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Due to its regenerative action, extracorporeal shock wave therapy (ESWT) is applied in treating integumentary and musculoskeletal diseases. However, other potential therapeutic interventions are being investigated. It is essential to fully understand its mitochondrial signaling pathway to achieve this, which plays a fundamental role in elucidating the mechanism of action and possible therapeutic interventions. Thus, this study aimed to analyze the effect of ESWT on mitochondrial pathways through the relationship between lipolysis and adipocyte apoptosis, as well as cellular functionality. This is a non-randomized case-control clinical trial where obese women received ESWT sessions in the abdominal region, after which tissue samples were collected for histological and immunohistochemical analyses of adipose tissue. The data demonstrated positivity in the expression of mitochondrial markers related to cell apoptosis, such as FIS1 (p < 0.0203) and OPA1 (p < 0.0283), in addition to the positivity of anti-MFN1, responsible for regulating mitochondrial cell proliferation (p < 0.0003). In summary, this study demonstrates that ESWT was able to activate specific mitochondrial signaling pathways, which may be associated with its ability to stimulate lipolysis and apoptosis in superficial adipose tissue. However, no significant improvements in cellular functionality were observed.
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Tratamento por Ondas de Choque Extracorpóreas , Feminino , Humanos , Tecido Adiposo , Proliferação de Células , Transdução de Sinais , Pele , Estudos de Casos e ControlesRESUMO
Shock waves, as used in medicine, can induce cell permeabilization, genetically transforming filamentous fungi; however, little is known on the interaction of shock waves with the cell wall. Because of this, the selection of parameters has been empirical. We studied the influence of shock waves on the germination of Aspergillus niger, to understand their effect on the modulation of four genes related to the growth of conidia. Parameters were varied in the range reported in protocols for genetic transformation. Vials containing conidia in suspension were exposed to either 50, 100 or 200 single-pulse or tandem shock waves, with different peak pressures (approximately 42, 66 and 83 MPa). In the tandem mode, three delays were tested. To equalize the total energy, the number of tandem "events" was halved compared to the number of single-pulse shock waves. Our results demonstrate that shock waves do not generate severe cellular effects on the viability and germination of A. niger conidia. Nevertheless, increase in the aggressiveness of the treatment induced a modification in four tested genes. Scanning electron microscopy revealed significant changes to the cell wall of the conidia. Under optimized conditions, shock waves could be used for several biotechnological applications, surpassing conventional techniques.
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Introducción: Por más de 20 años la litotricia extracorpórea se ha aplicado con éxito en el mundo. Objetivo: Evaluar la efectividad de la terapia por ondas de choque en el tratamiento a pacientes que presentan lesiones en los tendones y ligamentos del sistema osteomioarticular. Métodos: Se realizó un estudio descriptivo, de corte transversal, con 107 pacientes diagnosticados con lesiones en los tendones y ligamentos del sistema osteomioarticular, los cuales fueron tratados con el equipo Well Wave (ondas de choque extracorpóreas) en el Complejo Científico Ortopédico Internacional Frank País, en el período comprendido entre marzo de 2019 y abril de 2020. Se realizó el análisis de las variables edad, sexo, dolor y discapacidad. Se obtuvieron frecuencias absolutas y relativas, y con ellas se confeccionaron las tablas que resumen la información estadística de la investigación. Resultados: Predominó el sexo femenino (71,9 por ciento), de 51 - 60 años (28 por ciento). El 40,2 por ciento de los pacientes fueron atendidos por presentar una tendinitis del supraespinoso. Todos los pacientes presentaban dolor antes de la aplicación de la terapia. Luego del tratamiento el 78,5 por ciento de los enfermos dejaron de sentirlo y el 71 por ciento presentó ausencia de discapacidad según escala de DASH. Según los criterios de evaluación de la respuesta al tratamiento los resultados fueron satisfactorios en el 56 por ciento de los pacientes. Conclusiones: La terapia con las ondas de choque posibilitó una rápida recuperación de los pacientes atendidos y su incorporación a las actividades diarias(AU)
ABSTRACT Introduction: Over more than 20 years, extracorporeal lithotripsy has been successfully used worldwide. Objective: To evaluate the effectiveness of shock wave therapy in the treatment of patients with injuries to the tendons and ligaments of the osteomioarticular system. Methods: A descriptive, cross-sectional study was carried out with 107 patients diagnosed with injuries to the tendons and ligaments of the osteomioarticular system. These subjects were treated with the Well Wave equipment (extracorporeal shock waves) at Frank País International Orthopedic Scientific Center, from March 2019 to April 2020. The variables age, sex, pain and disability were analyzed. Absolute and relative frequencies were obtained, and the results of statistical information of the investigation was shown in summarizing tables. Results: The female sex prevailed (71.9percent), 51 - 60 years old (28 percent). 40.2 percent of the patients were treated for supraspinatus tendinitis. All patients had pain before the use of therapy. After treatment, 78.5 percent of the patients stopped feeling pain and 71 percent showed no disability according to DASH scale. According to the treatment response evaluation criteria, the results were satisfactory in 56percent of the patients. Conclusions: This therapy enabled rapid recovery of the patients treated and their integration into daily activities(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Traumatismos dos Tendões , Tendões , Resultado do Tratamento , Tratamento por Ondas de Choque Extracorpóreas/métodos , Ligamentos/lesões , Sistema Musculoesquelético , Epidemiologia Descritiva , Estudos TransversaisRESUMO
Resumen La fascitis plantar (FP) es una patología frecuente e invalidante que puede tratarse con ondas de choque focalizadas. El objetivo principal del estudio fue valorar la eficacia del tratamiento con ondas de choque focalizadas en la FP según la densidad de energía utilizada. Se incluyeron 82 pacientes con diagnóstico clínico de FP que fueron asignados mediante muestreo aleatorio simple a dos grupos de tratamiento: densidad de energía media- alta (0,59mJ/mm2) y densidad de energía media-baja (0,27mJ/mm2). Se evaluaron el dolor y la funcionalidad, mediante las escalas EVA (Escala Visual Analógica) y AOFAS (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale) respectivamente, al inicio del estudio (consulta base), y al primer, tercer y sexto mes tras el tratamiento. Por último, se evaluó el grado de satisfacción de los pacientes mediante la escala de Roles y Maudsley. Se compararon los resultados de las escalas en las revisiones posteriores al tratamiento, obteniéndose significación estadística para las variables principales del estudio (dolor y funcionalidad) en cada grupo de intervención. Aunque los niveles de dolor y la funcionalidad mejoraron en ambos grupos de estudio, se obtuvo una respuesta analgésica y funcional mayor y más precoz en el grupo tratado con densidad de energía media-alta.
Abstract Plantar fasciitis (FP) is a frequent and disabling condition that can be treated with focused extracorporeal shock waves. The main objective of this study was to assess the effectiveness of focused extracorporeal shockwave treatment in FP according to the energy density used. Eighty-two patients with a clinical diagnosis of FP were included and assigned, by simple random sampling, to two treatment groups: medium-high energy density (0.59mJ/mm2) and low-medium energy density (0.27mJ/mm2). Pain and functionality were assessed using the VAS (Visual Analogical Scale) and AOFAS (American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale) scales, respectively, at the start of the study (baseline consultation), and at the first, third and sixth month post-treatment. Finally, the degree of patient satisfaction was evaluated using the Roles and Maudsley score. The results of the scales in the post-treatment reviews were compared, and statistical significance was obtained for the main study variables (pain and functionality) in each intervention group. Although pain levels and functionality improved in both study groups after treatment, a greater and earlier analgesic and functional response was obtained for the medium-high energy density group.
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The technology of extracorporeal shock wave therapy (ESWT) has been studied around the world for its possible benefits in the treatment and rehabilitation of aesthetic disorders. To better elucidate its real physiological effect on the integumentary tissue, this study was proposed aimed at evaluating whether ESWT can act to stimulate the inflammatory process and angiogenesis in the dermis and epidermis of obese individuals. This is an immunohistological study that evaluated a set of samples of the integumentary tissue of women with grade II obesity with weight loss of 10% of the initial weight undergoing ESWT treatment; the collection of biological material was performed at the time of surgery of bariatric surgery. For immunohistochemical evaluation, the markers to assess the presence and distribution of inflammatory cells, anti-COX-2, CD3, CD20, CD163, and NK were used. For physiological stimulus pathways for blood vessel angiogenesis, markers CD 34, CD 105 and VEGF were used. Fourteen obese women were included in the study. Positivity was evidenced in the epidermal expression of markers of the inflammatory process COX-2, CD3, CD20, NK cells, CD68, and CD163 (p < 0.0001) in the intervention sample when compared to controls. There was a positive expression for the angiogenesis markers CD105 and VEGF (p < 0.0001) when comparing the intervention group with the control group. It was concluded that ESWT can stimulate a local inflammatory process, mediating and modulating important growth factors to act in the repair process and skin tissue regeneration, being considered a promising treatment for skin diseases related to weight gain or loss.
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Tratamento por Ondas de Choque Extracorpóreas , Ondas de Choque de Alta Energia , Feminino , Humanos , Inflamação , Obesidade/terapia , Pele , CicatrizaçãoRESUMO
INTRODUCTION: In this study, we analyze a new treatment option for pseudarthrosis using radial shock waves. The traditional treatment to pseudarthrosis is surgical. As an option to specific cases, focal shock waves seem to present good results with bone union without a subsequent surgical procedure. As radial shock waves reach less energy and less depth penetration than focal shock waves, they usually are not indicated for the treatment of pseudarthrosis of any bone segment. There are publications that show evidences of the action of radial shock waves stimulating bone consolidation in vitro, in animals and in humans. We will present a new option for failure of consolidation in superficial bones submitted to radial shock wave therapy. OBJECTIVE: To analyze the effectiveness of radial shock waves in the treatment of superficial bone pseudarthrosis. PATIENTS AND METHODS: Between 2016 and 2019, we conducted a prospective study with 44 consecutive patients with pseudarthrosis. All patients had prior indication for treatment with surgery and were treated with radial shock waves as a nonsurgical treatment option. Patients were evaluated clinically and radiographically pre-treatment and 6 months after. Clinically, patients complained of pain and dysfunction, according to the segment affected, and radiographically, evidences of pseudarthrosis in at least two X-ray views. As the outcomes: satisfactory when there was bone union, no pain, and return function; unsatisfactory when there was no bone union and maintain pain and dysfunction. All patients were treated with the same equipment and by the same physician. The treatment consisted in 3 sessions with weekly interval; in each session, 3000 radial shock waves were applied with 4 bar of energy. RESULTS: After 6 months, clinical analysis and X-ray evidence on 77.2% of the patients presented bone union and clinical improvement classified as satisfactory result. There were no complications. CONCLUSION: Treatment of pseudarthrosis in superficial bones with radial shock waves is effective and safe.
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Tratamento por Ondas de Choque Extracorpóreas , Pseudoartrose , Animais , Pé , Humanos , Estudos Prospectivos , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/terapia , RadiografiaRESUMO
Introdução: a obesidade é uma doença que afeta a saúde pública em nível mundial devido a suas comorbidades e ao risco de morte prematura. Diante disso, a tecnologia de terapia de ondas de choque extracorpóreas (ESWT) pode ser útil em seu tratamento e na prevenção de suas comorbidades. Objetivos: o objetivo foi avaliar se a ESWT é capaz de estimular a lipólise e/ou apoptose da célula adiposa de indivíduos obesos. Métodos: trata-se de um estudo comparativo de intervenção baseado em análises imuno- -histoquímicas de um conjunto de amostras de tecido subcutâneo de mulheres com obesidade, submetidas ao tratamento ESWT. O material biológico foi coletado no momento da cirurgia bariátrica. Resultados: 14 mulheres obesas foram incluídas na pesquisa. Foi evidenciada positividade na expressão de Casp3 (p<0,0001), cCasp3 (p<0,0024), macrófagos CD68+ (p<0,0001), HSL (p<0,0001) e adipofilina (p<0,0013) na amostra intervenção quando comparada ao controle. Conclusões: a ESWT estimula a apoptose com consequente lipólise do tipo autofágica no tecido adiposo de mulheres obesas. Assim, a ESWT pode ser considerada uma terapia adjuvante útil, segura e promissora para redução do tecido adiposo e, consequentemente, para prevenção e/ou tratamento de obesidade
Introduction: Obesity is a disease that affects public health worldwide due to its comorbidities and premature death risk. Therefore, extracorporeal shock wave therapy (ESWT) technology can help treat and prevent its comorbidities. Objective: This study aims to assess whether ESWT can stimulate lipolysis and/or apoptosis of the fat cells of obese individuals. Methods: This is a comparative interventional study based on immunohistochemical analyzes of a set of subcutaneous tissue samples from women with obesity submitted to ESWT treatment. The biological material was collected at the time of bariatric surgery. Results: The survey included 14 obese women. Positivity was shown in the expression of Casp3 (p<0.0001), cCasp3 (p<0.0024), CD68+ macrophages (p<0.0001), HSL (p<0.0001), and adipophilin (p<0.0013) in the intervention sample compared to the control. Conclusions: We conclude that ESWT stimulates apoptosis with consequent autophagic lipolysis in the adipose tissue of obese women. Thus, ESWT can be considered useful, safe, and promising adjuvant therapy for reducing adipose tissue and, consequently, for preventing and/or treating obesity.
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Resumen: La litotricia extracorpórea por ondas de choque para el tratamiento de la urolitiasis es un tratamiento ampliamente aceptado, pero no exento de complicaciones. La pancreatitis aguda que se desencadena inmediatamente posterior a este procedimiento es infrecuente, pero puede ser una complicación grave que amenaza la vida del paciente. La aparición aguda de dolor abdominal y vómitos en las horas posteriores al procedimiento, deben hacer al médico tratante sospechar esta complicación. Presentamos el caso de un paciente joven que luego de someterse a una sesión de litotricia para el tratamiento de una litiasis renal derecha instaló una pancreatitis aguda que requirió ingreso a terapia intensiva y que se suma a los escasos informes de casos publicados en la literatura médica.
Summary: Extracorporeal shock wave lithotripsy to treat urolithiasis is a widely aceptable treatment, although it may involve complications. Acute pancreatitis immediately after the procedures is rather unusual, but it may result in a serious life-threatening complication for patients. The appearance of severe pain and vomits a few hours after the procedure should make physicians suspicious of this complication. The study presents the case of a young patient who developed acute pancreatitis after undergoing lithotripsy to treat lithiasis in the right kidney, requiring his admission to the intensive care unit. This will add up to the scarce reports published in the medical literature.
Resumo: A litotrícia extracorpórea por ondas de choque para o tratamento da urolitíase é um tratamento amplamente aceito, mas não isento de complicações. A pancreatite aguda que se desencadeia imediatamente depois deste procedimento não é frequente, porém pode ser uma complicação grave que ameaça a vida do paciente. O surgimento súbito de dor abdominal e vómitos nas horas seguintes ao procedimento devem induzir à suspeita desta complicação. Apresentamos o caso de um paciente jovem que depois de uma sessão de litotrícia para o tratamento de uma litíase renal direita apresentou uma pancreatite aguda com posterior admissão a terapia intensiva; este caso se agrega aos poucos publicados na literatura médica.
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Pancreatite , Litotripsia/efeitos adversosRESUMO
RESUMEN Introducción: La terapia con ondas de choque son ondas acústicas presentes en situaciones diarias. Es un método que se emplea en la actualidad para tratar la bursitis trocantérica. Objetivo: Evaluar la efectividad de la terapia con ondas de choque en el tratamiento de la bursitis trocantérica. Métodos: Se realizó un estudio descriptivo, de corte transversal, con 46 pacientes diagnosticados con bursitis trocantérica, los cuales fueron tratados con el equipo Piezolith-3000 (ondas de choque extracorpóreas) en el Complejo Científico Ortopédico Internacional "Frank País", en el periodo comprendido entre marzo de 2014 y abril de 2018. Se realizó el análisis de las variables (edad, sexo, dolor y escala de Harris). Se obtuvieron las frecuencias absolutas y relativas, y con ellas se confeccionaron las tablas y gráficos que resumen la información estadística de la investigación. Resultados: Hubo predominio del sexo femenino (86,9 por ciento) y del grupo etario de 46 - 55 años (50 por ciento). Todos los pacientes presentaban dolor antes de la aplicación de las ondas de choque. Luego del tratamiento esta situación se revirtió y 69,5 por ciento de los enfermos dejaron de sentirlo. Según la escala de Harris, 50 por ciento de los pacientes estudiados tuvo una interpretación cualitativa de pobre (<70 puntos) antes de iniciar el tratamiento; posteriormente, solo 8,6 por ciento permanecieron con esa puntuación. Conclusiones: La terapia con las ondas de choque es una técnica no invasiva, segura y eficaz. Posibilitó una rápida recuperación de los pacientes atendidos y su incorporación a las actividades diarias(AU)
ABSTRACT Introduction: Shock wave therapy is acoustic waves present in daily situations. This method is currently used to treat trochanteric bursitis. Objective: To evaluate the effectiveness of shockwave therapy in the treatment of trochanteric bursitis. Methods: A descriptive, cross-sectional study was conducted with 46 patients diagnosed with trochanteric bursitis. They were treated with Piezolith-3000 equipment (extracorporeal shock waves) at Frank País International Orthopedic Scientific Complex, from March 2014 to April 2018. The analysis of the variables (age, sex, pain and Harris scale) was performed. The absolute and relative frequencies were obtained. Tables and graphs were prepared to summarize the statistical information of the investigation. Results: There was a predominance of the female sex (86.9 percent) and the age group of 46-55 years (50 percent). All patients had pain before receiving shock waves. After treatment this situation was reversed; the pain stopped in 69.5 percent of the patients. According to Harris scale, 50 percent of the patients studied had a poor qualitative interpretation (<70 points) before starting treatment; subsequently, only 8.6 percent remained at that score. Conclusions: Shockwave therapy is a non-invasive, safe and effective technique. It enabled a rapid recovery of patients and their return into daily activities(AU)
RÉSUMÉ Introduction: Les ondes de choc extracorporelles sont des ondes acoustiques présentes dans des situations de la vie quotidienne. C'est une technique actuellement utilisée pour traiter la bursite trochantérienne. Objectif: Évaluer l'efficacité de la thérapie par ondes de choc dans le traitement de la bursite trochantérienne. Méthodes: Une étude transversale descriptive de 46 patients diagnostiqués de bursite trochantérienne, et traités par ondes de choc extracorporelles à l'aide de l'appareil Piezolith-3000, a été réalisée dans le Complexe scientifique international d'orthopédie « Frank Pais¼, pendant la période de mars 2014 et avril 2018. On a effectué une analyse des variables (âge, sexe, douleur, score de Harris). On a obtenu les fréquences absolues et relatives, et grâce à elles, on a élaboré les tableaux et graphiques abrégeant l'information statistique de la recherche. Résultats: Le sexe féminin (86.9 pourcent) et la tranche d'âge de 46-55 ans (50 pourcent ) ont prédominé. Tous les patients soufraient de douleur avant l'application des ondes de choc. Après le traitement, cette situation s'est inversée, et 69.5 pourcent des malades ont cessé de la ressentir. D'après le score de Harris, les résultats obtenus dans 50 pourcent des patients ont été considérés comme mauvais (<70 points) avant le commencement du traitement ; puis après, seulement 8.6 pourcent des patients ont conservé cette évaluation. Conclusions: La thérapie par ondes de choc extracorporelles est donc une technique non invasive, fiable et efficace. Elle a permis la récupération des patients et leur retour aux activités de la vie quotidienne(AU)
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Humanos , Masculino , Feminino , Bursite/terapia , Fêmur , Tratamento por Ondas de Choque Extracorpóreas/métodosRESUMO
The purpose of this work was to develop a metamodel (Kriging model) to identify the most important input parameters of shock wave pressure profiles as used in biomedical applications without solving a large number of differential equations. Shock wave-induced cavitation is involved in several biological effects. During bubble collapse, secondary shock waves and microjets are formed. For some applications, it is desirable to enhance this phenomenon by applying a second shock wave before bubble collapse; however, the delay between the leading shock wave and the second pressure pulse has yet to be optimized. This optimization can be done using numerical analysis. A metamodel that predicts the most convenient ranges for the input variables and provides information on the joint effects between the input variables was tested. Because the metamodel is an analytical expression, running it fifty thousand times and analyzing variables, such as the pressure amplitude, delay between pulses, and pressure rise time, was fast and easy. Furthermore, this method can be a helpful tool to study the joint effect between the input variables and reduce the computation time. The metamodel can also be adapted to analyze simulations based on equations different from the Gilmore-Akulichev formulation, which was used in this study.
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Litotripsia/instrumentação , Microbolhas , Modelos Teóricos , Ultrassom , Microfluídica , Estresse MecânicoRESUMO
Ligninolytic enzyme production and lignin degradation are typically the rate-limiting steps in the biofuel industry. To improve the efficiency of simultaneous bio-delignification and enzyme production, Phanerochaete chrysosporium was transformed by shock wave-induced acoustic cavitation to co-overexpress 3 peroxidases and 1 laccase and test it on the degradation of sugarcane bagasse and wheat bran. Lignin depolymerization was enhanced by up to 25% in the presence of recombinant fungi in comparison with the wild-type strain. Sugar release on lignocellulose was 2- to 6-fold higher by recombinant fungi as compared with the control. Wheat bran ostensibly stimulated the production of ligninolytic enzymes. The highest peroxidase activity from the recombinant strains was 2.6-fold higher, whereas the increase in laccase activity was 4-fold higher in comparison to the control. The improvement of lignin degradation was directly proportional to the highest peroxidase and laccase activity. Because various phenolic compounds released during lignocellulose degradation have proven to be toxic to cells and to inhibit enzyme activity, a significant reduction (over 40%) of the total phenolic content in the samples treated with recombinant strains was observed. To our knowledge, this is the first report that engineering P. chrysosporium enhances biodegradation of lignocellulosic biomass.
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Biomassa , Lacase/biossíntese , Lacase/genética , Peroxidases/biossíntese , Peroxidases/genética , Phanerochaete/genética , Phanerochaete/metabolismo , Biodegradação Ambiental , Biocombustíveis , Celulose/metabolismo , Clonagem Molecular , Fibras na Dieta , Ergosterol , Proteínas Fúngicas/genética , Proteínas Fúngicas/metabolismo , Regulação Fúngica da Expressão Gênica , Lignina/metabolismo , Engenharia Metabólica , Phanerochaete/enzimologia , Phanerochaete/crescimento & desenvolvimento , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Saccharum , Transformação GenéticaRESUMO
Objetivo: Avaliar eficácia da terapia de ondas de choque focal (f-ESWT) comparada ao placebo para dor e incapacidade em pacientes com osteoartrose de joelho (OA). Métodos: Ensaio clínico randomizado, duplo-cego, placebo controlado, pacientes com OA primária de joelhos realizaram exercícios (alongamentos de isquiotibiais e fortalecimento de quadríceps) e randomizados em f-ESWT ou placebo. Todos os pacientes foram submetidos a 4 sessões semanais de 7.000 pulsos, e no grupo f-ESWT a energia foi de até 0.15mJ/mm2. O desfecho primário foi a escala analógica visual (VAS) para dor em 1 mês. Os desfechos secundários foram WOMAC, TUG, Lequesne e índice de resposta OMERACT-OARSI em 1 e 3 meses; bem como VAS aos 3 meses e eventos adversos (EAs). O teste de Mann-Whitney U e o teste exato Fisher foram utilizados com alfa = 5% e poder = 80% em uma análise de intenção de tratar. Os desfechos contínuos foram relatados como média ± desvio padrão. Resultados: 18 pacientes (9 em cada grupo), idade de 60.6±8.7 com 33.3% homens. Não houve diferença significativa entre grupos em qualquer variável. F-ESWT não foi superior ao placebo em 1 mês: VAS = -2,97 ± 3,18 e -2,68 ± 2,33 cm, respectivamente, p = 0,96. Somente o TUG no 1º mês foi significativo: 9.09 ± 2.30 e 11.01 ± 2.85 seg, p = 0.01. Conclusão: f-ESWT não foi superior ao placebo para osteoartrose de joelhos. Este estudo foi insuficiente para detectar diferenças. Novos estudos devem usar WOMAC A (subescala dor) como desfecho primário e recrutar 92 pacientes.
Objective: To assess the efficacy of focused extracorporeal shockwave therapy (f-ESWT) when compared to placebo for pain and disability in patients with knee osteoarthritis (OA). Methods: Randomized, parallel, double-blind, placebo-controlled clinical trial. Patients with primary knee OA were given a set of exercises (hamstring stretching and quadriceps strengthening) and randomized into f-ESWT or placebo (sham probe). All patients were submitted to 4 weekly sessions of 7,000 pulses, and in the f-ESWT group energy was up to 0.15mJ/mm2. Primary outcome was visual analog scale (VAS) for pain at 1 month. Secondary outcomes were WOMAC, TUG, Lequesne's index and OMERACT-OARSI responder index at 1 and 3 months; as well as VAS at 3 months and adverse events (AEs). Both patients and outcome assessors were blinded. Mann-Whitney U test and Fisher's exact test were used with alpha=5% and power=80% in an intention-to-treat analysis. Continuous outcomes were reported as mean± standard deviation. Results: 18 patients were included (9 in each group), aging 60.6±8.7, with 33.3% males. There was no significant difference at baseline across groups in any variables. f-ESWT was not superior to placebo at 1 month: VAS=-2.97±3.18 and -2.68±2.33cm, respectively, p=0.96. TUG at 1 month had significant differences: 9.09±2.30 and 11.01±2.85sec, p=0.01. No serious AEs were observed. Conclusions: f-ESWT was not superior to placebo for knee OA. This RCT was underpowered to detect differences in this study. New RCTs should use WOMAC A (pain subscale) as primary outcome and recruit at least 92 patients.
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Humanos , Osteoartrite do Joelho/terapia , Avaliação da Deficiência , Tratamento por Ondas de Choque Extracorpóreas/instrumentação , Exercício Físico , Método Duplo-CegoRESUMO
A síndrome do estresse tibial medial é uma lesão comum devido a sobrecarga mecânica, principalmente em atletas, devido a inflamação local e estresse ósseo. A terapia de ondas de choque (TOC) vem sendo utilizada como tratamento para esta patologia por seus efeitos analgésicos e anti-inflamatórios. Objetivo: Avaliar a eficácia da TOC no tratamento analgésico da síndrome do estresse tibial medial e medidas de funcionalidade. Métodos: Foi realizada uma revisão da literatura, sendo incluídos estudos clínicos em humanos. Resultados: 3 artigos preencheram os critérios de inclusão, incluindo 166 pacientes. Os trabalhos trouxeram uma ampla variedade de intervenções, tipos de aparelhos, frequência e energia utilizada, além de diferenças nas quantidades de sessões e tipos de ondas de choque utilizado no tratamento. Conclusão: Ainda não há evidências consistentes quanto ao uso da TOC no tratamento conservador da síndrome do estresse tibial medial, com estudos pequenos, de qualidade metodológica baixa. Os estudos inclusos no trabalho não relataram efeitos colaterais significativos
Medial tibial stress syndrome is a common injury due to mechanical overload, especially in athletes due to local inflammation and bone stress. Shockwave therapy (ESWT) has been used as a treatment for this pathology due to its analgesic and anti-inflammatory effects. Objective: To evaluate the effectiveness of ESWT in the analgesic treatment of medial tibial stress syndrome and measures of functionality. Methods: A review of the literature was conducted, with clinical studies in humans included. Results: 3 articles fulfilled the inclusion criteria, including 166 patients. The trials involved a wide variety of interventions, types of devices, frequency and energy used, as well as differences in the number of sessions and types of shock waves used in treatment. Conclusion: There is still no consistent evidence regarding the use of ESWT in the conservative treatment of medial tibial stress syndrome, with small studies of low methodological quality. Studies included in this review did not report significant side effects
Assuntos
Humanos , Ondas de Choque de Alta Energia/uso terapêutico , Síndrome do Estresse Tibial Medial/terapia , Resultado do TratamentoRESUMO
Shock waves are known to permeabilize eukaryotic cell membranes, which may be a powerful tool for a variety of drug delivery applications. However, the mechanisms involved in shock wave-mediated membrane permeabilization are still poorly understood. In this study, the effects on both the permeability and the ultrastructural features of two human cell lineages were investigated after the application of underwater shock waves in vitro. Scanning Electron Microscopy of cells derived from a human embryo kidney (HEK)-293 and Michigan Cancer Foundation (MCF)-7 cells, an immortalized culture derived from human breast adenocarcinoma, showed a small amount of microvilli (as compared to control cells), the presence of hole-like structures, and a decrease in cell size after shock wave exposure. Interestingly, these effects were accompanied by the permeabilization of acid and macromolecular dyes and gene transfection. Trypan blue exclusion assays indicated that cell membranes were porated during shock wave treatment but resealed after a few seconds. Deformations of the cell membrane lasted for at least 5 min, allowing their observation in fixed cells. For each cell line, different shock wave parameters were needed to achieve cell membrane poration. This difference was correlated to successful gene transfection by shock waves. Our results demonstrate, for the first time, that shock waves induce transient micro- and submicrosized deformations at the cell membrane, leading to cell transfection and cell survival. They also indicate that ultrastructural analyses of cell surfaces may constitute a useful way to match the use of shock waves to different cells and settings.
Assuntos
Membrana Celular , Células Eucarióticas , Ondas de Choque de Alta Energia , Membrana Celular/ultraestrutura , Permeabilidade da Membrana Celular , Sobrevivência Celular , Células Eucarióticas/metabolismo , Células Eucarióticas/ultraestrutura , Células HEK293 , Ondas de Choque de Alta Energia/efeitos adversos , Humanos , Células MCF-7 , TransfecçãoRESUMO
Objetivo: Avaliar a efetividade da Terapia por Ondas de Choque Extracorpórea (ESWT) e do Laser na redução da dor de indivíduos com fasciíte plantar. Métodos: Foram feitas buscas de ensaios clínicos randomizados nas bases de dados MEDLINE, LILACS e Cochrane até novembro de 2016, nos idiomas inglês e português. Foram incluídos estudos que tinham como forma de tratamento as ESWT ou Laser, comparados com outros métodos, e que avaliaram a dor com a escala visual analógica. Foi utilizada a escala de PEDro para avaliação da qualidade metodológica dos estudos. Resultados: Foram encontrados 131 artigos. Destes, 106 foram excluídos após a leitura de seus títulos e resumos e 15 após sua leitura na íntegra, restando oito que tiveram como forma de tratamento as ESWT e dois o Laser. Conclusão: Dos dez artigos encontrados seis apresentaram resposta estatisticamente significativa em relação à dor, sendo dois sobre Laser e quatro sobre ESWT.
Purpose: To evaluate the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) and Laser in pain reduction of individuals with plantar fasciitis. Methods: Searches were made of randomized trials in MEDLINE, LILACS and Cochrane until November 2016, in English and Portuguese. They included studies that had as a treatment ESWT or the Laser, compared with other methods, and assessed pain with a visual analogue scale. It used the PEDro scale to assess the methodological quality of the studies. Results: We found 131 articles. Of these, 106 were excluded after reading their titles and abstracts and 15 after reading in full, leaving eighy who had as a treatment the ESWT and two the Laser. Conclusion: Of the 10 articles found six showed statistically significant response in relation to pain, two on Laser and six on ESWT.
Assuntos
Fasciíte Plantar/terapia , Terapia a Laser , Tratamento por Ondas de Choque Extracorpóreas , Manejo da Dor/instrumentaçãoRESUMO
A terapia de ondas de choque (TOC) extracorpórea possui ação analgésica e anti-inflamatória. Com a evolução e compreensão de seus mecanismos físicos e biológicos, foi se estudando a sua aplicação em outras patologias, principalmente em afecções ósseas e musculo-tendíneas. Recentemente, estudos em modelos animais demonstraram a sua capacidade angiogênica e maior taxa de re-epitelização local. Estas pesquisas levaram ao início do uso de TOC radial de baixa energia no tratamento e manejo de diversas lesões de pele de difícil tratamento. As úlceras cutâneas possuem diversas etiologias, variando desde úlceras de pressão, queimaduras, úlceras venosas ou arteriais e também úlceras diabéticas. Seu tratamento é um desafio, devido ao seu tempo prolongado de tratamento (resultando em dificuldades quanto ao seguimento clínico) e também elevados custos. Objetivo: Avaliar a eficácia da TOC na cicatrização de úlceras de diversas etiologias: diabéticas, por pressão, queimaduras, pós-traumáticas, vasculares venosas e arteriais, por meio de uma revisão da literatura. Métodos: Foi realizada uma revisão da literatura, sendo incluídos estudos clínicos em humanos Resultados: 9 artigos preencheram os critérios de inclusão. Os estudos inclusos compreenderam 788 pacientes. Os manuscritos trouxeram uma variedade de padrão de intervenções diferentes. Houve heterogeneidade no tempo de intervenção, número de pulsos e na frequência de sessões, bem como na quantidade de sessões, densidade de energia aplicada, e também no tipo de ondas de choque utilizados nas terapias. Alguns dos trabalhos descritos encontraram uma maior taxa na cicatrização e fechamento completo de lesões em pacientes com lesões crônicas, que não responderam ao tratamento conservador. Porém, há poucos estudos na literatura com qualidade metodológica adequada. Conclusão: A TOC surge como uma alternativa promissora para pacientes que não respondem bem à terapia conservadora. Os resultados são promissores porém com evidências limitadas quanto a diminuição do tempo de cicatrização e na aceleração do fechamento de lesões. Os estudos selecionados não relataram efeitos colaterais significativos, sendo uma terapia segura
Extracorporeal shockwave therapy (ESWT) has analgesic and anti-inflammatory effects. With the evolution and comprehension of its biological and physical mechanisms, the application of ESWT on other pathologies has also been studied, especially in musculoskeletal diseases. Recently, studies on animal models have shown its angiogenic capacity and a higher rate of local re-epithelization. These small studies led to few trials using low-energy, radial ESWT to treat problematic chronic skin ulcers. Skin ulcers have diverse etiologies, ranging from pressure ulcers, burns, venous or arterial ulcers, and even diabetic ulcers. Their treatment is usually a challenge, due to the long-term treatment and high costs. Objective: To review the literature and evaluate the efficacy of ESWT in caring for skin ulcers of various etiologies: diabetic ulcers, pressure ulcers, burns, post-traumatic ulcers, venous and arterial ulcers. Method: A literature review was made, with only human trials included. Results: 9 articles were selected that fulfilled the eligibility criteria. The studies included evaluations of 788 patients. The manuscripts demonstrated a large variability regarding the interventions made. There was heterogeneity regarding intervention time, number of pulses, frequency of sessions, and also the number of sessions, energy density used, and the type of shock wave used in therapies. Some of the included trials found a higher rate of complete wound healing and faster epithelization in patients with chronic lesions, unresponsive to the traditional measures. However, there were few studies in the literature with proper methodological quality. Conclusion: ESWT is a promising alternative for the treatment of patients unresponsive to conventional measures. The results are promising, although the evidence regarding wound healing and acceleration of wound healing is still limited. The studies selected did not report any significant side effects
Assuntos
Humanos , Úlcera Cutânea/terapia , Tratamento por Ondas de Choque Extracorpóreas/instrumentação , Cicatrização , Resultado do TratamentoRESUMO
Black leaf streak disease, also known as black Sigatoka, causes dramatic losses in production of banana and plantains fruits. The disease is caused by the pathogenic fungus Mycosphaerella fijiensis (anamorph Pseudocercospora fijiensis; Mycosphaerellaceae). Genetic transformation of M. fijiensis would allow a better understanding of molecular basis of pathogenicity and design novel approaches to control the infection caused by this pathogen. However, transformation of this fungus has not been easy. We report here a protocol for genetic transformation of M. fijiensis employing underwater shock waves and intact conidia. The recombinant strains recovered showed genetic stability over >10 generations. The frequency of transformation obtained was between 75 and 150 times higher than the efficiency reported in the only article published on transformation of M. fijiensis using spheroplasts. This improvement allowed the use of a thousand times less cells than the amount employed before, avoiding the need for cumbersome successive batch cultures. Our protocol is simple, highly efficient, fast and reproducible and together with the available genomes of M. fijiensis and Musa acuminata, it offers new possibilities to study the diverse mechanisms of pathogenesis of the fungus.
Assuntos
Ascomicetos/genética , Técnicas Genéticas , Musa/microbiologia , Doenças das Plantas/microbiologia , Esporos Fúngicos/genética , Transformação Genética , Água/químicaRESUMO
Phanerochaete chrysosporium belongs to a group of lignin-degrading fungi that secretes various oxidoreductive enzymes, including lignin peroxidase (LiP) and manganese peroxidase (MnP). Previously, we demonstrated that the heterologous expression of a versatile peroxidase (VP) in P. chrysosporium recombinant strains is possible. However, the production of laccases (Lac) in this fungus has not been completely demonstrated and remains controversial. In order to investigate if the co-expression of Lac and VP in P. chrysosporium would improve the degradation of phenolic and non-phenolic substrates, we tested the constitutive co-expression of the lacIIIb gene from Trametes versicolor and the vpl2 gene from Pleurotus eryngii, and also the endogenous genes mnp1 and lipH8 by shock wave mediated transformation. The co-overexpression of peroxidases and laccases was improved up to five-fold as compared with wild type species. Transformant strains showed a broad spectrum in phenolic/non-phenolic biotransformation and a high percentage in synthetic dye decolorization in comparison with the parental strain. Our results show that the four enzymes can be constitutively expressed in a single transformant of P. chrysosporium in minimal medium. These data offer new possibilities for an easy and efficient co-expression of laccases and peroxidases in suitable basidiomycete species.