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Aims: Spinal cord injury (SCI) is a major cause of long-term physical impairment. Currently, treatment for SCI is limited to supportive measures, which can lead to permanent disability, representing a serious social burden. The present study aimed to evaluate the inflammatory microenvironment effects of human umbilical cord mesenchymal stem cells (HUCMSCs)+ Ultrashort Wave (USW) therapy on SCI and reveal possible mechanisms., Main Methods: Low-dose USW was treated one day after SCI, and HUCMSCs suspension was transferred to the lesion using a micro-syringe 7 days after SCI. The functional effects of HUCMSCs and USW, separately and combinedly, were measured, together with the infiltration of CD3 + cells, formation of A1 astrocytes and activation of NUR77/ NF-κB pathway., Key Findings: Our results showed that HUCMSCs+USW therapy improved motor function of SCI rat, together with decreased infiltration of CD3 + T cells, and decreased induction of microglia and A1 astrocytes. And also USW treatment played a very important role on decreasing the infiltration of CD3 + T cells and IBA-1 + cells. Reduced production of pro-inflammatory cytokines IL-1β and IL-6 was also observed in rats receiving HUCMSCs+USW therapy, medicated by NUR77/NF-κB pathway., Significance: These findings indicated that HUCMSCs+USW therapy could attenuate inflammatory microenvironment through NUR77/NF-κB signaling pathway, which might contribute to its better outcome., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA., Methods: This prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC), numerical rating pain scale (NRPS), pressure pain threshold (PPT), self-perceived fatigue and sit-to-stand test (STST), which were evaluated before and after 24 treatment sessions at a frequency of three sessions per week., Results: In all groups, there was a significant improvement (p < 0.05) in all variables over time, except pressure pain threshold. We observed significant differences (p < 0.05) between the groups for WOMAC function (exercise vs. exercise + placebo, mean difference [MD] = 5.55, 95% confidence interval [CI] = 3.63 to 7.46; exercise vs. exercise + ICT, MD = 3.40, 95% CI = 1.46 to 5.33; exercise vs. exercise + SDT, MD = 4.75, 95% CI = 1.85 to 7.64; exercise vs. exercise + PHOTO, MD = 5.45, 95% CI = 3.12 to 7.77) and WOMAC pain, with better scores achieved by the exercise group. However, these differences were not clinically relevant when considering the minimum clinically important difference., Conclusion: The addition of ICT, SDT or PHOTO into an exercise program for individuals with knee OA is not superior to exercise performed in isolation in terms of clinical benefit. clinicaltrials.gov: NCT02636764, registered on March 29, 2014.

Aim: The central sensitization inventory (CSI) is a validated, patient-reported questionnaire that quantifies symptoms of hypersensitivity disorders such as chronic pain, for which central sensitization (CS) may be the etiology. Objective: To investigate the analgesic effectiveness of ActiPatch and analyze the relationship between baseline CSI scores and demographics of chronic pain sufferers. Methods: Upon completing a 7-day ActiPatch trial, baseline CSI scores along with other assessment measures were obtained via e-mail from 174 chronic pain sufferers. Conclusion: CSI scores were positively correlated with gender (higher for women), baseline visual analog scale scores and pain duration. ActiPatch was found to be effective in reducing baseline pain for all subjects by an average of 4.3 visual analog scale points.

One of the main characteristics of cancer tissues is poor development of neovascularization that results in a limited blood circulation. Because of this phenomenon, it is harder for cancer tissues to diffuse their elevated heat into other parts of the body. The scientific principle of radiofrequency hyperthermia relies on this quality of cancer tissues which with higher temperature becomes more apparent. Despite the obvious necessity to selectively heat the cancer tissue for radiofrequency hyperthermia, a proper thermosensitizer has not been developed until now. Here, we show that transferrin containing ferric ion could be an ideal thermosensitizer for the increased efficiency of radiofrequency hyperthermia. In our result, the ferric ion-enriched cancer tissues dramatically react with 13.56 MHz radiofrequency wave to cause cancer-selective dielectric temperature increment. The overall anticancer efficacy of a 13.56 MHz radiofrequency hyperthermia using transferrin as a thermosensitizer was much higher than the oncotherapeutic efficacy of paclitaxel, successfully eradicating cancer in a tumor-xenografted mouse experiment.

Purpose:: To evaluate whether low energy shock wave preconditioning could reduce renal ischemic reperfusion injury caused by renal artery occlusion., Methods:: The right kidneys of 64 male Sprague Dawley rats were removed to establish an isolated kidney model. The rats were then divided into four treatment groups: Group 1 was the sham treatment group; Group 2, received only low-energy (12 kv, 1 Hz, 200 times) shock wave preconditioning; Group 3 received the same low-energy shock wave preconditioning as Group 2, and then the left renal artery was occluded for 45 minutes; and Group 4 had the left renal artery occluded for 45 minutes. At 24 hours and one-week time points after reperfusion, serum inducible nitric oxide synthase (iNOS), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), creatinine (Cr), and cystatin C (Cys C) levels were measured, malondialdehyde (MDA) in kidney tissue was detected, and changes in nephric morphology were evaluated by light and electron microscopy., Results:: Twenty-four hours after reperfusion, serum iNOS, NGAL, Cr, Cys C, and MDA levels in Group 3 were significantly lower than those in Group 4; light and electron microscopy showed that the renal tissue injury in Group 3 was significantly lighter than that in Group 4. One week after reperfusion, serum NGAL, KIM-1, and Cys C levels in Group 3 were significantly lower than those in Group 4., Conclusion:: Low-energy shock wave preconditioning can reduce renal ischemic reperfusion injury caused by renal artery occlusion in an isolated kidney rat model.

Objective: To evaluate the efficacy and safety of short-wave therapy with sham or no intervention for the management of patients with knee osteoarthritis., Methods: We searched the following databases from their inception up to 26 October 2016: MEDLINE, CENTRAL, EMBASE, Physiotherapy Evidence Database, CINAHL and OpenGrey. Studies included randomized controlled trials compared with a sham or no intervention in patients with knee osteoarthritis. The results were calculated via standardized mean difference (SMD) and risk ratio for continuous variables outcomes as well as dichotomous variables, respectively. Heterogeneity was explored by the I 2 test and inverse-variance random effects analysis was applied to all studies., Results: Eight trials (542 patients) met the inclusion criteria. The effect of short-wave therapy on pain was found positive (SMD, -0.53; 95% CI, -0.84 to -0.21). The pain subgroup showed that patients received pulse modality achieved clinical improvement (SMD, -0.83; 95% CI, -1.14 to -0.52) and the pain scale in female patients decreased (SMD, -0.53; 95% CI, -0.98 to -0.08). In terms of extensor strength, short-wave therapy was superior to the control group ( p < 0.05, I 2  = 0%). There was no significant difference in the physical function (SMD, -0.16; 95% CI, -0.36 to 0.05). For adverse effects, there was no significant difference between the treatment and control group., Conclusion: Short-wave therapy is beneficial for relieving pain caused by knee osteoarthritis (the pulse modality seems superior to the continuous modality), and knee extensor muscle combining with isokinetic strength. Function is not improved.

Aim: Back pain, the most prevalent musculoskeletal chronic pain condition, is usually treated with analgesic medications of questionable efficacy and frequent occurrence of adverse side effects., Objective: The objective was to determine the effectiveness of the ActiPatch medical devices in reducing chronic back pain, document medication related adverse side effects and establish their impact on quality of life., Methods: Upon completing a 7-day trial, subjects were contacted via email with an assessment form using the Constant Contact email program. A total of 1394 responses were collected from subjects who used the device for back pain., Conclusion: Medication adverse effects are common and impact quality of life in the lay population. ActiPatch is an effective intervention for the majority of subjects for treating chronic back pain, although this requires further investigation in randomized clinical trials.

Introduction: Osteoarthritis (OA) represents a public health challenge since the pathogenic treatment, able to induce cartilage regeneration, still remains unknown. Ageing of the population and increasing OA prevalence have led to a lot of research, aiming to identify treatments acting on chondrocytes that play a determinant role in cartilage degeneration÷regeneration balance. Pulsed shortwave therapy (with the classical application form - Diapulse) is a physiotherapy method with anabolic effects demonstrated on nervous, conjunctive and vascular tissues, but its effects on OA cartilage are not known., Aim: Our aim was to demonstrate the effects of Diapulse on the cartilage in experimental induced OA., Materials and Methods: Experimental OA was induced in 10 mature female rabbits by anterior cruciate ligament transection (ACLT). Ten weeks after ACLT, rabbits were randomized in a treatment group and a control group. Treatment group was exposed to Diapulse at a frequency of 27.12 MHz, pulse length of 65 μs, pulse frequency of 300 pulses÷s (300 Hz) for 10 minutes÷day. Control group was exposed to sham therapy. After treatment, rabbits were sacrificed and the cartilage was evaluated by histopathological examinations with Hematoxylin-Eosin (HE) staining and transmission electron microscopy (TEM)., Results: OA characteristic changes were found in both groups. In the treatment group, we found that Diapulse influenced the degenerative process in the OA cartilage by improving the chondrocyte viability and the capacity to maintain cellular matrix integrity and structure., Conclusions: Diapulse can be considered a disease modifying therapeutic procedure and could be a reliable option for treatment of OA patients.

Context: Regaining full, active range of motion (ROM) after trauma to the elbow is difficult., Objective: To report the cases of 6 patients who lacked full ROM in the elbow because of trauma. The treatment regimen was thermal pulsed shortwave diathermy and joint mobilizations., Design: Case series., Setting: University therapeutic modalities laboratory., Patients or Other Participants: Six patients (5 women [83%], 1 man [17%]) lacked a mean active ROM of 24.5° of extension approximately 4.8 years after trauma or surgery., Intervention(s): Treatment consisted of 20 minutes of pulsed shortwave diathermy at 800 pulses per second for 400 microseconds (40-48 W average power, 150 W peak power) applied to the cubital fossa, immediately followed by 7 to 8 minutes of joint mobilizations. After posttreatment ROM was recorded, ice was applied to the area for about 30 minutes., Main Outcomes Measure(s): Changes in extension active ROM were assessed before and after each treatment. Once the patient achieved full, active ROM or failed to improve on 2 consecutive visits, he or she was discharged from the study., Results: By the fifth treatment, 4 participants (67%) achieved normal extension active ROM, and 2 of the 4 (50%) exceeded the norm. Five participants (83%) returned to normal activities and full use of their elbows. One month later, the 5 participants had maintained, on average, (mean ± SD) 92% ± 6% of their final measurements., Conclusions: A combination of thermal pulsed shortwave diathermy and joint mobilizations was effective in restoring active ROM of elbow extension in 5 of the 6 patients (83%) who lacked full ROM after injury or surgery.

Objective: To investigate the efficacy of intermittent and continuous traction in the treatment of knee osteoarthritis., Design: A randomized, controlled, observer-blind seven-week trial., Setting: Hospital-based outpatient practice., Subjects: Ninety-eight patients with stage 3 knee osteoarthritis according to Kellgren-Lawrence radiological rating scale., Interventions: All 98 patients were randomly assigned to three treatment groups, for three weeks (weekends excluded). The control group (n=30, mean age: 59.30±8.16) received hot pack and short wave diathermy; the intermittent group (n=30, mean age: 58.20±7.78) received hot pack, short wave diathermy and intermittent traction; and the continuous group (n=30, mean age: 57.97±9.53) received hot pack, short wave diathermy and continuous traction., Outcome Measurements: The values of the Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale, and knee passive range of motion were measured at baseline, three-week and seven-week follow-up., Results: Compared with baseline at weeks 3 and 7, all the outcome measures, except range of motion, were significantly reduced in all groups (all P≤0.001). In terms of the change data from baseline to week 3, both traction groups were significantly superior to the control in the WOMAC physical function scores. Considering the change data from baseline to week 7, both traction groups were significantly superior to the control in the pain scores, physical function and total scores, while only the continuous group was significantly better than the control in the stiffness scores (control: 1.17 ± 1.64; continuous: 2.38 ± 1.44) (P=0.014). Compared with baseline at weeks 3 and 7, range of motion values significantly increased in both traction groups (P<0.05) but not in the control (P>0.05). However, there were no significant differences among the three groups considering the change data from baseline to week 7 in range of motion values (P=0.300)., Conclusions: Joint traction was found to be beneficial for the improvement of pain and physical function loss related to knee osteoarthritis.

Objectives: To determine the efficacy of cardiac shock wave therapy (CSWT) in the management of patients with end-stage coronary artery disease (CAD)., Introduction: Patients with end-stage CAD have symptoms such as recurrent angina, breathlessness, and other debilitating conditions. End-stage CAD patients are usually those who have angina pectoris following a coronary artery bypass surgery or a percutaneous coronary intervention. These patients are refractory to optimal medical therapy and not fit for a redo procedure, and are often termed as 'no option' patients., Methods: We carried out a prospective cohort study to examine the effects of CSWT application in patients who had end-stage CAD and were no option patients. Characteristics such as angina class scores and functional status scores among cases (patients with end-stage CAD who received CSWT) and controls (patients with end-stage CAD who did not receive CSWT) were compared at baseline and at 6 months after CSWT therapy., Results: There were 43 patients in the case group and 43 patients in the control group. The mean age of the patients was 58.7 ± 9.5 years in the case group and 56.6 ± 11.6 years in the control group. Other characteristics such as the prevalence of diabetes, hypertension, coronary artery bypass graft and percutaneous coronary intervention were similar in both groups. Clinical results showed a significant improvement in exercise time between the cases and the controls 6 months after treatment with CSWT (20.1 ± 15.7 min in cases vs. 10.1 ± 4.2 min in controls; P<0.0001), and symptomatic improvement in the CCS class scores (1.95 ± 0.80 in cases and 2.63 ± 0.69 in controls; P<0.0001) and NYHA class scores (1.95 ± 0.80 in cases vs. 2.48 ± 0.59 in controls; P<0.001). In the control group, there was no improvement in angina class, functional class and exercise time., Conclusion: The present study shows that CSWT application to the ischemic myocardium in patients with refractory angina pectoris improved symptoms and reduced the severity of ischemic areas at 6 months after CSWT treatment compared with the baseline. No side effects were observed with this therapy.

The aim of this study is to observe the effect of different treatment time of millimeter wave (MMW) on chondrocyte apoptosis, caspase-3, caspase-8, and matrix metalloproteinase-13 (MMP-13) in rabbit knee osteoarthritis induced by anterior cruciate ligament transection (ACLT). Thirty-two New Zealand White rabbits were randomly assigned into 4 groups: millimeter wave treatment for 20-min group (MWT20); millimeter wave treatment for 40-min group (MWT40); model control group (MC) and normal control group (NC). All groups received anterior cruciate ligament transection in the right knee except NC group. Six weeks after transection, the MWT20 group and MWT40 group were given millimeter wave (MMW) at 37.5 GHz frequency, 8 mm wavelength, and 10 mW/cm(2) power for 20 and 40 min, respectively, for 10 days. Eight weeks after transection, all animals were killed. Modified Mankin Score was assessed for histological assessment. Chondrocytes apoptosis was tested by the TUNEL assessment, and the expressions of related proteins were tested by the immunohistochemistry observation and Western blot. The modified Mankin Score, the chondrocyte apoptosis, and the expression of caspase-3 and MMP-13 in MWT40 group were significantly lower than those in MC group. Only a decreasing trend of modified Mankin Score and caspase-3 and MMP-13 expression was found in MWT20 group. The caspase-8 expression of the treatment groups was lower than model control group and higher than normal control group, but no significant difference was found. This study revealed MWT40 had a better therapeutic benefit to osteoarthritis cartilage structure, decreased the apoptosis of chondrocyte, and caspase-3 and MMP-13 expression compared to MWT20. But only a decreasing trend of caspase-8 expression was found.

Hepatic surgery has evolved significantly in the past decade. The current article describes the largest series of patients in United States undergoing liver resective therapy with the use of microwave technology for liver precoagulation. Glisson's capsule was incised after securing inflow and outflow control. Two antennae, 2 cm apart, connected to a 915-MHz generator, were inserted 5 cm into liver parenchyma at a 130° angle. Once the parenchyma was firm and changed its color to gray, the antennae were advanced along the line of transection. The parenchyma was divided with electrocautery. Intra- and postoperative data were analyzed. Thirty-five patients (24 men) underwent liver resections. Diseases treated were colorectal metastases (n = 9), hepatic adenoma (n = 3), gallbladder cancer (n = 3), hepatocellular carcinoma (n = 4), neuroendocrine tumor (n = 2), cholangiocarcinoma (n = 5), hemangioma (n = 2), focal nodular hyperplasia (n = 2), metastatic gastrointestinal stromal tumor (n = 1), hydatid cyst (n = 1), hepatoid carcinoma (n = 1), hepatolithiasis (n = 1), and suspected metastatic breast cancer (n = 1). Resections done were right hepatectomy (n = 19), segmental resection (n = 5), left hepatectomy (n = 4), extended right hepatectomy (n = 4), Segment IVb and Segment V resections during radical cholecystectomy (n = 2), and left lateral sectionectomy (n = 1). Median operative time for major resection was 188 and 251 minutes for minor resection. There was one postoperative mortality. Bile leak needing stenting occurred in one patient. Median blood loss for major resection was 500 mL and 265 mL for minor resection. Intraoperative transfusion was required in nine major and one minor resections. Other complications were ileus in four, deep vein thrombosis in two, intra-abdominal abscess in one, and cardiac events in two patients. Liver precoagulation with microwave technology is a novel and efficient technique with minimal morbidity and mortality for liver transection.

The purpose of this paper is to report the cases of 7 subjects who lacked full range of motion (ROM) in the elbow, and my treatment regimen of PSWD and joint mobilizations. 7 subjects presented with decreased elbow (ROM) due to extensive fractures and or dislocations from traumatic injuries. All subjects were post-surgical, 2 with internal fixation devices. Initial active extension for each patient was 17°, 23°, 28°, 25°, 45°, 30°, 26° respectively (range of 17-45 degrees). Treatment regimen consisted of PSWD to the anterior elbow for 20 min at 48 watts. Immediately after PSWD, mobilizations were administered to the elbow. Extension improved 19°, 21°, 25°, 23°, 20°, 30°, and 26°, respectively, after 6 or less treatments (range of 19-30 degrees). All but 1 patient returned to normal activities with functional ROM in all planes. Follow-up 4 weeks later indicated that all of the subjects maintained 85-100% of their extension. No negative effects were reported during the short-term follow-up. When precautions are taken, I propose PSWD (48 W) may be an appropriate adjunct to joint mobilizations to increase ROM in peripheral joints despite implanted metal., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Purpose: The study aimed to investigate the thermal and non-thermal effects of pulsed short wave therapy (PSWT) using high and low dose of PSWT together with placebo and control conditions in healthy subjects., Method: A single-blind, crossover design was employed with 31 subjects who all participated in three conditions: High PSWT (PD 200 μsec, PRR 800 Hz, MP 24 W, 10 minutes), Low PSWT (PD 100 μsec, PRR 200 Hz, MP 3 W, 10 minutes), and Placebo PSWT (PD 20 μsec, PRR 50 Hz, MP 0.05 W, 10 minutes). Fourteen subjects additionally participated in a Control condition (no treatment, 10 minutes). Measurements of skin temperature, blood flow, heart rate, and core temperature were taken before, during, and after the application of PSWT. Data were analyzed using a repeated measures analysis of variance (ANOVA) model with a Bonferroni post-hoc comparison., Results: A significant increase in blood volume and skin temperature with both the high- and low-dose applications during the treatment period was demonstrated. There were significant differences between time periods and between treated and untreated limbs compared with the control condition. The blood flow changes during the low-dose application were not significantly different from placebo. Some subjects were unable to detect significant changes in skin temperature., Conclusion: Significant physiological changes associated with the application of PSWT have been demonstrated, challenging the notion of a lack of effect of this therapy. The study also demonstrated a measurable increase in skin temperature, which was not associated with thermal sensory perception; thus, skin sensation may not be clinically reliable for detecting real changes in temperature. Subjects with a wide age range of ages were deliberately recruited; however, these results may not extrapolate to a patient population who could react differently to the same intervention. Further studies in the clinical environment are therefore needed., (Copyright © 2010 John Wiley & Sons, Ltd.)

Objectives: To observe the effect of ultrashortwave (USW) therapy on nerve regeneration after acellular nerve allografts(ANA) repairing the sciatic nerve gap of rats and discuss its acting mechanisms., Methods: Sixteen Wistar rats weighing 180-220 g were randomly divided into four groups with four rats in each group: normal control group; acellular group (ANA, treated by hypotonic-chemical detergent, was applied for bridging a 10 mm-long sciatic nerve defect); USW group (After 24 h of ANA repairing the sciatic nerve gap, low dose USW was administrated for 7 min, once a day, 20 times a course of treatment, three courses of treatment in all); and autografts group. 12 weeks after operation, a series of examinations was performed, including electrophysiological methods, the restoring rate of tibialis anterior muscle wet weight, histopathological observation (myelinated nerve number, myelin sheath thickness, and axon diameter), vascular endothelial growth factor (VEGF) mRNA expression of spinal cord, and muscle at injury site, and analyzed statistically., Results: Compared to acellular nerve allografts alone, USW therapy can increase nerve conductive velocity, the restoring rate of tibialis anterior muscle wet weight, myelinated nerve number, axon diameter, VEGF mRNA expression of spinal cord, and muscle at injury site, the difference is significant. There were no differences between USW group and autografts group except myelin sheath thickness., Conclusions: USW therapy can promote nerve axon regeneration and Schwann cells proliferation after ANA repairing the sciatic nerve gap of rats, the upregulation of VEGF mRNA expression of spinal cord and muscle may play an important role.

Microwave endometrial ablation is an effective treatment for heavy menstrual loss that achieves high satisfaction rates, is acceptable to patients, and is recommended by the National Institute of Clinical Excellence. It has been evaluated extensively in randomized trials against first- and second-generation endometrial ablative techniques. Its simplicity of use and short treatment time make it suitable for outpatient treatments, whilst it can also treat larger and irregular cavities. This article reviews the available clinical research and scientific basis of this endometrial ablation technique.

Purpose: To evaluate the use of radiofrequency energy to correct advanced keratoconus., Setting: Universidade Federal de Minas Gerais, Belo Horizonte, and Universidade de Ciências da Saúde de Alagoas, Maceió, Brazil., Methods: In this prospective comparative study, radiofrequency was applied to 25 eyes of 21 consecutive patients. One group comprised patients with a K-reading between 54.0 diopters (D) and 58.0 D; 8 thermal spots were placed at the 4.0 mm optical zone. The other group comprised patients with a K-reading greater than 58.0 D; 16 spots were applied at the 4.0 mm and 5.0 mm optical zones. The minimum follow-up was 18 months in all patients. Differences between preoperative and postoperative uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, and K-readings were clinically and statistically evaluated., Results: At end of the 18-month follow-up, the mean BSCVA in the 8-spot group improved from 20/100 (0.71+/-0.25 logMAR) preoperatively to 20/40 (0.32+/-0.11 logMAR) and in the 16-spot group, from 20/200 (1.03+/-0.30 logMAR) to 20/60 (0.62+/-0.22 logMAR). The mean manifest refractive spherical equivalent (MRSE) improved from -7.70 D+/-5.20 (SD) preoperatively to -6.82+/-4.41 D after 18 months in the 8-spot group and from -11.33+/-6.70 to -8.38+/-5.12 D, respectively, in the 16-spot group. The mean best contact lens-corrected visual acuity was 20/30 (0.18+/-0.24 logMAR) in the 8-spot group and 20/40 (0.31+/-0.19 logMAR) in the 16-spot group. A dense corneal scar was seen in 1 patient in the 16-spot group at the 6-month follow-up., Conclusions: Radiofrequency appeared safe for the treatment of advanced keratoconus. Contact lens fitting was stable in all cases.

Background and Purpose: Shortwave (SW) diathermy can be used to improve vascular circulation and reduce inflammation and pain for patients with osteoarthritis. However, reduction in synovial inflammation has never been explored. The purpose of this study was to investigate whether repetitive SW diathermy, using ultrasonographic examination, could reduce synovitis in patients with knee osteoarthritis., Subjects and Methods: Thirty subjects with 44 osteoarthritic knees participated in this study. Eleven subjects received SW, and 10 subjects received SW and nonsteroidal anti-inflammatory drugs. Nine subjects received no treatment and served as a control group. Synovial sac thickness superior, medial, and lateral to the patella was measured using ultrasonography. The sum of these 3 measurements was taken as the total synovial sac thickness. Subjects in the treatment groups underwent ultrasonographic examination before and after 10, 20, and 30 treatments, whereas control subjects underwent ultrasonographic examination before the experiment and then once every 2 or 3 weeks for a total of 3 follow-up measurements., Results: After 10 SW diathermy treatments, the total synovial sac thickness in both treatment groups was significantly less than the initial thickness, and the synovial sac continued to become significantly thinner with 20 sessions of treatment. These observations were not made in the control subjects., Discussion and Conclusion: The results indicate that SW diathermy in patients with knee osteoarthritis can significantly reduce both synovial thickness and knee pain. Such reductions of synovial sac thickness and pain index continue over treatment sessions.

Background: Radiofrequency treatment is increasingly used to treat shoulder instability. Patients are asked to restrain their physical activities after this treatment but there is no precise information concerning the necessity for the restrain., Methods: There were two groups of ten specimens each. Treatment group specimens were stretched to subfailure injury, treated by a radiofrequency probe, and then cyclically loaded. Control group specimens were stretched to the same subfailure injury, Sham treated, and then cyclically loaded. Between each step of the experiment in both groups there was a relaxation test to examine the ligament viscoelastic properties. At the end, each ligament was stretched to failure and the load-elongation curve obtained., Findings: Relaxation forces decreased after the subfailure injury in both groups (average 76% and 81% of intact state, in treatment and control groups, respectively). In the treatment group, the relaxation forces first increased after the radiofrequency treatment (average 99% of intact state), and then decreased after the cyclic loading (average 50% of intact state). The treated ligaments failed at lower loads and smaller deformations than the controls., Interpretation: The radiofrequency treatment restored viscoelastic properties of the injured ligaments, but cyclic loading degraded these. Protection of the treated ligament is advised during the immediate post-operative period.

Objective: To determine if Paraspinal Square Wave Stimulation (PSWS) is effective in treating Post Traumatic Stress Disorder (PTSD) and or Chronic Pain., Method: PSWS is applied to the paraspinal area from the craniocervical junction to the lower sacrum., Results: Patient achieved dramatic relief from PTSD, unequaled by any previous pharmacologic or psychotherapies. The chronic pain is almost completely disappeared, unlike any previous therapies., Conclusion: PSWS is the treatment of choice for this patient with PTSD and Chronic Pain. This patient appears to have completely recovered from PTSD, unlike any other study reported so far.

Study Design: A randomized, counterbalanced 2x3x5 repeated-measures design., Objective: To compare changes in hamstring flexibility after treatments of pulsed shortwave diathermy and prolonged stretch, sham diathermy and prolonged stretch, and control., Background: Heat and stretch techniques have been touted for years. To date, the effect of shortwave diathermy and hamstring stretching has not been studied. Because diathermy heats a large area and penetrates deep into the muscle, use of this device prior to or during hamstring stretching may increase flexibility., Methods and Measures: Thirty college-age students (mean age, 21.5 years) with tight hamstrings (inability to achieve greater than 160 degrees knee extension at 90 degrees hip flexion) participated. Subjects were assigned to 1 of 3 groups: diathermy and stretch, sham diathermy and stretch, and control). Range of motion was recorded before and after each treatment for 5 days and on day 8. A straight leg-raise stretch was performed using a mechanical apparatus. Subjects in the diathermy-and-stretch group received 10 minutes of diathermy (distal hamstrings) followed by 5 minutes of simultaneous diathermy and stretch, followed by 5 minutes of stretching only. Subjects in the sham-diathermy-and-stretch group followed the same protocol, but with the diathermy unit turned off. Subjects in the control group lay on the table for 20 minutes. Data were analyzed using an ANOVA and post hoc t tests., Results: Mean (+/- pooled SE) increases in knee extension after 5 days were 15.8 degrees 2.2 degrees for the diathermy-and-stretch group, 5.2 degrees +/- 2.2 degrees for the sham-diathermy-and-stretch group, and -0.3 degrees +/- 2.2 degrees for the control group. Seventy-two hours after the last treatment, the diathermy-and-stretch group lost 1.9 degrees +/- 2.2 degrees, the sham-diathermy-and-stretch group lost 3.0 degrees +/- 2.2 degrees, and the control group changed -0.4 degrees +/- 2.2 degrees., Conclusion: These results suggest that hamstring flexibility can be greatly improved when shortwave diathermy is used in conjunction with prolonged stretching.

Background: Pain relief is reported to be the most common clinical application of electromagnetic millimetre waves., Aim: To evaluate safety and pain relief effect of millimetre wave therapy (MWT) for treatment of chronic joint pain in a group of patients with diffuse connective tissue diseases., Methods: Twelve patients with diffuse connective tissue diseases received MWT in addition to their analgesic medication with non-steroidal anti-inflammatory drugs. MWT procedure included the exposure of tender points around the painful joints to electromagnetic waves with frequency 54-78GHz and power density of 2.5mW/cm(2). The time of exposure was 35 +/-5 min and the total number of sessions ranged from 5 to 10 (median 6). Intensity of pain, medication requirement, joint stiffness and subjective assessment of therapy success were measured before, during and immediately after the treatment, and after a 6-months follow-up., Results: No adverse effects of MWT were noted. Pain intensity and required medication decreased significantly after the treatment (p<0.05) and remained at the same level throughout the follow-up period. The joint stiffness decreased and the subjective assessment of the treatment success after 6 month did not change except in only one patient., Conclusion: MWT applied to tender points around the affected joints was safe under the conditions of our study and after an appropriate full-scale double-blind clinical study, may be recommended as an effective adjunct therapy for chronic pain treatment in patients with diffuse connective tissue diseases.

Objectives: To investigate the influence of pulsed short-wave diathermy (PSWD) on fibroblast and chondrocyte cell proliferation rates and to establish the influences of different dosages applied., Design: Four single-blind trials., Setting: Laboratory, in vitro study., Specimens: Human adult dermal fibroblast and chondrocyte cells were plated at known concentrations and incubated for 5 days., Intervention: Exposure to PSWD, twice daily, on days 2, 3, and 4., Main Outcome Measure: After crystal violet staining (day 5), optical density (cell number) was determined spectrophotometrically., Results: PSWD, given at mean power of 48W for 10 minutes, increased fibroblast proliferation compared with control groups (P<.001). There was a relationship between cell proliferation and the amount of energy given (P<0.001). The optimal mean power for proliferation was estimated to be 13.8W. While keeping mean power constant at 6W, altering pulse duration and pulse repetition rate dosage parameters did not have a significant effect on proliferation (P=.519). Chondrocyte proliferation also increased with PSWD exposure of 6W at 10 minutes duration (P=.015). In addition, treatment time was significantly associated with chondrocyte proliferation (P<.001)., Conclusion: PSWD is associated with increased rates of fibroblast and chondrocyte proliferation in vitro, which is dose dependent. These results contribute to an understanding of the physiologic mechanisms underlying the therapeutic effects of PSWD., (Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation)

Background and Purpose: Short-wave diathermy (SWD) is widely available, yet a comprehensive examination of current clinical practice remains absent from the literature. The present paper aims to assess clinical and safety issues in continuous (CSWD) and pulsed (PSWD) short-wave diathermy application and subsequently indicate areas for future research., Method: A postal survey was carried out among 116 senior physiotherapists in 41 Irish hospital-based physiotherapy departments., Results: The response rate to the study was 75%. Analysis found that PSWD was the preferred mode of treatment with 27% of respondents using it more than once daily. Respondents considered both modes of treatment indicated for a variety of conditions. CSWD was rated as an effective treatment for chronic osteoarthritis, polyarthritis, non-specific arthrosis and haematomas. PSWD was reported an effective modality for acute soft tissue injury, haematomas, acute osteoarthritis, sinusitis and rheumatoid arthritis. Dose selection varied greatly but tended to be based on the type, nature and duration of the condition. Analysis of safety practices uncovered concerning findings. Although a high level of agreement was found on measures for patient safety, 30% of respondents reported that no measures for operator safety were taken and only five respondents stated they remained a specified distance from SWD equipment. Measures to ensure the safety of other personnel in the physiotherapy department were also lacking., Conclusions: Given the availability of SWD equipment and its apparent efficacy in certain conditions, future research should aim to establish this by means of controlled clinical trials. The findings on safety practices underline the urgent need for comprehensive guidelines to ensure the safety of operators, patients and the general public during SWD application.

A new device made of piezoelectric ceramic placed in a semispherical dish and focussed at 320 mm was developed in order to generate heat and cavitation responsible for coagulative necrosis of deep tissues. The target to be treated is located with a central ultrasound probe of 3.5 MHz. In vitro studies with polyurethane phantoms showed that the ultrasound melted a surface of 2 x 12 mm within 1 s. The temperature recorded at the focus was 270 degrees C. In tissue samples (prostate cancer and benign prostate hyperplasia), the temperature rose to 85 degrees C in vitro and a hyperechoic zone appeared at the focus during shots. In vivo 8-mm plastic spheres, introduced surgically into the bladder of pigs, were melted by repeat shots without burning of crossed tissues. These studies were performed in the kidney and the liver. Autopsy performed on day 0 showed congestion, autopsy performed between day 6 and day 11 showed necrosis, whereas at 3 months the focussed area was fibrosed. This technique, which we called 'focussed extracorporeal pyrotherapy', combines phenomena of cavitation and high heat at the focus. Prostate tumors, bladder tumors, kidney tumors and liver metastases are potential indications for pyrotherapy.

Continuous shortwave diathermy is the technique of choice when uniform marked elevation of temperature is required in the deep tissues. This heating can be targeted accurately by using an appropriate applicator positioned correctly. SWD also allows superficial structures to be heated selectively, although for this the various methods of surface heating are usually preferable. Sub-acute or chronic conditions respond best to continuous shortwave diathermy which, when used properly, can be as effective as ultrasound. Acute lesions are better treated with pulsed shortwave diathermy. Continuous shortwave diathermy can help to relieve pain and muscle spasm, resolve inflammatory states and reduce swelling, promote vasodilation, increase the compliance of connective tissue, increase joint range and decrease joint stiffness.

This article discusses some of the basic principles involved in the deposition of microwave power in the tissue. Insight is offered into the characteristics of the instrumentation, its limitations, and the necessary quality control needs.

We conducted a phase I clinical trial of the feasibility of using the Thermotron RF-8, a capacitative heating device utilizing 8-MHz RF, for the treatment of deep-seated and bulky human tumors. Preclinical studies with agar phantoms demonstrated that deep heating can be achieved with this device when the electrode diameters are sufficiently large relative to the thickness of the heated object. In the clinical application of capacitive heating with radiofrequency, excessive heating of subcutaneous tissue has often been a problem. However, this could be minimized by continuous cooling of the subcutaneous fat with a 10 degrees C saline bolus, beginning more than 20 minutes prior to the start of heating. It was often possible to raise the temperature of deep-seated tumors even in obese patients by applying this pre-cooling method. The mean achieved temperature during 30 to 40 minutes of heating was higher than 42 degrees C and 40 degrees C to 42 degrees C in 26% and 50% of 58 tumors treated, respectively. A combination of hyperthermia (four to ten sessions, twice a week) with full-course or a limited dose of radiotherapy resulted in complete tumor remission in 7% of patients, and partial tumor remission in 50% of patients. In the full-course radiotherapy group, 69% of the tumors were judged to show complete or partial regression, and in the low-dose group, 43% of the tumors regressed completely or partially. Histologic examination of many of the tumors that did not regress showed massive necrosis, indicating that tumor size after hyperthermia is not an accurate criterion of the treatment result. Side effects were minimal, and vital sign changes during heating were insignificant. Our data, together with those reported by Japanese investigators, clearly demonstrated that hyperthermia with the Thermotron RF-8 in combination with radiotherapy is useful in treating deep-seated and bulky tumors that fail to respond to conventional treatment modalities.

The effectiveness of spinal manipulation carried out by a non-medical qualified osteopath was compared with that of short-wave diathermy (SWD) and a placebo (detuned SWD) in 109 patients with low back pain. More than half the subjects in each of the 3 treatment groups benefited immediately from therapy. Significant improvements were observed in the 3 groups at the end of 2 weeks' treatment, and these were still apparent at 12 weeks. The outcome of treatment was unrelated to the initial severity or duration of pain or to the trend of pain towards deterioration or improvement. It is, therefore, unlikely that the results simply reflect the natural history of low back pain. Benefits obtained with osteopathy and SWD in this study may have been achieved through a placebo effect.