as a replacement for some other therapies. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis (PF) is the most common cause of heel pain affecting both young active patients and older sedentary individuals. It most often arises as a result of degenerative changes in the proximal plantar fascia. Aim: The purpose of this study was to investigate the effect of extracorporeal shockwave on gait parameters in patients with plantar fasciitis. Design: A randomized controlled clinical trial. Setting: The outpatient physiotherapy clinic of the teaching hospital Shibin El Kom. Methods: Participants were randomly divided into two equal groups. Group (A) (study group): received extracorporeal shockwave therapy one session per week and traditional treatment (ultrasound, stretching exercises, and strengthening exercises) three sessions per week for 4 weeks. Group (B)(the control group): received traditional treatment (ultrasound, stretching exercises, and strengthening exercises) 3 sessions per week for 4 weeks. The pre- and post-treatment development of the patients was evaluated by visual analog scale (VAS) to measure pain, foot function index (FFI) to measure foot function, and Kinovea software to analyze gait parameters (stride length, stride time, walking speed, and cadence). Results: Both groups showed improvement in all study variables, but the study group showed more improvement. There was a statistically significant decrease in VAS (p = 0.001), a significant decrease in FFI (p = 0.001), a significant increase in stride length (p = 0.001), a significant decrease in stride time (p = 0.001), a significant increase in walking speed (p = 0.001), and a significant increase in cadence (p = 0.01) post-treatment compared to group (B). Conclusion: Extracorporeal shockwave treatment is regarded as a useful treatment for improving gait parameters in patients with plantar fasciitis. Clinical rehabilitation impact: Extracorporeal shockwave therapy improved gait parameters in patients with plantar fasciitis as it increases stride length, walking speed, cadence, and decreases stride time. So, it is recommended to be included in the rehabilitation program for patients with plantar fasciitis and gait disabilities. [ABSTRACT FROM AUTHOR]

Background: The aim of the randomized controlled clinical trial study was to evaluate the effectiveness in reducing pathologically increased pocket probing depths (PPD > 3 mm) using the Guided Biofilm Therapy (GBT) protocol (adapted to the clinical conditions in non-surgical periodontal therapy (NSPT): staining, air-polishing, ultrasonic scaler, air-polishing) compared to conventional instrumentation (staining, hand curettes/sonic scaler, polishing with rotary instruments) both by less experienced practitioners (dental students). Methods: All patients were treated according to a split-mouth design under supervision as diseased teeth of quadrants I/III and II/IV randomly assigned to GBT or conventional treatment. In addition to the treatment time, periodontal parameters such as PPD and bleeding on probing (BOP) before NSPT (T0) and after NSPT (T1: 5 ± 2 months after T0) were documented by two calibrated and blinded examiners (Ethics vote/ Trial-register: Kiel-D509-18/ DRKS00026041). Results: Data of 60 patients were analyzed (stage III/IV: n = 36/ n = 24; grade A/ B/ C: n = 1/ n = 31/ n = 28). At T1, a PPD reduction of all diseased tooth surfaces was observed in 57.0% of the GBT group and 58.7% of the control group (p = 0.067). The target endpoint (PPD ≤ 4 mm without BOP) was achieved in 11.5% for GBT (conventional treatment: 11.2%; p = 0.714). With the exception for number of sites with BOP, which was at T1 15.9% in the GBT group and 14.3% in the control group (p < 0.05) no significant differences between the outcomes of the study were found. At 30.3(28.3) min, the treatment time was significantly shorter in GBT than in the control group at 34.6(24.5) min (p < 0.001). Conclusions: With both protocols (GBT/ conventional instrumentation) comparably good clinical treatment results can be achieve in NSPT in stage III-IV periodontitis patients. Trial registration: The study was registered before the start of the study and can be found under the number DRKS00026041 in the German Clinical Trials Register. The registration date was 19/08/2021. [ABSTRACT FROM AUTHOR]

Simple Summary: Recently, sonodynamic therapy (SDT) has emerged as a promising non-invasive approach for treating cancer by activating sensitizers with ultrasound (US). In this context, we investigated C60 fullerene (C60) as a nanocarrier for the promising drug Berberine (Ber)—both potential aromatic sonosensitizers. The preferential mitochondrial accumulation of C60 and the proapoptotic effects of Ber also make the C60-Berberine nanocomplex (C60-Ber) a good candidate for direct induction of the intrinsic apoptotic cell death under US action. The in vitro research on C60-Ber can provide insights into novel, non-invasive cancer treatments. These findings lead to the development of targeted therapies with reduced side effects, inspire interdisciplinary collaboration, and open new avenues for drug delivery and cancer therapy research. Objectives: The primary objective of this research targeted the biochemical effects of SDT on human cervix carcinoma (HeLa) and mouse Lewis lung carcinoma (LLC) cells grown in 2D monolayer and 3D spheroid cell culture. Methods: HeLa and LLC monolayers and spheroids were treated with a 20 µM C60-Ber for 24 h, followed by irradiation with 1 MHz, 1 W/cm2 US. To evaluate the efficacy of the proposed treatment on cancer cells, assessments of cell viability, caspase 3/7 activity, ATP levels, and ROS levels were conducted. Results: Our results revealed that US irradiation alone had negligible effects on LLC and HeLa cancer cells. However, both monolayers and spheroids irradiated with US in the presence of the C60-Ber exhibited a significant decrease in viability (32% and 37%) and ATP levels (42% and 64%), along with a notable increase in ROS levels (398% and 396%) and caspase 3/7 activity (437% and 246%), for HeLa monolayers and spheroids, respectively. Similar tendencies were observed with LLC cells. In addition, the anticancer effects of C60-Ber surpassed those of C60, Ber, or their mixture (C60 + Ber) in both cell lines. Conclusions: The detected intensified ROS generation and ATP level drop point to mitochondria dysfunction, while increased caspase 3/7 activity points on the apoptotic pathway induction. The combination of 1 W/cm2 US with C60-Ber showcased a promising platform for synergistic sonodynamic chemotherapy for cancer treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Submicron bubbles, known as nanobubbles, are demonstrated to overcome the limitations of microbubbles. The small size of the bubbles allows it to penetrate the vascular endothelial wall, enabling it to move freely through tumor tissues. Studies suggest that ultrasound-stimulated nanobubbles (USNBs) enhance the effect of existing cancer therapies (chemotherapy, immunotherapy, and/ or radiation therapy). This review overviews recent research on nanobubbles and their combinatory biological effects with existing cancer therapies. In recent years, ultrasound-stimulated microbubbles (USMBs) have gained great attention because of their wide theranostic applications. However, due to their micro-size, reaching the targeted site remains a challenge. At present, ultrasound-stimulated nanobubbles (USNBs) have attracted particular interest, and their small size allows them to extravasate easily in the blood vessels penetrating deeper into the tumor vasculature. Incorporating USNBs with existing cancer therapies such as chemotherapy, immunotherapy, and/or radiation therapy in several preclinical models has been demonstrated to have a profound effect on solid tumors. In this review, we provide an understanding of the composition and formation of nanobubbles (NBs), followed by the recent progress of the therapeutic combinatory effect of USNBs and other cancer therapies in cancer treatment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. Methods: 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. Results: After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. Conclusion: ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients. Implications for Rehabilitation: Extracorporeal shock wave therapy represents a useful non-invasive, additional modality for reduction of foot spasticity and equinus deformity in chronic stroke patients. The application of such a modality improves limb posture, range of motion, and muscle extensibility. Early extracorporeal shock wave rehabilitative intervention in stroke patients reduces fat infiltration and fibrosis replacement of spastic muscle. [ABSTRACT FROM AUTHOR]

Background: Infected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment. Methods: A total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05). Results: In the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05). Conclusions: UI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the efficacy of five analgesic strategies combined with conventional physiotherapy program (CPT) in managing chronic shoulder pain. Methods: Two authors independently screened studies, extracted data using a pre-formatted chart, and assessed bias using the Cochrane Risk of Bias tool. A network meta-analysis was performed by the Stata 17.0 and R 4.3.2 software. Results: A total of 14 studies with 862 subjects were identified. These analgesic strategies included extracorporeal shock wave therapy (ESWT), suprascapular nerve block (SSNB), corticosteroid injection (CSI), hyaluronic acid injection (HAI), and kinesio taping (KT). ESWT plus CPT was the most efficient intervention in alleviating pain intensity and improving physical function. SSNB plus CPT was the optimal intervention in improving shoulder mobility. Compared to CPT alone, CSI + CPT only significantly improved the SPADI total score, but showed no difference in pain intensity or shoulder mobility. HAI + CPT showed no significant difference in improving pain intensity, physical function, or shoulder mobility compared to CPT alone. Adding KT to CPT did not yield additional benefits in improving shoulder mobility. Conclusion: Overall, in managing chronic shoulder pain, ESWT + CPT was the most effective intervention for reducing pain intensity and improving physical function. SSNB + CPT was optimal for enhancing shoulder mobility. Future rigorous clinical trials with larger sample sizes and higher methodological rigor are strongly required to confirm the current results. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sustained acoustic medicine (SAM) is a noninvasive long-term treatment that provides essential mechanical and thermal stimulus to accelerate soft tissue healing, alleviate pain, and improve physical activity. SAM increases localized deep tissue temperature, blood flow, cellular proliferation, migration, and nutrition exchange, resulting in reduced inflammation and an increased rate of tissue regeneration. OBJECTIVE: To assess the efficacy of SAM treatment of discogenic back pain in the lower spinal column to reduce pain, improve quality of life, and lower pharmacotherapy use. METHODS: Sixty-five subjects with chronic low back pain were randomly assigned to SAM (N = 33) or placebo (N = 32) groups. Subjects self-applied SAM device bilaterality on the lower lumbar region for 4 hours daily for 8 weeks and completed daily pain diaries before, during, and after treatment. Subjects recorded pain reduction using a numeric rating scale (NRS), medication use, and physical activity using the Global Rating of Change (GROC) and Oswestry Disability Index (ODI). RESULTS: SAM treatment significantly reduced chronic lower back pain from baseline relative to placebo treatment (p < 0.0001). SAM treated subjects reported significantly lower back pain at 4 weeks, with the highest pain reduction (- 2.58 points NRS, p < 0.0001) reported at 8 weeks. Similar trends were observed in improved physical activity (3.48 GROC, p < 0.0001, 69–88% ODI, p < 0.0001) and 22.5% (15.2 morphine milligram equivalent) reduction in the use of opioid medication from baseline to 8 weeks. CONCLUSION: Daily, home-use SAM treatment significantly improves the clinical symptoms of chronic lower back pain, improves physical mobility, and reduces daily medication use. SAM treatment is well-tolerated by patients and may be considered a safe, non-invasive treatment option for chronic discogenic, lower back pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: Ultrasound has a long history as a diagnostic and therapeutic tool. Low-intensity pulsed ultrasound (LIPUS), whose intensity is below 300 mW/cm2, has been widely used in orthopedic rehabilitation treatment. However, the detailed bioeffects and underlying mechanisms of LIPUS treatment need to be explored. OBJECTIVE: To make a comprehensive view of the field, bibliometric and visualization analysis was used to reveal the global research trends of LIPUS in orthopedics and rehabilitation treatment between 1994 and 2023. METHODS: All literature data on LIPUS were retrieved from the Web of Science Core Collection database. VOSviewer and CiteSpace were applied for the bibliometric and visualization analysis. RESULTS: A total of 760 publications were included. The distribution of publications generally showed an unstable rising trend. China had the highest number of publications (28.0%), and Chong Qing Medical University was the organization with the highest number of publications (5.8%). Ultrasound in Medicine and Biology had the highest number of publications (8.8%), while BMJ-British Medical Journal had the highest impact factor among the retrieved journals. Ling Qin from the Chinese University of Hong Kong was the most active researcher. Our overlay visualization map showed that the keywords such as pain, knee osteoarthritis, apoptosis, chondrocytes, cartilage, and autophagy, which link to osteoarthritis, have becoming the new research trends and hotspots. CONCLUSION: LIPUS is a popular and increasingly important area of orthopedic rehabilitation, and collaboration of authors from different countries should be further strengthened. Predictably, clinical application of LIPUS on chronic inflammation-related diseases and regenerative medicine, and in-depth biological mechanisms are the orientations of LIPUS in orthopedic rehabilitation treatment. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphos-phataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts. [ABSTRACT FROM AUTHOR]

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Background: Extracorporeal shockwave therapy (ESWT) is a noninvasive treatment modality that is used in the treatment of chronic Achilles tendinopathy (AT). Purposes: To (1) retrospectively assess outcomes after ESWT for both noninsertional AT (NAT) and insertional AT (IAT) at >1-year follow-up and (2) identify potential predictors of outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Chart review was conducted to identify patients who underwent ESWT for AT with a minimum of 1-year follow-up. Data collected and assessed included patient demographic characteristics, pathological characteristics including the location of AT (NAT or IAT), presence of a Haglund deformity, and severity of tendon degeneration on magnetic resonance imaging (MRI), in addition to treatment characteristics including number of sessions and intensity of ESWT. The Victorian Institute of Sports Assessment–Achilles (VISA-A) and visual analog scale (VAS) pain scores were obtained before ESWT, 6 months after ESWT, and at final follow-up. Failures were also recorded, which were defined as no improvement in VISA-A or VAS scores or need for surgical intervention. Linear regression was performed to identify potential predictors of inferior subjective clinical outcomes and failures. Survival analysis was conducted using Kaplan-Meier curves. Results: The study included 52 patients with IAT and 34 patients with NAT. The mean follow-up in the NAT cohort was 22.3 ± 10.2 months and the mean follow-up in the IAT cohort was 26.8 ± 15.8 months. Improvements in VISA-A and VAS scores were observed in the NAT cohort at 6-month follow-up and at final follow-up (P <.05). Improvements in VISA-A and VAS scores were recorded in the IAT cohort at 6-month follow-up, which subsequently deteriorated at final follow-up. In the NAT cohort, the failure rate at 6-month follow-up was 11.8%, which increased to 29.4% at final follow-up. In the IAT cohort, the failure rate at 6-month follow-up was 32.7%, which increased to 59.6% at final follow-up. Predictors of inferior subjective clinical outcomes and failures in the NAT cohort included pre-ESWT subjective clinical score, male sex, presence of a cardiovascular risk factor, and more severe MRI grading of tendinopathy. Predictors of inferior subjective clinical outcomes and failures in the IAT cohort included pre-ESWT subjective clinical score and more severe MRI grading of tendinopathy. Conclusion: Superior subjective clinical outcomes together with a lower failure rate were maintained for >1 year in the NAT cohort compared with the IAT cohort, calling into question the long-term benefit of ESWT for patients with IAT. [ABSTRACT FROM AUTHOR]

Background The magnetic resonance imaging-guided focused ultrasound (MRgFUS) has emerged as an innovative treatment for patients with medically refractory essential tremor (ET).

Background: To investigate the use of high intensity focused ultrasound (HIFU) for great saphenous vein (GSV) incompetence. Material and methods: Patients with GSV incompetence underwent HIFU. The primary endpoint was the rate of GSV target segment shrinkage or closure after 1 year. Results: Out of 188 limbs treated, the GSV treated segment shrinkage/closure rate at 1 week, 3 months, 6 months, and 12 months was 93.3%, 98.2%, 97.6%, and 98.3%, respectively. Conclusion: These preliminary results suggest that HIFU holds promise for the treatment of GSV incompetence. Further trials are needed to compare it with other techniques and assess long-term outcomes. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is increasing the intensity of high-intensity focused ultrasound (HIFU) by 30% in the treatment of rectal endometriosis a safe procedure? SUMMARY ANSWER This study demonstrates the safety of a 30% increase in the intensity of HIFU in the treatment of rectal endometriosis, with no Clavien–Dindo Grade III complications overall, and namely no rectovaginal fistulae. WHAT IS KNOWN ALREADY A feasibility study including 20 patients with rectal endometriosis demonstrated, with no severe complications, a significant improvement in digestive disorders, dysmenorrhoea, dyspareunia, and health status, although the volume of the endometriosis nodule did not appear to be reduced. STUDY DESIGN, SIZE, DURATION A prospective multicentre cohort study was conducted between 2020 and 2022 with 60 patients with symptomatic rectal endometriosis. Following the failure of medical treatment, HIFU treatment was offered as an alternative to surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS As the main objective of this study was to examine safety, all adverse events observed during the 6 months of follow-up were analysed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and Clavien–Dindo classifications. Secondary objectives included evaluating the evolution of symptoms using validated questionnaires: gynaecological and digestive pain symptoms with a visual analogue scale, health status with the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire, average post-operative daily pain level, and analgesic medication required in the 10 days following treatment. MRI was also performed at Day 1 to detect early complications. Finally, we performed a blinded MRI review of the evolution of the nodule at 6 months post-treatment. MAIN RESULTS AND THE ROLE OF CHANCE The procedure was performed under spinal anaesthesia for 30% of the patients. The median duration of treatment was 32 min. Fifty-five patients left the hospital on Day 1. MRI scans performed on Day 1 did not highlight any early-onset post-operative complication. Using the Clavien–Dindo classification, we listed 56.7% Grade I events, 3.4% Grade II events, and no events Grade III or higher. At 1, 3, and 6 months, all gynaecologic, digestive and general symptoms, as well as health status, had significantly improved. The evolution of the nodule was also significant (P  < 0.001) with a 28% decrease in volume. LIMITATIONS, REASONS FOR CAUTION The main objective was safety and not effectiveness. The study was not randomized and there was no control group. WIDER IMPLICATIONS OF THE FINDINGS HIFU treatment for rectal endometriosis results in an improvement of symptoms with low morbidity; as such, for selected patients, it could be a valuable alternative to surgical approaches following the failure of medical treatment. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the company EDAP TMS. Professors Dubernard and Rousset are consultants for EDAP TMS. Dubernard received travel support from EDAP-TMS. Dr F. Chavrier received industrial grants from EDAP-TMS. He has developed a device for generating focused ultrasonic waves with reduced treatment time. This device has been patented by EDAP-TMS. Dr Lafon received industrial grants from EDAP-TMS; he declares that EDAP-TMS provided funding directly to INSERM to support a young researcher chair in therapeutic ultrasound, which is unrelated to the current study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT04494568. [ABSTRACT FROM AUTHOR]

[Purpose] The purpose of this study was to compare the effectiveness of the Structural Diagnosis and Management (SDM) approach with Myofascial Release (MFR) in improving plantar heel pain, ankle range of motion, and disability. [Subjects] Sixty-four subjects, aged 30–60 years, with a diagnosis of plantar heel pain, plantar fasciitis, or calcaneal spur by a physician according to ICD-10, were equally allocated to the MFR (n = 32) and SDM (n = 32) groups by hospital randomization and concealed allocation. [Methods] In this assessor-blinded randomized clinical trial, the control group performed MFR to the plantar surface of the foot, triceps surae, and deep posterior compartment calf muscles, while the experimental group performed a multimodal approach utilizing the SDM concept for 12 sessions over 4 weeks. Both groups also received strengthening exercises, ice compression, and ultrasound therapy. Pain, activity limitations and disability were assessed as primary outcomes using the Foot Function Index (FFI) and Range of motion (ROM) assessment of the ankle dorsiflexors and plantar flexors using a universal goniometer. Secondary outcomes were measured using the Foot Ankle Disability Index (FADI) and a 10-point manual muscle testing process for the ankle dorsiflexors and plantar flexors. [Results] Both MFR and SDM groups exhibited significant improvements from baseline in all outcome variables, including pain, activity level, disability, range of motion, and function after the 12-week intervention period (p <.05). The SDM group showed more improvements than MFR for FFI pain (p <.01), FFI activity (p <.01), FFI (p <.01) and FADI (p = <.01). [Conclusion] Both MFR and SDM approaches are effective in reducing pain, improving function, ankle range of motion, and reducing disability in plantar heel pain, however, the SDM approach may be a preferred treatment option. [ABSTRACT FROM AUTHOR]

This systematic review with meta-analysis aimed to assess the effectiveness of electrophysical agents in improving pain, function, disability, range of motion, quality of life, perceived stiffness, and time to recovery in subjects with frozen shoulder (FS). A thorough search of MEDLINE, Cochrane Library, PEDro, and EMBASE yielded 1143 articles, of which 23 randomized controlled trials were included. Risk of bias (RoB) was assessed through Cochrane Risk of Bias 2 tool. The certainty of evidence was evaluated through the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). The analysis included a total of 1073 subjects. None of the studies were judged as low RoB. Potentially clinically significant differences were observed in pain at 6 weeks and 5 months after extracorporeal shockwave therapy (ESWT), and in disability up to 3 months with laser therapy, albeit with uncertain results due to the high RoB and to the study heterogeneity. Ultrasound (US) therapy did not yield significant differences in any outcomes. The certainty of evidence was very low. Based on the high heterogeneity and low quality and certainty of evidence, ESWT, laser, and US cannot be recommended for FS treatment. Caution should be exercised in interpreting the findings. Although a clinical difference in pain and disability was observed, the certainty of the evidence was low. Ultrasound therapy is not recommended in patients with frozen shoulder. Electrophysical agents may not ensure adequate therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of extracorporeal shock waves versus corticosteroids injections on pain, thickness of plantar fascia and foot function in patients with plantar fasciitis. Secondarily, to assess the efficacy of radial and focused extracorporeal shock waves and the most appropriated intensity (high, medium or low). Data sources: PubMed, SCOPUS, CINAHL and PEDro, until April 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Review methods: Randomized controlled trials comparing the efficacy of extracorporeal shock waves versus corticosteroids injections on pain intensity and sensitivity, thickness of plantar fascia and foot function in patients with plantar fasciitis. Methodological quality and risk of bias were assessed using PEDro Scale and Cochrane Risk of Bias Tool. Pooled effect was calculated using the standardized mean difference (SMD) and its 95% confidence interval (95%CI). Results: Sixteen studies involving 1121 patients, showing a mean of 6 points in PEDro scale, were included. At three months, extracorporeal shock waves were better than corticosteroids injections in reducing pain (SMD −0.6; 95%CI −1.1 to −0.11) and thickness of the plantar fascia (SMD −0.4; 95%CI −0.8 to −0.01) and increasing foot function (SMD 0.27; 95%CI 0.12–0.44). At six months, extracorporeal shock waves are more effective in reducing pain (SMD −0.81; 95%CI −1.6 to −0.06) and increasing foot function (SMD 0.67; 95%CI 0.45–0.89). Local pain and slight erythema were the most frequent adverse events. Conclusions: Extracorporeal shock waves are a safe therapy, presenting more efficacy than corticosteroids injections in improving pain, thickness of plantar fascia and foot function at mid-term. [ABSTRACT FROM AUTHOR]

Objective: To compare the immediate effects of shockwave therapy using two different tips in patients with chronic non-specific low back pain. Design: Randomised placebo-controlled study with three intervention groups. Setting: The patients recruited for this study were sent for physiotherapy treatment at primary care between May and July 2022. Participants: Eighty-one patients with chronic non-specific low back pain aged 18–80 years with pain for ≥3 months and pain intensity ≥3 were randomly recruited for the study. Intervention: The patients received a single intervention of radial shockwave therapy with 2000 discharges at 100 mJ energy and 5 Hz frequency using concave or convex tips or placebo treatment. Main measures: The primary outcome was pain intensity immediately post-intervention. The secondary outcomes were pressure pain threshold, temporal summation of pain, and functional performance. Data were collected at baseline and post-intervention. Results: The post-intervention pain intensity in the concave tip group is an average of two points lower (95% CI = −3.6, −0.4; p < 0.01) than that in the placebo group. The post-intervention pressure pain threshold for the concave tip group was an average of 62.8 kPa higher (95% CI = 0.4, 125.1; p < 0.05) than for the convex tip group and 76.4 kPa higher (95% CI = 14, 138.7; p < 0.01) than in the placebo group. Conclusion: The concave tip shockwave therapy is effective in reducing pain and local hyperalgesia in patients with chronic non-specific low back pain. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the efficacy of low‐intensity, high‐frequency shock waves in the treatment of temporomandibular joint disorders. Methods: Twenty‐six patients with temporomandibular joint disorder admitted to the Second Hospital of Shanxi Medical University from August 2022 to December 2022 were selected as study subjects and randomly divided into two groups, A and B, with 13 patients each. In Group A, there were 5 males and 8 females with an average age of 38.85 ± 11.03 years. In Group B, there were 4 males and 9 females with an average age of 39.15 ± 11.16 years. Group A was the control group, which received routine treatment (manual massage + transcutaneous electrical nerve stimulation + ultrashort wave therapy) plus sham shock wave therapy; Group B was the experimental group, which received routine treatment (manual massage + transcutaneous electrical nerve stimulation + ultrashort wave therapy) plus shock wave therapy. The routine treatment was administered once/day, five times per week for a total of 2 weeks of treatment. In addition, shock wave therapy was administered once every 5 days, and the treatment was administered three times. The treatment period was 2 weeks, and the two groups were compared before treatment, at the end of the treatment period, and 4 weeks after treatment. The pain level of the two groups was assessed by the visual analogue scale (VAS) before and after treatment, and the temporomandibular opening index (TOI) before and after treatment was compared between the two groups. VAS and TOI scores were evaluated using the Mann–Whitney U‐test, the Kruskal–Wallis H‐test and two‐way ANOVA. Results: There was no significant difference in the VAS score and temporomandibular opening index between the two groups before treatment (p =.829 and.75, respectively). After 2 weeks of treatment, the VAS score and temporomandibular joint opening index of both groups were significantly improved compared to those before therapy. In addition, the VAS score and temporomandibular joint opening index in the experimental group were significantly better than those in the control group (p <.001 and <.001, respectively). There was a small increase in scores 4 weeks after the treatment compared to just after the treatment period, but the difference was not significant. Conclusion: This is a preliminary small sample study that demonstrates the positive effect of using low‐intensity, high‐frequency shock waves on the treatment of temporomandibular joint disorders and is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of nonsurgical treatment of patellar tendinopathy is questioned due to the conflicting results of placebo-controlled randomized controlled trials (RCTs) in which placebo arms often show impressive results. Purpose: To quantify the magnitude of placebo effect of the different nonsurgical treatments of patellar tendinopathy. We also evaluated the influence of patients and treatments characteristics on the response to the placebo. Study Design: Systematic review; Level of evidence, 1. Methods: We searched PubMed, Web of Science, Embase, Scopus, Cochrane Library, and gray literature databases on May 10, 2023, with no time limitation. RCTs on nonoperative treatment of patellar tendinopathy, including a placebo control arm reporting the evolution of symptoms after placebo administration, were included. A single-arm meta-analysis was performed with the Victorian Institute of Sport Assessment-Patella (VISA-P) at mid-term follow-up (3-6 months) as the primary outcome. The VISA-P score at short-term (1-3 months) and long-term (6-12 months) follow-ups, as well as visual analog scale (VAS) for pain at all 3 time points were also analyzed. A subanalysis based on the type of placebo and a meta-regression were conducted to look for potential determinants of the placebo effect. Risk of bias and level of evidence were also analyzed using the revised tool for risk of bias in randomized trials and Grading of Recommendations Assessment, Development and Evaluation. Results: In total, 14 studies (251 patients) were included. VISA-P score at mid-term follow-up (3-6 months) showed statistically significant improvements of 13 of 100 points (P =.001). The change at short-term follow-up (1-3 months) was not statistically significant, whereas at long-term follow-up (6-12 months) it was 27 of 100 points (P <.001). Regarding VAS, results were statistically significant only at mid-term (MD = −1.5/10; P =.02) and long-term (MD = −3.2/10; P <.001) follow-ups. The meta-regression showed positive correlations between the response to placebo and the follow-up length (P <.001) and the effect size in the experimental group (P =.006). The level of evidence was moderate for mid- and long-term results and low for short-term results. Conclusion: The placebo effect for nonsurgical treatments of patellar tendinopathy is long-lasting (up to 12 months) and statistically and clinically significant. It has a perceived and true component and differs among treatments. The duration of follow-up and the effect size of experimental groups correlate with the magnitude of the placebo component, underlining the importance of RCTs to determine the effectiveness of new treatments of patellar tendinopathy. [ABSTRACT FROM AUTHOR]

The tumor microenvironment is increasingly acknowledged as a critical contributor to cancer progression, mediating genetic and epigenetic alterations. Beyond diverse cellular interactions from the microenvironment, physicochemical factors such as tumor acidosis also significantly affect cancer dynamics. Recent research has highlighted that tumor acidosis facilitates invasion, immune escape, metastasis, and resistance to therapies. Thus, noninvasive measurement of tumor acidity and the development of targeted interventions represent promising strategies in oncology. Techniques like contrast-enhanced ultrasound (CEUS) can effectively assess blood perfusion, while ultrasound-stimulated microbubble cavitation (USMC) has proven to enhance tumor blood perfusion. We therefore aimed to determine whether CEUS assesses tumor acidity and whether USMC treatment can modulate tumor acidity. Firstly, we tracked CEUS perfusion parameters in MCF7 tumor models and compared them with in vivo tumor pH recorded by pH microsensors. We found that the peak intensity and area under curve of tumor contrast-enhanced ultrasound correlated well with tumor pH. We further conducted USMC treatment on MCF7 tumor-bearing mice, tracked changes of tumor blood perfusion and tumor pH in different perfusion regions before and after the USMC treatment to assess its impact on tumor acidity and optimize therapeutic ultrasound pressure. We discovered that USMC with 1.0 Mpa significantly improved tumor blood perfusion and tumor pH. Furthermore, tumor vascular pathology and PGI2 assays indicated that improved tumor perfusion was mainly due to vasodilation rather than angiogenesis. More importantly, analysis of glycolysis-related metabolites and enzymes demonstrated USMC treatment can reduce tumor acidity by reducing tumor glycolysis. These findings support that CEUS may serve as a potential biomarker to assess tumor acidity and USMC is a promising therapeutic modality for reducing tumor acidosis. [ABSTRACT FROM AUTHOR]

This study aimed to develop a model based on radiomics and deep learning features to predict the ablation rate in patients with adenomyosis undergoing high-intensity focused ultrasound (HIFU) therapy. A total of 119 patients with adenomyosis who received HIFU therapy were retrospectively analyzed. Participants were included in the training and testing queues in a 7:3 ratio. Radiomics features were extracted from T2-weighted imaging (T2WI) images, and VGG-19 was used to extract advanced deep features. An ensemble model based on multi-model fusion for predicting the efficacy of HIFU in adenomyosis was proposed, which consists of four base classifiers and was evaluated using accuracy, precision, recall, F-score, and area under the receiver operating characteristic curve (AUC). The predictive performance of the combined model combining radiomics and deep learning features outperformed the radiomics and deep learning feature models alone, with accuracy of 0.848 and 0.814 in training and test sets, and AUC of 0.916 and 0.861, respectively. Compared with the base classifiers that make up the multi-model fusion model, the fusion model also exhibited better prediction performance. The fusion model incorporating both radiomics and deep learning features had certain predictive value for the ablation rate of adenomyosis under HIFU therapy and could help select patients with adenomyosis who would benefit from HIFU therapy. [ABSTRACT FROM AUTHOR]

Although guidelines and systematic reviews recommend the use of exercise in the treatment of chronic pain and neck pain, there are no clear recommendations for conservative treatments frequently used in clinics. The effect of supporting clinical Pilates exercises with passive physiotherapy methods on biopsychosocial status is still unknown. The objective was to investigate the effects of conventional treatment (CT) in addition to clinical Pilates on pain levels, physical condition, functional status, and psychosocial status in individuals with chronic neck pain. Fifty women were randomly divided into 2 groups, the clinical Pilates group (Pilates, n= 25), and the group receiving CT in addition to clinical Pilates (Pilates-CT, n= 25). Both groups received treatment 3 days a week for 6 weeks. The CT program involved the implementation of hot pack (HP) application, Transcutaneous Electrical Nerve Stimulation (TENS), and therapeutic ultrasound (US) to the cervical area. CT in addition to Pilates was more effective in reducing the Visual Analog Scale (at rest and during activity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, NeckPix Scale, Hospital Anxiety and Depression Scale-depression, and Cognitive Exercise Therapy Approach–Biopsychosocial questionnaire scores (p< 0.05) and in increasing the degree of change in the extension range of motion (ROM) and cervical flexor endurance values and scores in the energy parameter of Short Form-36 (p< 0.05). CT provided in addition to Pilates was more effective in reducing pain levels, disability, fear of movement, depression levels, and negative biopsychosocial status and improving extension ROM and cervical flexor endurance, neck awareness, and the energy/vitality parameter of quality of life in individuals with chronic neck pain. [ABSTRACT FROM AUTHOR]

The study's goal was to compare and evaluate the benefits of deep friction massage and ultrasonic therapy (US) vs extracorporeal shockwave therapy (ESWT) for people with lateral epicondylitis. This double-blind, parallel-arm randomized clinical trial was conducted after ethical approval on a sample of 80 subjects with lateral epicondylitis. Participants were enrolled based on predefined eligibility criteria. They were randomly allocated to groups A and B. Group A received ESWT, while Group B received the US combined with deep friction massage. Data was collected using the Numeric Pain Rating Score (NPRS) and Patient-rated tennis elbow evaluation questionnaire (PRTEE) at baseline, at 3rd, and at 7th week of treatment. On the basis of the normality of the data, a non-parametric test was applied to evaluate between-group and within-group differences. P value ≤ 0.05 was considered significant. There was a significant difference between groups (p < 0.001). Comparisons of PRTEE scores at 3rd week and 7th week of intervention were found significant for both groups (p < 0.001). While considering between-group comparisons based on percentile scores of PRTEE at baseline, 3rd and 7th week of intervention, in group A Median (IQR) at the baseline was 24.00 (5.00), at 3rd week, 10.00 (5.00) and 7th week was 1.50 (2.50) and in group B Median (IQR) at the baseline was 25.00 (4.00), at 3rd week 19.50 (4.50) and at 7th week was 11.50 (2.50). The results were significant in both groups (p = 0.000), but between-group analysis revealed that ESWT is more effective in patients with lateral epicondylitis. [ABSTRACT FROM AUTHOR]

Introduction: This cohort study aimed to compare the effect of ultrasonic scaling on the expression of IL-1β in the gingival crevicular fluid (GCF) among ENDS users and non-smokers (NS) with gingivitis. Methods: Self-reported current electronic nicotine delivery system (ENDS) users and NS with generalized gingivitis were included in this study. All the patients underwent scaling at the baseline visit (T0). Clinical measures, periodontal parameters [probing depth (PD), plaque index (PI), and bleeding on probing (BOP)], and GCF IL-1β were measured at T0, after 1 week (T1) and after 3 weeks (T2). Wilcoxon signed rank test was used to assess the changes in the periodontal measurements and IL-1β levels at different time points and Mann–Whitney U Test was used to compare the two groups. Results: A total of 38 individuals (18 NS and 20 ENDS users) participated in the study. The PD was significantly higher in ENDS users than in NS at baseline. However, the PI and BOP were similar in all groups at baseline. At T1, the PI was significantly lower for NS than for ENDS users (p=0.045). At T2, there were no significant differences in any of the parameters assessed between the two groups. For ENDS users, BOP was significantly lower at T1 than at baseline. For NS, the BOP at T1 and T2 and the PI at T1 were significantly lower than at baseline. There was no difference in the GCF IL-1β levels in NS and ENDS users at baseline, T1, and T2. At T2, there was a significant reduction in IL-1β (p<0.05) than at baseline in both groups. Conclusions: Both ENDS users and NS with gingivitis responded similarly to scaling. GCF IL-1β levels were significantly higher at baseline (p<0.05) compared with their levels at T1 and T2 for both the groups. CLINICAL TRIAL REGISTRATION: The study was registered on the official website of ClinicalTrials.gov IDENTIFIER: ID NCT05745324 [ABSTRACT FROM AUTHOR]

Purpose: To investigate if Extracorporeal Shock Wave therapy (ESWT) is effective in reducing pain and disability, in improving function, quality of life and complete resorption rate of calcification in patients with Rotator Cuff Calcific Tendinopathy. To investigate which modality of ESWT brings the greatest clinical improvements between High (HE)‐SWT and Low Energy (LE)‐SWT and between Focal (F)‐SWT and Radial (R)‐SWT. Methods: MEDLINE, EMBASE, CENTRAL Database, and PEDro databases until February 2024 were searched. Study registers were further investigated. The Risk of Bias (RoB) was assessed with the Revised Cochrane RoB Tool (RoB 2). The certainty of evidence was rated with GRADE. Results: Twenty‐one randomized controlled trials were included. None was judged as overall low RoB. Comparing ESWT and Ultrasound Guided Needling Procedures (USGNP), the pooled results reported a significant difference favoring USGNP in pain at <24 and <48 weeks (MD = 1.17, p = 0.004, I2 = 59%; MD = 1.31, p = 0.004, I2 = 42%, respectively). Comparing ESWT and sham‐ESWT, the pooled results reported a clinically significant difference favoring ESWT in pain and function at 24 weeks (MD = −5.72, p < 0.00001, I2 = 0%; Standardized Mean Difference = 2.94, p = 0.02 I2 = 98%, respectively). Comparing HE‐SWT and LE‐SWT, HE‐SWT was statistically and clinically superior in pain and function at <24 weeks (MD = −1.83, p = 0.03, I2 = 87%; MD = 14.60, p = 0.002, I2 = 77%, respectively) and showed a significantly higher complete resorption rate of calcification at 12 weeks (Risk Ratio = 2.53, p = 0.001, I2 = 0%). F‐SWT and R‐SWT appear equally effective in reducing pain, improving disability and resorption rate. The certainty of evidence was rated as very low through GRADE approach. Conclusion: USGNP was statistically superior to ESWT in pain reduction at <24 and <48 weeks. ESWT was clinically better to sham‐ESWT in pain reduction and function improvement at 24 weeks. HE‐SWT was clinically more effective than LE‐SWT in reducing pain, improving function at <24 weeks, and resolving calcific deposits at 12 weeks, while no differences between F‐SWT and R‐SWT were reported. [ABSTRACT FROM AUTHOR]

BACKGROUND: Currently, the use of radiofrequency diathermy for the treatment of neck pain is booming. OBJECTIVE: This study aimed to evaluate the clinical efficacy of Digital Capacitive Diathermy (DCD®) on stiffness, pain, cervical range of motion, and cervical disability and to compare it with ultrasound (US) in patients with latent myofascial trigger point (MTrP) in the upper trapezius. METHODS: Nineteen participants with latent MTrPs in the upper trapezius were included in the assessor-masked, randomized, clinical crossover trial. Subjects were exposed to both interventions: US and DCD® and treatment effectiveness was measured by myotonometric variables, pressure pain threshold (PPT), visual analog scale (VAS), cervical side-bending flexion ranges, and the neck disability index scale (NDI). RESULTS: There were no significant differences between US and DCD® interventions regarding changes in outcome measures. The US group achieved a statistically significant difference of 2.16 to 1.13 points (p = 0.005; r = 0.646) for the VAS. The DCD® intervention showed a statistically significant improvement of 1.11 points for the NDI at 1-week following intervention (95% CI 0.14–2.07; p = 0.27; d = 0.217). CONCLUSION: Our findings suggest that DCD® and US can both be considered effective modalities for the treatment of latent MTrPs, having a longer duration of action with DCD® therapy. [ABSTRACT FROM AUTHOR]

Objective Vulvodynia is a chronic clinical condition characterized by provoked or non-provoked vulvar pain for at least 3 months of unknown etiology. The onset of vulvodynia involves a complex interplay of peripheral and central pain mechanisms, such as pelvic floor muscle and autonomic dysfunction, and interpersonal factors. A stepwise approach of pelvic floor physical therapy as medical management is suggested. In this scenario, by this meta-analysis of randomized controlled trials, we aimed to evaluate the efficacy of rehabilitation interventions in patients with vulvodynia. Methods On October 13, 2022, PubMed, Scopus, and Web of Science were systematically searched for randomized controlled trials that assessed the efficacy of the rehabilitative approach to pain during intercourse in patients with vulvodynia. The quality assessment was performed with the Cochrane risk-of-bias tool for randomized trials. The trial registration number is CRD42021257449. At the end of the search, 9 studies were included for a total of 332 patients. A pairwise meta-analysis was performed to highlight the efficacy of rehabilitative approaches for reducing pain during intercourse, as measured with a visual analog scale or a numerical rating scale. Results Meta-analysis showed that all these rehabilitative approaches had an overall effect size of −1.43 (95% CI = −2.69 to −0.17) in decreasing vulvodynia pain in terms of the visual analog scale. In the subgroup analysis, a significant effect size in acupuncture (effect size = −2.36; 95% CI = −3.83 to −0.89) and extracorporeal shockwave therapy (effect size = −2.94; 95% CI = −4.31 to −1.57; I2 = 58%) was observed. According to the Cochrane risk-of-bias tool, a low risk of bias for outcome selection in 89% of studies. Conclusion Findings from this meta-analysis suggested that the physical agent modalities and complementary medicine techniques in people with vulvodynia appear to be more effective than placebo, sham, or waiting list. Further evidence on physical agent modalities and complementary therapies are warranted in the future. Impact This was the first systematic review and meta-analysis of randomized controlled trials to provide evidence on the efficacy of rehabilitation interventions in patients with vulvodynia. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasonic vibration for metallic post removal seems to be a unanimous choice between endodontists and general practitioners for providing the best results and having the highest safety. This study compared the time required by ultrasonic vibration for removing metallic post (MP) when 1 or 2 ultrasonics devices are used. Materials and Methods: One hundred and fifteen teeth with MPs from 105 patients, indicated for nonsurgical endodontic retreatment were divided into 2 groups according to the number of ultrasonic devices used (G1-1 device) and (G2-2 devices). In G1, the MP was worn with a transmetal bur, alongside the wear of the cement line (around 2 mm deep). Then, an ultrasonic tip attached to an ultrasonic unit, with a power of 100% was activated at the level of the post, with constant water spray at a level of 1 mm above the axial surface of the tooth. The position of the tip was changed between buccal and lingual surfaces every 10 seconds until the MP was removed. In G2 the same procedures were performed as described in G1, but two ultrasonic tips were activated simultaneously at buccal and lingual surfaces until the MP was removed. The vibration time necessary for removing each MP was recorded using a chronometer. Results: The mean time was 131.10±29.68 seconds (mean±standard error of the mean) for MP removal using one ultrasonic device, and 24.86±6.88 seconds for two devices. The time required for MP removal using two ultrasonic devices was significantly less than when using one ultrasonic device (P<0.001). Conclusion: The technique with 2 ultrasonic devices proved to be more efficient than the one using only 1 ultrasonic device. [ABSTRACT FROM AUTHOR]

Background: Interphalangeal coalition is characterized by fusion of interphalangeal joint between the middle and distal phalanges. Interphalangeal coalition fractures often result in delayed union or nonunion. The purpose of this study was to evaluate the results of focused extracorporeal shock wave therapy (ESWT) for painful delayed union or nonunion of fractures of the interphalangeal coalition. Methods: The study group consisted of 9 patients (9 feet) diagnosed with painful delayed union or nonunion due to persistent pain and no tendency toward bony union for at least 3 months after the interphalangeal coalition fracture on plain radiographs between 2021 and 2023 were included. The mean age was 51.3 years (23-64). Focused ESWT was performed in all patients. The mean time from the date of injury to the start of ESWT was 16.1 weeks (12-15). ESWT was performed every 2 weeks, with each session consisting of 3000 impulses (0.15-0.25 mJ/mm2). Plain radiographs were used to confirm bone union, and visual analog scale (VAS) scores were used for pain assessment. Results: Complete bony union was documented in all 9 patients. The application of focused ESWT was performed a mean of 2.7 times (2-4), and the mean duration from the initiation of treatment to the confirmation of bony union was 7.4 weeks (3.6-12.7). In all cases, the symptoms of swelling and pain were alleviated. The VAS scores exhibited significant improvement, with the mean VAS score decreasing from 3.8 (2-6) before ESWT to 0 after the achievement of union (P <.001). Conclusion: In this small cohort, all patients with painful delayed union or nonunion of fractures at the interphalangeal coalitions achieved complete bony fusion after focused ESWT. Moreover, bony union was observed within 2 months of ESWT initiation. These findings suggest that focused ESWT may be a valuable treatment option for painful delayed union or nonunion of interphalangeal coalition fractures. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

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Conservative treatments for plantar fasciitis have different levels of effectiveness, so it is necessary to personalize the therapeutic modality that improves the patients' symptoms. Methods: A double-blinded randomized clinical trial was designed to evaluate the short-term efficacy of a physical treatment in chronic plantar fasciitis, namely iontophoresis, compared with radial shockwave therapy. Heel pain, health status using the EuroQol-5D questionnaire, and fascia thickness measured with ultrasound were evaluated. In total, 127 patients were randomly selected for group A and treated with iontophoresis therapy (lidocaine 0.4% and dexamethasone 0.5%), or for group B, in which they were treated with radial shockwave therapy (EWST). Measurements were taken at baseline and at follow-up during the 5 weeks of the study. Results: Statistically significant differences were observed to the shockwave therapy group in respect to the final fascia thickness, and the VAS scale (p = 0.001). The differences between groups A and B showed that the shockwave group follow-up after 3 weeks experienced complete pain remission (1.0 ± 0.9; 95%CI 0.8–1.2) and after the 6-week follow-up, complete pain remission of plantar fasciitis was observed for both therapies. Patients had a better perception of the use of EWST at the end of the treatment, although in both groups it was satisfactory (p = 0.001). Conclusions: The results of this study showed a shorter-term effectiveness of shockwave treatment compared with the use of iontophoresis. However, both techniques were effective in satisfactorily reducing pain in this short period. [ABSTRACT FROM AUTHOR]

Objective: The aim of the systematically review the short-, intermediate-, and long-term effects of extracorporeal shockwave therapy on pain intensity and shoulder function in individualswith noncalcific rotator cuff tendinopathy. Design: TheMEDLINE, CINAHL, SPORTDiscus, and Embase were searched from inception up to June 2023. We included randomized controlled trials that investigated the effects of extracorporeal shockwave therapy on pain intensity and shoulder function. Results: Nine studieswere included with a total sample of 543 individuals. Extracorporeal shockwave therapy was superior to sham extracorporeal shockwave therapy in improving pain intensity at short-term follow-up (standardized mean difference = -0.28; 95% confidence interval, -0.55 to -0.01). Extracorporeal shockwave therapy was not superior to sham extracorporeal shockwave therapy in improving pain intensity at intermediate- and long-term follow-ups (P > 0.05). Extracorporeal shockwave therapy was not superior to other treatments in improving pain intensity at short- and intermediate-term follow-ups (P > 0.05). Extracorporeal shockwave therapy was not superior to sham extracorporeal shockwave therapy and other treatments in improving shoulder function at short-, intermediate-, and long-term follow-ups (P > 0.05). Conclusions: Moderate-certainty evidence indicated that extracorporeal shockwave therapy showed small improvement in shoulder pain over sham extracorporeal shockwave therapy at short-term followup. In addition, extracorporeal shockwave therapy was not superior to sham extracorporeal shockwave therapy in improving function, and it was not superior to other treatments in improving shoulder pain and function. [ABSTRACT FROM AUTHOR]