No description available.

The aim of this study was to clarify the relationship between the dosage parameters and temperature increase at the target tissues (up to 5 cm below the skin surface), and to explore the possibility of proposing a preliminary model to guide clinicians and researchers in determining treatment dosages based on expected increase in temperatures at the target tissue. Prior to the conduct of the main study several protocol-related issues were investigated. These included the reliability of the measurement procedures, the optimum speed of movement of the transducer, the optimum size of the treatment area, and the maximum output intensity that could be considered safe for treatment applications and investigations. An in-vitro post-mortem pig model was chosen for the experimental design using only adult-sized pigs, weighing between 60 to 80 kilograms. A total of 76 specimens were obtained from the shoulder and thigh sections of 19 pigs. The therapeutic ultrasound machine used throughout the study was the Omnisound 3000TM (Physio Technology Inc., Topeka, Kansas, USA) Output from the Omnisound 3000TM was checked and calibrated as necessary prior to each experiment using a power meter (Model UPM-DT-10, Ohmnic Instruments Co., St. Michaels, Maryland 21663, USA). Calibration was only performed when the checks demonstrated an error in the output intensity of the machine exceeded ±10%. The Minolta spot thermometer (HT-11, Minolta Co. Ltd., Japan) and the Avio thermal video system (TVS) 2000TM (Nippon Avionics Co. Ltd., Japan) were used to measure the change in tissue temperatures (dependent variable) at the skin surface and subcutaneously (at l, 2, 3, 4 and 5 cm below skin surface) respectively. The prepared specimen was mounted on a fixed table, with the clean cross-section facing the infrared thermographic camera. / The camera to specimen distance was standardised at 50 cm for all experiments. Markers corresponding to 1, 2, 3, 4, and 5 cm on the specimen were plotted on the display unit, and saved to a 3.5 inch floppy disk. Measurements were recorded at baseline (prior to commencement of the experiment) and subsequently at 1-minute intervals during 10 minutes of exposure to the ultrasound, and for a further 10 minutes post-exposure, until the end of the experiment at 20 minutes. In general, there were five main parameters for all the studies: the movement speed of the transducer, the size of the treatment, and the frequency, intensity and duration of exposure and post-exposure to ultrasound. These five parameters represented the independent variables for all the studies. The dependent variable throughout was change in tissue temperature (measured in °C) at the skin surface, and at 1, 2, 3, 4 and 5 cm below the skin surface. Data were analysed using the SPSS for Windows software, Version 10.0 (SPSS Inc., 444N Michigan Avenue, Chicago, Illinois 60611, USA). Analyses of the data, using a repeated measures analysis of variance procedure, were performed on change in temperature, rather than actual temperature measured at selected time points. Only data from the 5th, 10th, 15th, and 20th minutes were analysed. This corresponded to the middle and end of the ultrasound exposure phase (5th and 10th minute) and post-exposure phase (15th and 20th minute), as these were considered to be representative of both these phases of data collection. / Data for all 20-minute sampling is provided in the table of means for each experiment. The level of statistical significance was set at 0.05. Results of the reliability study showed that both the infrared spot thermometer and the video thermography unit were reliable within acceptable limits (as defined in this study). The latter, however, was more reliable than the former. In addition, the reliability was better for the post-exposure phase compared with the exposure phase, and for deeper tissues compared with the superficial and surface tissues. An unplanned analysis of the twenty minutes of data (at one minute intervals) suggested the possibility of reducing the duration factor from 20 to 4 (5th, 10th, 15th and 20th minute). In this manner, the data analyses for subsequent studies could be simplified considerably without affecting the overall results. Results of the other protocol-related studies showed that: a. There was no difference in change in temperatures between the slow (60 beats/min or 7cm/s), moderate (120 beats/min or 14cm/s) and fast (180 beats/min or 21cm/s) movement speeds of the transducer. However, for practical reasons, the moderate speed was recommended for subsequent studies; b. There was a significant difference in change in temperatures between the small (2X ERA), medium (3X ERA) and large (4X ERA) treatment sizes. The small treatment size provided the most effective and deeper heating, and was the recommended treatment size for subsequent studies; c. For both 1 and 3 MHz, tissue damage did not occur for intensities up to 1.5 Watts/cm[superscript]2. However, irreversible thermal injury to the tissues occurred at 2.0 Watts/cm[superscript]2 (1 MHz). / Therefore, the recommended maximum intensity at which investigations could be carried out without any risks of thermal injury to the tissues was 1.5 Watt s/cm[superscript]2 for both 1 and 3 MHz. The results from the main study demonstrated that the increase in temperature due to absorption of the ultrasonic energy at any of the investigated target sites (up to 5 cm below surface) was related to the ultrasound frequency, intensity and duration of exposure. For the frequency factor, the evidence seems to suggest that compared with the 3 MHz ultrasound, the 1 MHz frequency may be more appropriate for clinical applications as it does not overheat surface tissues, and at the same time, is able to increase the temperatures of target tissues up to a depth of 5 cm. For the intensity factor, the results suggest that the therapeutic range of intensities which can be considered neither too low (as to be ineffective) nor too high (as to be damaging) are 0.5 to 1.3 Watts/cm 2 and 0.3 to 0.5 Watts/cm[superscript]2 for 1 and 3 MHz respectively The narrow therapeutic range for 3 MHz could render it questionable for clinical applications. In contrast, the larger therapeutic range available for the 1 MHz frequency suggests that it is more suitable for clinical applications and research. For the duration factor, the results demonstrated that the temperatures at all tissue sites increased as the duration of exposure increased. / However, for the post-exposure phase, while the superficial tissues decreased with time, the deeper tissues continued to increase in their temperatures, albeit gradually. In summary, the results demonstrated that a higher frequency, a higher intensity, a greater exposure time and a more superficial site all contribute to a greater change in mean temperature. From these results, a preliminary model to guide clinicians and researchers in determining treatment dosages, based on expected increase in tissue temperatures at the target site, was proposed. While the preliminary model provided is only a first step effort, it is hoped that it can be refined further through use by physical therapists and other users of therapeutic ultrasound.

Therapeutic ultrasound (TUS) is a treatment modality that is used to accelerate tissue healing. TUS is thought to affect cellular processes of tissue healing, especially those that occur in the inflammatory and early proliferative phases. TUS can be applied using various parameter selections including intensity, wavelength, duty cycle and treatment duration and no clear consensus exists on optimal parameters for healing enhancement. Macrophages are important mediators of inflammation and their actions are critical to normal progression into the proliferative phase of healing. They complete many functions during these periods of tissue healing, among those being release of cytokines and growth factors. These paracrine factors affect other inflammatory cells, resident cells of the healing tissue, including fibroblasts and endothelial cells that are necessary for restoration of damaged tissue. The hypothesis of this investigation is that TUS enhances early healing, in part, through stimulation of macrophage release of paracrine factors involved in coordination of the cellular aspects of tissue healing and that specific levels of TUS are most stimulatory for macrophages. This study examined macrophage release of interleukin-1beta (IL-1Beta), vascular endothelial growth factor (VEGF), transforming growth factor-Beta 1 (TGF-B1) and fibroblast mitogens, in response to varied levels of TUS. Fibroblasts incubated up to 48-hours in media conditioned by TUS-stimulated macrophages were not induced to proliferate regardless of the parameters sets of TUS applied. TUS (1 MHz, 400mW/cm2 SATA, 20% duty cycle, 10-minute exposure) induced macrophage release of VEGF and IL-1Beta within 10-minutes post-TUS, without any additional release being stimulated at 1-hour post-insonation. No other combination of TUS parameters studied induced release of IL-1Beta and VEGF. TUS did not induce release of TGF-Beta 1 at either time point post-TUS. VEGF and IL-1Beta release occurred in conjunction with lactate dehydrogenase (LDH) release from treated macrophages, indicating non-specific cell membrane permeabilization was involved in the cellular response. For IL-1Beta, TUS-stimulated release was inhibited at lower exposure temperatures. Inhibition of TUS-induced release at lower temperatures indicates that a cellular metabolic process, most likely exocytosis, was also stimulated by TUS. Based on these results, it appears that TUS exposure at 1 MHz, 400mW/cm2 SATA, 20% duty cycle induces non-specific and cell-mediated release of secretory proteins. Thus, enhanced release of cytokines and growth factors from macrophages is a possible mechanism by which TUS enhances tissue healing.

Articular cartilage, also called shock absorber, is a complex living soft tissue that covers gliding surfaces of joint and enables the joint to withstand weight bearing from human. Since there is no direct blood supply in the articular cartilage, it is generally hard to be repaired itself when it is injured. Although there have been several approaches to the repair of injured articular cartilage, current medical treatment is not able to give patients satisfactory treatment. Ultrasound has been used as one of physical therapy tools. Recently, there have been frequent reports that ultrasound has beneficial effect on the repair of bone fracture and soft tissue healing including articular cartilage. Although there have been appreciation of beneficial effect of ultrasound therapeutically, its mechanism is not fully understood and under investigation. From literature review, several researches tried to find optimal conditions of ultrasound such as intensity, frequency and duration on the repair of articular cartilage and it was reported that more effective ultrasound dose was found. However, different reports have different optimized ultrasound dose. It might be due to the variations of the type of ultrasound wave, intensity, frequency and duration as well as the different condition of experimental samples. Therefore, low intensity pulsed ultrasound (LIPUS) was investigated on the repair of articular cartilage and chondrocyte migration from this study. Also, optimal conditions of LIPUS dose on chondrocyte migration were investigated for the repair of articular cartilage.

Une sonde HIFU transoesophagienne a été proposée comme une alternative aux traitements actuels de fibrillation auriculaire. Le présent travail décrit une étude de faisabilité de l'ablation thermique transoesophagienne sur des coeurs battant in vivo chez des primates non humains et ex vivo sur un cœur isolé / Transesophageal HIFU was proposed as an alternative to the current atrial fibrillation treatments. The present work described a feasibility study of transesophageal thermal ablation in the heart on beating hearts in vivo non-human primates and ex vivo on isolated heart

Therapeutic ultrasound is a deep heating modality often used to produce vigorous heating (≥4°C Δ) in tissues. The vigorous heating effects of 3 MHz therapeutic ultrasound have only been tested to a 2.5 cm depth, but its maximal depth of producing vigorous heating has yet to be established. Objective: To investigate the tissue temperature change produced by a 3 MHz ultrasound treatment at depths of 3 and 3.5 cm in the human triceps surae muscle group. Design: Randomized control design. Setting: Therapeutic modalities research laboratory. Patients or Other Participants: Twenty healthy college-aged participants (male = 13, female = 7; age = 23.4 ± 1.31; calf subcutaneous fat thickness= 0.6 cm ± 0.2 cm). Participants were randomized into treatment (n = 15) and sham (n = 5) groups. Participants were blinded to their group assignment. Interventions: Two MT-26/6 needle thermocouples were inserted into the left posterior triceps surae at depths of 3.0 ± 0.1cm and 3.5 ± 0.1cm from the skin's surface. Participants in the treatment group received a continuous 3 MHz ultrasound treatment at 1.4 W/cm2 for 8 minutes with 10mL of 100% ultrasound gel as a coupling medium. Participants in the sham group received the same treatment parameters, but the ultrasound device was not turned on. The Omnisound 3000 ultrasound device (ERA = 4.2cm2, BNR = 3.0:1) was used for all treatments. A 15 cm2 template was used to ensure a constant and proper treatment size. Baseline temperature (TB) was established by taking a mean of intramuscular tissue temperature (TIM)for five minutes before the treatment and TIM were recorded every 10 seconds throughout the experiment session. Participants marked a visual analog scale (VAS) indicating heat sensation at pre-treatment and post-treatment. Main Outcome Measures: A 2 x 2 x 2 (probe depth x condition x time) ANCOVA with TB used as a covariate analyzed the difference in TIM. We only used the time points of baseline and final TIM for our analysis as we are only interested in the change in TIM from beginning to end of the ultrasound treatment. Descriptive statistics for TIM and VAS for heat sensation were computed as post-treatment minus pre-treatment for each condition and probe depth. Results: There was a significant difference in TIM between the conditions at the different probe depths from the beginning and end of the ultrasound treatment (F1,15 = 7.35, p = 0.016). The mean changes in TIM for each condition at each probe depth were: sham 3cm = -0.4 ± 0.3°C, sham, 3.5cm = -0.2 ± 0.3°C, treatment, 3cm = 4.4 ± 0.2°C, treatment, 3.5cm = 3.5 ± 0.2°C. Mean VAS scores for each group were: sham = 0 ± 0mm and treatment = 71.8 ± 11.8mm. Conclusions: At 3cm deep into the posterior calf, the Omnisound 3000 using a 3 MHz treatment produced vigorous heating (≥4°C Δ). Moderate heating (2-3°C Δ) occurred at 3.5cm deep into the calf. Three MHz ultrasound may be used to heat tissues deeper than previously theorized, but it does, however, create a moderately high level of heat sensation for the patient.

No description available.

Chronic lower back pain is a major public health problem, with direct and indirect economic costs comparable to those of heart disease, depression and diabetes. In many cases this pain derives from degeneration of the intervertebral disc (IVD), a fibrous, avascular tissue that sits between the vertebrae in the spinal column. A novel treatment approach for this ‘discogenic’ pain is the injection of a hydrogel that hybridises in situ and restores the normal biomechanical function of the disc. While a number of promising materials are currently under development, existing approaches to removing degenerate material from the disc prior to injection are invasive and compromise the structural integrity of the disc. Mechanical fractionation of the tissue using acoustic cavitation generated by high intensity focussed ultrasound (HIFU) has the potential to be non-invasive, and to enhance the effectiveness of the procedure by preserving the outer regions of the disc. The primary goal of this thesis is to investigate the feasibility of this approach. The acoustic properties of the disc were first measured using a modified scanning acoustic microscope. The outer region of the disc, the annulus fibrosus (AF) was found to be highly attenuative compared to the central nucleus pulposus (NP). These measured properties were then used in a simplified two-dimensional model to simulate the shape of the acoustic pressure field within the disc. A configuration using two confocal spherically focussed 0.5 MHz single-element transducers was able to produce a tightly focused field suitable for use in the IVD. As preliminary experiments suggested that high pressure amplitudes were required to initiate cavitation inside the disc, the use of exogenous nuclei to lower this threshold was investigated. A novel class of solid sonosensitive nanoparticles (SNPs) suitable for use in the IVD were developed and characterised. These SNPs comprise a layer of hydrophobic silica particles deposited onto a polystyrene core, and are thought to trap small gas pockets in surface crevices. Coated particles were found to reduce the cavitation threshold significantly in both water and blood, from some 2.0 - 2.5 MPa at 1.067 MHz to below 1.0 MPa. The particles were also found to provide repeatable initiation of cavitation activity during prolonged or repeated exposures, and to exhibit good storage stability, suggesting that they they may be appropriate for use within the IVD. Finally, a combined therapy and monitoring system was designed, built and validated. The system comprised two confocal 0.5 MHz spherically focussed HIFU transducers with central openings, each co-axially aligned with either a single element passive cavitation detector or a 64-element array that could be used for both active and passive imaging. The system was found to be capable of initiating inertial cavitation in the disc at pressures as low as 2.5MPa in the presence of sonosensitive nanoparticles. Use of the array in active mode enables creation of a B-mode image that provides anatomical information on the boundaries of the IVD, whist the same array could be used for passive mapping of acoustic emissions arising fromthe HIFU focus during therapy. Two different exposure regimes were found to be capable of producing sizeable perforations within the NP without significantly damaging the AF, and preliminary investigations were carried out into themechanism of damage. The location and extent of cavitation as seen on passive maps acquired during treatment was found to coincide with the regions of NP fractionation. This confirms that passive acoustic mapping can provide the real-time treatment monitoring necessary to ensure both safety and efficacy of ultrasonic IVD fractionation. Prior to clinical application, a significant amount of further development is required to further validate non-invasive disc fractionation by HIFU and the subsequent steps for minimally invasive disc replacement using injectable hydrogels. The present work has nonetheless demonstrated for the first time that minimally invasive removal of degenerate disc tissue is feasible trough the combined use of sonosensitive nanoparticles and a relatively low-cost therapeutic ultrasound system that provides simultaneous anatomical imaging and real-time treatment monitoring by passive acoustic mapping.

O ultra-som terapêutico é o recurso físico mais empregado como coadjuvante na promoção do reparo tecidual em vários tipos de lesão de partes moles. Neste trabalho, foi estudada a influência do ultra-som terapêutico no processo de cicatrização de feridas cutâneas num modelo experimental em coelhos. Foram utilizados 36 coelhos adultos, nos quais foram produzidas três lesões cutâneas no dorso, pela ressecção de um segmento circular de pele de 1 cm de diâmetro, distando 5 cm uma da outra, em linha. Uma das lesões era submetida ao tratamento efetivo com o ultra-som, a outra era submetida a tratamento placebo e a terceira era deixada intocada. Os animais foram divididos em dois grupos de 18 cada, conforme a intensidade do ultra-som aplicado, de 0,8 W/cm2 e 0,4 W/cm2, respectivamente. O tratamento foi iniciado no primeiro dia pós-operatório e aplicado diariamente até o sétimo dia, após o que os animais eram sacrificados e as lesões eram ressecadas com larga margem de segurança, para posterior exame histopatológico. Foram obtidos cortes histológicos de 5 &#956m de espessura, corados com duas técnicas e examinados ao microscópio de luz. Os parâmetros avaliados foram o infiltrado inflamatório, fibrose e reepitelização, aos quais foram atribuídos valores numéricos, de 0 a 3, que permitissem a análise estatística. Os resultados mostraram que o ultra-som induz a alterações teciduais e celulares variáveis, mas não significativas em nenhum dos parâmetros avaliados. / Therapeutic ultrasound is the most used adjunct physical resource to promote tissue repair in many types of soft tissue lesion. In the present work the influence of therapeutic ultrasound on the healing process of skin wounds was studied in rabbits. Thirty-six adult rabbits were used, three round skin wounds of 1 cm in diameter being made on the dorsum about 5 cm in line from one another. Ultrasound treatment was applied to one of the wounds only, a placebo being applied to another and the third being left untouched. The animals were distributed into two groups of 18 according to the intensity of the ultrasound applied, of 0.8 W/cm2 and 0.4 W/cm2, respectively. The treatment was started on the first postoperative day and applied daily till the seventh day. The animals were killed the next day and the wounds were resected with a wide safety margin for histology, 5 &#956m-thick sections being cut and died with two different techniques. The sections were examined on the light microscope for inflammatory infiltrate, fibrosis and regeneration of the epithelium, which were quantified from 0 to 3, so as to make the statistical study possible. Results showed that ultrasound induces cell and tissue alterations but not significantly in any of the parameters analyzed.

Os equinos atletas, especialmente os cavalos de corrida, são frequentemente acometidos por lesões do sistema locomotor. A tendinite é uma enfermidade frequente, sendo o flexor digital superficial (TFDS) o mais acometido. Muitos dos métodos de tratamento para lesões de tendão são utilizados, mas poucos proporcionam cura eficiente e duradoura. Este trabalho tem por finalidade investigar o efeito do ultrassom terapêutico (UST) no processo de cicatrização do TFDS em equinos. Para tanto foram utilizados 20 equinos da raça Puro Sangue Inglês, com idade variando entre dois e nove anos, machos e fêmeas, distribuídos em três grupos (G1, G2 e G3). O G1 foi formado por oito animais, sendo que os TFDS de seus membros torácicos não foram infiltrados com colagenase e nem expostos ao UST. O G2 e o G3 foram compostos por seis animais cada. A indução da lesão foi realizada no terço médio do TFDS com 1ml da solução de colagenase (2,5mg/ml), em todos os membros torácicos dos animais do G2 e do G3. A cicatrização dos tendões foi acompanhada pelos exames clínicos e ultrassonográficos. Aleatoriamente, apenas um membro torácico de cada cavalo do G2 e do G3 foi tratado com UST, modo pulsado (ciclo de trabalho 20%), frequência de 1 MHz e intensidade 0,5 W/cm2 (SATA spatial average temporal average), por 5 minutos. Foram colhidas amostras de tecido tendíneo lesado no 15° dia após o início do tratamento (T15) no G2 para determinar a expressão das proteínas IGF-1, TGF-&beta;1 e PCNA por imunoistoquimica; no 60° dia após o início do tratamento (T60) no G3 para detectar e mensurar a variação da organização dos feixes de colágenos por análise da birrefringência. Não foram observadas diferenças clínicas entre os membros tratados e não tratados dos grupos G2 e G3. Por meio da avaliação ultrassonográfica observou-se que o tamanho e ecogenicidade do tendão, tamanho e ecogenicidade da lesão, alinhamento longitudinal das fibras dos membros tratados do G3 não diferiram de tendões normais (G1) (P>0,05). Não houve diferença estatística entre os grupos para a expressão de PCNA. Entretanto, os membros tratados do G2 apresentaram maior expressão do TGF-&beta;1, enquanto os membros não tratados apresentaram maior expressão para o IGF-1 (P<0,05). Os resultados da birrefringência mostraram diferença estatística significativa entre o G1 e os membros não tratados do G3 e, entre os membros tratados e não tratados do G3 (P<0,001). A análise dos resultados sugere que o tempo de tratamento com UST não foi suficiente no G2 para promover regeneração do tendão, mas alterou a expressão de IGF-1 e TGF-&beta;1, indicando aceleração do processo cicatricial. Já a irradiação do UST no G3 promoveu reorganização, agregação das fibras de colágeno e regeneração do tendão. Conclui-se que, este protocolo de tratamento de UST é eficaz tanto para acelerar o processo de cicatrização do tendão, como para melhorar a organização de suas fibras de colágeno. / Equine athletes are frequently afflicted with locomotor injuries, especially racing horses. Tendinitis is a common problem of lameness in horse, and then the superficial digital flexor tendinitis (SDFT) is the greatest affected. Many of the tendinitis methods of treatment have an empirical basis; but none has proved an effective cure. The purpose of this study was to evaluate the effects of therapeutic ultrasound (TUS) on equine SDFT healing process. It was submitted 20 thoroughbred horses, mares and stallions, between two and nine years old, which were divided into three groups (G1, G2 and G3). The G1 was composed of eight horses; no tendinitis was induced, so they did not received any treatment. G2 and G3 were composed of six animals each one. All G2 and G3 forelimbs received 1.0 ml of collagenase (2.5 mg/ml) in the middle of SDFT. Healing process was monitored by clinical and sonographic evaluations. Randomly, one forelimb from each horse of G2 and G3 was treated with TUS performed at a frequency of 1 MHz on pulsed mode, an intensity of 0.5 W/cm2 (SATA - spatial average temporal average), for 5 minutes. After 15 treatment days, a tendon biopsy was performed on G2 tendons and protein expression for IGF-1, TGF-&beta;1 and PCNA were determined by immunohistochemistry. After 60 treatment days, a tendon biopsy was performed on G3 with the purpose of detecting and measuring the organization of collagen fibers through birefringence. Results showed no statistically difference for clinical examination on G2 and G3 treated and untreated tendons. Sonographic evaluation parameters such as isoechogenicity of tendon and lesion, diminution of lesion and tendon cross-sectional area, good axial alignment of collagen fibers was demonstrated by G3 treated limbs compared with normal tendon (P>0,05). The results showed no statistically difference between G1 and G2 treated and untreated tendons cells for PCNA expression. However, ultrasound-treated tendon cells (G2) were stained more strongly for TGF-&beta;1; whereas untreated tendon cells (G2) stained more strongly for IGF-1. The results showed a statistically difference (P<0.001) between G1 x G3 untreated tendons and between G3 treated and untreated tendons. Our results suggest that G2 TUS treatment time was not sufficient to improve tendon regeneration; although it modified IGF-1 and TGF-&beta;1 expression, accelerating tissue healing rate. In addition, G3 TUS protocol improved the arrangement and aggregation state of the collagen fibril, and promotes tendon regeneration. In conclusion, this TUS protocol is effective either to accelerate tendon healing or to improve the arrangement of the collagen fibril.