Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 73-87).

With the high development of society and economy, the rising level of national education, and the awareness of consumer rights in Taiwan, consumers¡¦ demands for medical and health care is increasing. The role of consumers has transformed to actively select and require medical and health care. The implementation of the National Health Insurance leads to the role change of the medical provider from a price maker to a price receiver, which benefits hospitals with mass product and cost control. Therefore, price-drive medical consumers become quality¡Vdriven ones, which benefits hospitals with good faculty, facilities and service. Nowadays, the hospital business environment is becoming more and more competitive. It is vital not only for hospital substantial business to create customer value of service and quality but also for hospital competitiveness to satisfy customer needs. The business strategy of hospitals is to greatly strengthen internal management and actively seek for the interaction with the external environment to keep survival and growth. Besides, hospitals apply CRM in order to attract new customers, retain old customers and to increase the profits of the customer contribution. Because of the limit of cost and budget tight policy, large hospitals are increasing their scale and the limited resource /number of customers. In this case, it is necessary for hospital¡¦s business strategy to focus on both quality and cost effectiveness. Hospitals build the tight relationship with customers so that they are willing to be diagnosed. Thus, Customer Relationship Management is the core competitive advantage for hospitals. Nevertheless, hospitals are less willing to purchase extracorporeal shock wave lithotripsy machines for the sake of the tight finance budget. As far as medical device suppliers are concerned, they have to adopt BOT approach in order to maintain business growth. Regarding the medical service and cooperation model for renal calculus patients, we discover that it is the equipment suppliers that are responsible for CRM rather than hospitals establishment. The retention number and returning frequency is the key to the revenues of the equipment suppliers, which means the relationship between hospitals and suppliers are unbroken. Our research indicates that the business model of extracorporeal shock wave lithotripsy machine can apply the concept of CRM. The medical equipment business and medical organization develop the model of the patient service with the base; CRM, the core value: customers and the hospital vision. We construct the ¡§four wins¡¨ model for the hospital, the patient, the Health Insurance Bureau and the business with the decision-making strategy, customer service and IT application.

In cell culture, the cellular responses on Day 6 and Day 18, and matrix mineralization (Day 35) of human periosteal cells after stimulated by ESW, LIPUS and ESW+LIPUS treatments were studied. Our results showed that LIPUS only exerted transiently beneficial effects on Day 6, but no effect was observed on Day 18. In contrast, ESW inhibited the differentiation on Day 6, and then exerted a time-delayed stimulation effect on cellular response and matrix mineralization. Data of the ESW+LIPUS showed that it was mainly under ESW effects, but LIPUS might impact the beneficial effect of ESW on Day 18, leading to reduced ALP and matrix mineralization. The potentials of the osteocytes to function as mechanosensors and signal relay were also investigated with untreated periosteal cells that separately received conditioned medium from MLO-Y4 osteocyte-like cells, which received the ESW LIPUS and ESW+LIPUS treatments. The periosteal cells showed stimulated proliferation in the ESW+LIPUS and ESW groups, indicating that the stimulus of ESW was transferred in the conditioned medium. / In conclusion, although our in vivo and in vitro findings did not support our hypothesis of the beneficial effects of combined treatment, but ESW had been shown to improve BMD and bone microarchitecture in osteoporotic bone, by stimulation of osteogenic activities in osseous cells. ESW might potentially be developed as treatment for osteoporosis. Our study also indicated that stimulation of osteogenic activities may be the direct interaction of ESW on osteoblast/periosteal cells, or indirectly through biochemical signals relayed by the osteocytes which acted as mechanosensors. / Osteoporosis is a bone disorder with decreased bone mass and deteriorated microarchitecture, leading to increased fracture risk. By using non-invasive biophysical interventions that stimulate osteogenesis, i.e. extracorporeal shockwave (ESW) and low-intensity pulsed ultrasound (LIPUS), may reduce bone loss effectively. We hypothesized that the combined treatment of ESW and LIPUS might produce synergistic effects on osteoporotic bone. The aim of this study was to investigate the efficacy of using ESW treatment alone and combined treatment of ESW and LIPUS to increase bone mineral acquisition on intact osteoporotic bone in vivo, and to investigate their underlying mechanisms in vitro. / Ten osteoporotic goats were used and divided into ESW and ESW+LIPUS groups (n=5). The ESW group received shockwave at calcaneus, distal radius, and femoral condyle on the left limbs once per month. The ESW+LIPUS group also received ESW treatment monthly and LIPUS for 6 day/week. The opposite limbs served as contralateral control. After nine months, percentage BMD changes, mineral apposition rate, trabecular thickness in treatment sites were found higher than that of controls in both groups. Cumulatively increase of serum bone-specific alkaline phosphatase indicated that the improvements were due to the increased osteogenic activities in bone. Of all parameter, no significant difference was found between the ESW+LIPUS and ESW groups. / by Tam Kam Fai. / "August 2006." / Adviser: Kwok Sui Leung. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1550. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 156-184). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Conclusion This series of investigations demonstrated how we can apply our knowledge to improve the treatment outcome of ESWL. Based on clinical information, such as age, suitable candidates for ESWL can be identified, and hence better application of ESWL can be achieved. With an understanding of the benefits and limitations of imaging (NCCT and intravenous urography), treatment success can be predicted, and better treatment plans for patients can be formulated. A policy of more liberal use of analgesia during ESWL can also help to improve the treatment outcomes of patients. Finally, with the use of different assessment methods, the true impact of various new technologies or treatment protocols can be assessed, and the results can lead to better understanding of ESWL and also improvement in the treatment outcomes. / Materials and Methods In a retrospective review of treatment information of 2192 patients, the effect of age on stone-free rates after ESWL was assessed. Next, in a prospective study, the role of stone parameter, measured using non-contrast computerized tomography (NCCT), in predicting the treatment outcomes of upper ureteric stones was examined. The general applicability of caliceal pelvic height (CPH) in determining the treatment outcomes for lower caliceal stones for three different lithotriptors was assessed in the third study. In another retrospective comparative study, the effect on treatment outcomes of additional usage of intravenous analgesic during ESWL, as compared to oral analgesic premedication alone, was analyzed. Finally, the feasibility of the use of two statistical methods, logistic regression and matched-pair analysis, in comparing the treatment results of different lithotriptors was investigated. / Objectives Despite the initial success of extracorporeal shock wave lithotripsy (ESWL), the performance of the contemporary machines has never been as good as that of the first-generation machine. Therefore, a series of studies was conducted to advance the current knowledge of ESWL and investigate possible ways to further optimize the treatment outcomes. / Results We found that the stone-free rate after ESWL for older patients with renal stones, but not for those with ureteric stones, was significantly lower than that of younger patients. Stone parameters measured using NCCT, namely, mean stone density, stone volume, and skin-to-stone distance, were significant predictive factors for successful ESWL for upper ureteric stones. However, caliceal pelvic height, measured by intravenous urography, was a significant predictor of treatment outcomes of lower caliceal stones for only the Piezolith 2300 lithotriptor, and not the other two types of lithotriptors. The additional usage of intravenous analgesic improved the effectiveness quotient and hence treatment outcomes of ESWL. Finally, both logistic regression and matched-pair analysis were found to be feasible approaches for the comparison of the performance of different lithotriptors. / Chi-Fai Ng. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 224-243). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.

Made available in DSpace on 2014-06-11T19:31:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-05-27Bitstream added on 2014-06-13T21:02:10Z : No. of bitstreams: 1 pyles_md_dr_botfmvz.pdf: 1285768 bytes, checksum: c7e043fd85c25b169c8a9bb3a6e24772 (MD5) / Universidade Estadual Paulista (UNESP) / O objetivo deste estudo foi avaliar os efeitos da aplicação de ondas de choque extracorpóreas no osso terceiro metacarpiano de equinos hígidos através da determinação da elasticidade óssea. Para tanto, foram utilizados 20 equinos da raça Puro Sangue Inglês, machos e fêmeas, com dois anos de idade, clinicamente sadios e em início de treinamento, sendo selecionados quanto ao estado de higidez com especial atenção quanto à integridade do aparelho locomotor. No D0, dia zero do experimento, todos os animais foram submetidos à avaliação da elasticidade óssea realizada no osso terceiro metacarpiano. Os animais foram divididos aleatoriamente em dois grupos de dez animais em cada (Grupo Controle e Grupo Tratamento). A aplicação da terapia com ondas de choque extracorpóreas (ESWT) foi realizada no membro torácico direito dos animais do Grupo Tratamento, na região coincidente à da avaliação da elasticidade óssea e para tanto foi utilizado aparelho para terapia de ondas extracorpóreas com densidade de fluxo de energia de 0,15 mJ/mm2 e 2000 pulsos com sonda E6R20, com a característica do foco da onda de choque de 20mm. As aplicações da ESWT foram repetidas a cada 21 dias totalizando três sessões (D0, D21 e D42). A análise da determinação da elasticidade óssea, além do D0, foi realizada no 21o dia após a primeira aplicação, no 21o dia após a segunda aplicação e no 30o dia após a terceira aplicação de ESWT (D21, D42 e D72). A média da velocidade ultrassonográfica (SOS) diferiu entre os grupos no D21, D42 e D72, sendo que os animais do Grupo Tratamento apresentaram menor densidade mineral óssea após as aplicações da ESWT. Houve diferença também à análise da massa óssea (Z-Score) entre os grupos no D21 e D42, quando... / The purpose of this study was to evaluate the effects of extracorporeal shock waves in third metacarpus bone from healthy horses by determination of bone elasticity. It were used 20 Thoroughbred horses, male and female, with two years old, clinically healthy and on top of training, selected as healthy state and special attention on the integrity of the locomotor system. At D0, day zero of the experiment, all animals were submitted to evaluation of bone elasticity held in the third metacarpus bone. The animals were randomly divided into two groups of ten animals (Control Group and Treatment Group). The application of extracorporeal shock wave therapy (ESWT) was performed on the right forelimb of the animals in the Treatment group in the same location evaluated for bone elasticity and extracorporeal therapy of waves was applied with 0.15mJ/mm2 energy flux density and 2000 pulses with E6R20 probe, with focus feature of the shock wave of 20mm. The applications of ESWT were repeated every 21 days, a total of three sessions (D0, D21 and D42). The analysis of bone elasticity determination was realized at D21, D42 and D72. The average speed ultrasound (SOS) differed between groups at D21, D42 and D72, and the animals from treatment group had lower bone mineral density after applications of ESWT. There was also difference in the analysis of bone mass (Z-Score) between the groups at D21 and D42, where animals from treatment group showed a significant decrease in bone mass. The risk of fracture were higher in animals from treatment group at D21. It was concluded that ESWT is able to promote change in bone mineral density.

The enforcement of national health insurance brings the new transition of medical service. The main purpose of this study is to investigate patients¡¦ emphasis and satisfaction on different dimension of service quality. The study referred to industrial views, related literature review and 5Qs model (Zineldin, 2006). Eventually, the practical research results are used to conduct a competitive niche strategy and a positioning plan of extracorporeal shock wave lithotripsy market to seek the unique value of medical service differentiation. According to the empirical view, the satisfaction and loyalty of those patients who had operations under the hospital treatment were significantly higher than those patients who didn¡¦t. ¡§Quality of atmosphere¡¨ and ¡§Quality of infrastructure¡¨ were the two factors which had positive impact on the satisfaction of patients. Also, ¡§Quality of medical care interaction¡¨ and ¡§Quality of atmosphere¡¨ affected the loyalty of patients greatly. Therefore, this study suggested that doctors should provide professional medical services to offer unique attributes which were valued by patients, and then achieved the influence of word-of-mouth marketing. The Competitive strategy is (1) from standardization to differentiation: creating values to patients by standard operation procedure. (2) from selfish departmentalism to patient-orientation: providing more interactions during medical service to fulfill the cognitive and emotional needs of patients. (3) from tradition to innovation: carrying out a new model which was designed by whole new ideas to supply medical service with sustainable competitive advantage. (4) from closed to open environment: emphasizing on profession and abandoning asymmetric information to develop trust relationship between doctors and patients. The strategic positioning of ESWL is to provide cordial, effective and fast integrated medical service for patients, and the establishment of ¡§Shock Wave Lithotripsy Center¡¨ is the further step of this strategy.

Orientador: Ana Liz Garcia Alves / Banca: Carlos Alberto Hussni / Banca: Elisa Holthausen Caminoto / Banca: Luciane Rasera / Banca: Vânia Maria Vasconcelos Machado / Resumo: O objetivo deste estudo foi avaliar os efeitos da aplicação de ondas de choque extracorpóreas no osso terceiro metacarpiano de equinos hígidos através da determinação da elasticidade óssea. Para tanto, foram utilizados 20 equinos da raça Puro Sangue Inglês, machos e fêmeas, com dois anos de idade, clinicamente sadios e em início de treinamento, sendo selecionados quanto ao estado de higidez com especial atenção quanto à integridade do aparelho locomotor. No D0, dia zero do experimento, todos os animais foram submetidos à avaliação da elasticidade óssea realizada no osso terceiro metacarpiano. Os animais foram divididos aleatoriamente em dois grupos de dez animais em cada (Grupo Controle e Grupo Tratamento). A aplicação da terapia com ondas de choque extracorpóreas (ESWT) foi realizada no membro torácico direito dos animais do Grupo Tratamento, na região coincidente à da avaliação da elasticidade óssea e para tanto foi utilizado aparelho para terapia de ondas extracorpóreas com densidade de fluxo de energia de 0,15 mJ/mm2 e 2000 pulsos com sonda E6R20, com a característica do foco da onda de choque de 20mm. As aplicações da ESWT foram repetidas a cada 21 dias totalizando três sessões (D0, D21 e D42). A análise da determinação da elasticidade óssea, além do D0, foi realizada no 21o dia após a primeira aplicação, no 21o dia após a segunda aplicação e no 30o dia após a terceira aplicação de ESWT (D21, D42 e D72). A média da velocidade ultrassonográfica (SOS) diferiu entre os grupos no D21, D42 e D72, sendo que os animais do Grupo Tratamento apresentaram menor densidade mineral óssea após as aplicações da ESWT. Houve diferença também à análise da massa óssea (Z-Score) entre os grupos no D21 e D42, quando... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The purpose of this study was to evaluate the effects of extracorporeal shock waves in third metacarpus bone from healthy horses by determination of bone elasticity. It were used 20 Thoroughbred horses, male and female, with two years old, clinically healthy and on top of training, selected as healthy state and special attention on the integrity of the locomotor system. At D0, day zero of the experiment, all animals were submitted to evaluation of bone elasticity held in the third metacarpus bone. The animals were randomly divided into two groups of ten animals (Control Group and Treatment Group). The application of extracorporeal shock wave therapy (ESWT) was performed on the right forelimb of the animals in the Treatment group in the same location evaluated for bone elasticity and extracorporeal therapy of waves was applied with 0.15mJ/mm2 energy flux density and 2000 pulses with E6R20 probe, with focus feature of the shock wave of 20mm. The applications of ESWT were repeated every 21 days, a total of three sessions (D0, D21 and D42). The analysis of bone elasticity determination was realized at D21, D42 and D72. The average speed ultrasound (SOS) differed between groups at D21, D42 and D72, and the animals from treatment group had lower bone mineral density after applications of ESWT. There was also difference in the analysis of bone mass (Z-Score) between the groups at D21 and D42, where animals from treatment group showed a significant decrease in bone mass. The risk of fracture were higher in animals from treatment group at D21. It was concluded that ESWT is able to promote change in bone mineral density. / Doutor

Objectives: To compare optical values in the osteotomy gap created after a Tibial Tuberosity Advancement (TTA) treated with autogenous cancellous bone graft (ACBG), extracorporeal shock wave therapy (ESWT), a combination of ACBG and ESWT, and absence of both ACBG and ESWT using densitometry. Methods: Dogs presenting for surgical repair of a cranial cruciate ligament rupture were randomly assigned to one of four groups; TTA with ACBG (TTA-G), TTA with ACBG and ESWT (TTA-GS), TTA with ESWT (TTA-S), and TTA with no additional therapy (TTA-O). Mediolateral radiographs at 0, 4 and 8 weeks after surgery were evaluated to compare healing of the osteotomy gap via densitometry. An analysis of variance (ANOVA) statistical analysis was used to compare the densitometric values between groups. Results: At 4 weeks after surgery, a significant difference in osteotomy gap density was noted between TTA-GS (8.4 millimeters of Aluminum equivalent [mmAleq]) and TTA-S (6.1mmAleq), and between TTA-GS (8.4 mmAleq) and TTA-O (6.4 mmAleq). There were no significant differences noted between groups at the 8 week recheck. Clinical Significance: There were no significant differences in the osteotomy gap density at 8 weeks after surgery regardless of the treatment modality used. The combination of ACBG and ESWT may lead to increased density of the osteotomy gap in the first 4 weeks after surgery. Densitometry using an aluminum step wedge is a feasible method for comparison of bone healing after TTA in dogs. / Master of Science

by Lo, Kin Yin Anthony. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 168-195). / Abstracts in English and Chinese. / Abstract --- p.i / Declaration --- p.V / Publications and Conference Presentations --- p.vi / Scholarships and Awards --- p.vii / Acknowledgements --- p.viii / Table of contents --- p.X / Abbreviations --- p.xiv / List of Figures --- p.xvi / List of Tables --- p.xvii / Chapter 1. --- General Introduction --- p.1 / Chapter 2. --- Literature Review --- p.7 / Chapter 2.1 --- Introduction of nephrolithasis and surgical management --- p.9 / Chapter 2.1.1 --- Epidemology and physiochemistry --- p.9 / Chapter 2.1.2 --- Surgical management of nephrolithasis parallel with stone factors --- p.15 / Chapter 2.2 --- Extracorpoeral Shock Wave Lithotripsy in present study --- p.17 / Chapter 2.2.1 --- The 4th generation - Sonolith Vision electroconductive lithotripter --- p.18 / Chapter 2.2.2 --- The role of shock wave delivery rate in treatment outcome and its prediction --- p.23 / Chapter 2.2.3 --- Patient-controlled analgesia during Shock Wave Lithotripsy treatment and its pain management --- p.29 / Chapter 2.2.4 --- Shock wave induced renal injury & the use of urinary biomarker --- p.35 / Chapter 3. --- Materials and Methods --- p.62 / Chapter 3.1 --- Study Design --- p.63 / Chapter 3.2 --- Patient Selection --- p.64 / Chapter 3.3 --- Treatment Protocol --- p.63 / Chapter 3.4 --- Sample size calculation --- p.68 / Chapter 3.5 --- Statistical analysis --- p.68 / Chapter 4. --- The effect of shock wave delivery rate on treatment outcome and its prediction --- p.69 / Chapter 4.1 --- Introduction --- p.70 / Chapter 4.2 --- Materials and Methods --- p.72 / Chapter 4.2.1 --- ESWL treatment protocol --- p.72 / Chapter 4.2.2 --- Outcome Assessment --- p.73 / Chapter 4.2.3 --- Mathematical model development --- p.75 / Chapter 4.2.4 --- Statistical analysis --- p.76 / Chapter 4.3 --- Results --- p.77 / Chapter 4.3.1 --- Baseline characteristics and treatment modalities --- p.78 / Chapter 4.3.2 --- ESWL treatment outcome --- p.79 / Chapter 4.3.3 --- Mathematical model --- p.81 / Chapter 4.4 --- Discussion --- p.82 / Chapter 4.4.1 --- Overall treatment outcome improved by the use of slower rate --- p.82 / Chapter 4.4.2 --- When should we use fast/slow rate? --- p.86 / Chapter 4.4.3 --- Mathematical model to predict ESWL outcome --- p.88 / Chapter 4.5 --- Conclusion --- p.91 / Chapter 5. --- The role of shock wave delivery rate and patient-controlled analgesia in pain --- p.101 / Chapter 5.1 --- Introduction --- p.102 / Chapter 5.2 --- Materials and Methods --- p.104 / Chapter 5.2.1 --- ESWL treatment protocol and PCA settings --- p.104 / Chapter 5.2.2 --- Outcome Assessment --- p.105 / Chapter 5.2.3 --- Statistical analysis --- p.107 / Chapter 5.3 --- Results --- p.108 / Chapter 5.3.1 --- Baseline characteristics and treatment modalities --- p.108 / Chapter 5.3.2 --- Pain experience and satisfaction with PCA at different shock wave delivery rates --- p.108 / Chapter 5.3.3 --- Correlation between rate pain --- p.110 / Chapter 5.3.4 --- Vital signs --- p.110 / Chapter 5.4 --- Discussion --- p.111 / Chapter 5.4.1 --- Adverse complication was mild with PCA using alfentanil --- p.111 / Chapter 5.4.2 --- Less pain experience with 60 SWs/min --- p.112 / Chapter 5.4.3 --- Why PCA usage was the same in both groups? --- p.112 / Chapter 5.4.4 --- No correlation with treatment outcome --- p.114 / Chapter 5.5 --- Conclusion --- p.115 / Chapter 6. --- "The relations among rate of shock wave delivery, induced renal injury and acute complications" --- p.128 / Chapter 6.1 --- Introduction --- p.129 / Chapter 6.2 --- Materials and Methods --- p.130 / Chapter 6.2.1 --- ESWL treatment protocol --- p.130 / Chapter 6.2.2 --- Outcome Assessment --- p.131 / Chapter 6.2.3 --- Statistical analysis --- p.136 / Chapter 6.3 --- Results --- p.137 / Chapter 6.3.1 --- Baseline characteristics and treatment modalities --- p.137 / Chapter 6.3.2 --- Quality control of creatinine and NAG --- p.137 / Chapter 6.3.3 --- Standard curves ofIL-18 and NGAL --- p.137 / Chapter 6.3.4 --- Higher levels of urinary NAG and IL-18 in 60 SWs/min group --- p.138 / Chapter 6.3.5 --- Similar levels of urinary NGAL in both groups --- p.138 / Chapter 6.3.6 --- Unplanned hospital visits were similar in both groups --- p.139 / Chapter 6.4 --- Discussion --- p.140 / Chapter 6.4.1 --- More tubular damages caused by slower rate --- p.140 / Chapter 6.4.2 --- Escalated inflammatory activities in 60 SWs/min --- p.141 / Chapter 6.4.3 --- Vascular damage and ischemic insults were the same in both groups? --- p.142 / Chapter 6.4.4 --- Post-operative complications are similar in both groups --- p.142 / Chapter 6.4.5 --- 60 SWs/min vs. 120 SWs/min - What makes the difference in renal injury? --- p.143 / Chapter 6.5 --- Conclusion --- p.145 / Chapter 7. --- Discussion --- p.154 / Chapter 7.1 --- General discussion --- p.155 / Chapter 8. --- Conclusion --- p.158 / Chapter 8.1 --- General conclusion --- p.159 / Appendix --- p.160 / Appendix I --- p.161 / Appendix II --- p.163 / References --- p.167

Diplomová práce Účinky rázové vlny v léčbě tendinopatie Achillovy šlachy 1 Abstract This thesis focuses on the observation of the effects of low-energetic focused extracorporeal shock wave therapy (ESWT) in the treatment of Achilles tendinopathy. The theoretical part summarizes the current knowledge of anatomical, histological, kinesiological and biomechanical aspects of Achilles tendon (AT), as well as pathological processes, which can be described as Achilles tendinopathy, their differential diagnosis and treatment options. Last but not least, we present up-to-date information on the physical principles and biological effects of ESWT, not only in the treatment of AT diseases. The main goal of our research was to determine the effectiveness of low-energetic focused ESWT in the treatment of Achilles tendinopathy in comparison to the placebo group. The subject of observation was not only changes in clinical manifestations, but also possible changes in the morphology of AT using ultrasonography (USG). Methods: A total of 20 patients with symptomatic Achilles tendinopathy was included in the study, while only 18 of them completed the entire program, and therefore only the results of these patients were evaluated. They were randomly divided into two groups in 1:1 ratio. Group A was treated by ESWT with...