OBJECTIVE:To report our experience with salvage high-intensity focused ultrasound (HIFU) in patients with local failure after brachytherapy for prostate cancer.

PATIENTS AND METHODS:Whole-gland HIFU was administered to prospectively recruited patients with local histologic failure after brachytherapy at 2 institutions in the United Kingdom and Canada. Functional and oncologic outcomes of the procedure were analyzed.

RESULTS:Nineteen patients underwent the treatment, 12 with Gleason sum 7 and 5 with Gleason sum 8 at recurrence. Thirteen men had grade-3a or -3b complications by the Clavien system; there were no grade-4 or -5 complications. The most common postoperative complication was dysuria, which was self-limited. Three men developed rectourethral fistulae. The overall continence rate was 68.4%. At a mean follow-up of 51.6 months, all men were alive. The overall biochemical recurrence-free survival rate was 66.7% and 73.3% using the"nadir prostate-specific antigen level"+1.3 ng/mL and +2 mg/ml criteria, respectively. This study is limited by the small cohort size, relatively short follow-up period, and heterogeneity of the patient population.

CONCLUSION:In this, the largest prospective series to date, we demonstrate that salvage HIFU for locally recurrent prostate cancer after failed primary brachytherapy has encouraging disease control results, albeit with a relatively high complication rate.

Chronic skin healing defects are one of the leading challenges to lifelong wellbeing, affecting 2-5% of populations. Chronic wound formation is linked to age and diabetes and frequently leads to major limb amputation. Here we identify a strategy to reverse fibroblast senescence and improve healing rates. In healthy skin, fibronectin activates Rac1 in fibroblasts, causing migration into the wound bed and driving wound contraction. We discover that mechanical stimulation of skin with ultrasound can overturn healing defects by activating a calcium/CamKinaseII/Tiam1/Rac1 pathway that substitutes for fibronectin-dependent signaling and promotes fibroblast migration. Treatment of diabetic and aged mice recruits fibroblasts to the wound bed and reduces healing times by 30%, restoring healing rates to those observed in young, healthy animals. Ultrasound treatment is equally effective in rescuing the healing defects of animals lacking fibronectin receptors, and can be blocked by pharmacological inhibition of the CamKinaseII pathway. Finally, we discover that the migration defects of fibroblasts from human venous leg ulcer patients can be reversed by ultrasound, demonstrating that the approach is applicable to human chronic samples. By demonstrating that this alternative Rac1 pathway can substitute for that normally operating in skin, we identify future opportunities for management of chronic wounds.Journal of Investigative Dermatology accepted article preview online, 16 June 2015. doi:10.1038/jid.2015.224.

BACKGROUND:Oxaliplatin is frequently used in the treatment of metastatic colorectal cancer. However, peripheral neuropathy is a severe adverse effect of oxaliplatin that may persist and impact quality of life.

OBJECTIVE:To assess the potential effects of ultrasound acupuncture for the alleviation of symptoms related to oxaliplatin-induced peripheral neuropathy (OIPN) among metastatic colorectal cancer patients.

DESIGN:A prospective cohort pilot study.

SETTING:Education and research hospital.

PARTICIPANTS:Patients with a diagnosis of stages II-IV colorectal cancer treated with oxaliplatin-based treatment regimens and with the presence of OIPN symptoms (n = 17).

INTERVENTIONS:Pulsed therapeutic ultrasound (1 MHz) at bilateral acupuncture points of PC6, PC7, BL60 and KI1 were administered for 5 min/point daily for 12 d.

MAIN OUTCOME MEASURES:Pain Quality Assessment Scale (PQAS), Chemotherapy-induced Neurotoxicity Questionnaire (CINQ), quantitative touch-detection threshold, cold-trigger pain withdrawal latency and quality of life (EORTC QLQ-C30) were measured at baseline (day 0), pre-intervention (day 12, post wash-out period), post-intervention (day 24) and final follow-up (day 54). A P values of less than 0.05 was considered statistically significant.

RESULTS:Scores of PQAS and CINQ significantly improved post ultrasound acupuncture at post-intervention and follow up compare to both base-line and pre-intervention. Similar trends were also observed for the Quantitative Sensory Testing where touch-detection threshold significantly decreased and cold-trigger pain withdrawal latency significantly increased post ultrasound acupuncture. Patients also showed an improvement on Quality of Life outcomes as measured by QLQ-C30 post-intervention and at follow up.

CONCLUSIONS:Ultrasound acupuncture could potentially be an effective intervention for OIPN symptoms for colorectal cancer patients. However, larger and randomized clinical trials with placebo controls are needed to confirm such effect. This article is protected by copyright. All rights reserved.

This study evaluated the synergistic effects of ultrasound (US) and low-level laser therapy (LLLT) with or without therapeutic exercises (TE) in women with knee osteoarthritis. Forty-two Caucasian women with knee osteoarthritis were allocated into three groups: (1) the placebo group who did not perform TE, but the prototype without emitting light or ultrasonic waves was applied, (2) the US + LLLT group in which only the prototype was applied and (3) the TE + US + LLLT group that performed TE before the prototype was applied. However, 35 women completed the full clinical trial. Pressure pain thresholds (PPT) using an algometer and functional performance during the sit-to-stand test were carried out. The average PPT levels increased for US + LLLT (41 ± 9 to 54 ± 15 N, p < 0.01) and TE + US + LLLT (32 ± 8 to 45 ± 9 N, p < 0.01) groups. The number of sit-to-stands was significantly higher for all groups. However, the change between pre-treatment and post-treatment (delta value) was greater for the US + LLLT (4 ± 1) and TE + US + LLLT groups (5 ± 1) than for the placebo group (2 ± 1) witha significant intergroup difference (p < 0.05). This study showed reduced pain and increased physical functionality after 3 months of US + LLLT with and without TE.

This study evaluated the synergistic effects of ultrasound (US) and low-level laser therapy (LLLT) with or without therapeutic exercises (TE) in women with knee osteoarthritis. Forty-two Caucasian women with knee osteoarthritis were allocated into three groups: (1) the placebo group who did not perform TE, but the prototype without emitting light or ultrasonic waves was applied, (2) the US + LLLT group in which only the prototype was applied and (3) the TE + US + LLLT group that performed TE before the prototype was applied. However, 35 women completed the full clinical trial. Pressure pain thresholds (PPT) using an algometer and functional performance during the sit-to-stand test were carried out. The average PPT levels increased for US + LLLT (41 ± 9 to 54 ± 15 N, p < 0.01) and TE + US + LLLT (32 ± 8 to 45 ± 9 N, p < 0.01) groups. The number of sit-to-stands was significantly higher for all groups. However, the change between pre-treatment and post-treatment (delta value) was greater for the US + LLLT (4 ± 1) and TE + US + LLLT groups (5 ± 1) than for the placebo group (2 ± 1) witha significant intergroup difference (p < 0.05). This study showed reduced pain and increased physical functionality after 3 months of US + LLLT with and without TE.

An estimated 15% of patients with diabetes will develop a foot ulcer sometime in their life, making them 30 to 40 times more likely to undergo amputation due to a non-healing foot ulcer than the non-diabetic population. To determine the safety and efficacy of a new, non-contact, kilohertz ultrasound therapy for the healing of recalcitrant diabetic foot ulcers - as well as to evaluate the impact on total closure and quantitative bacterial cultures and the effect on healing of various levels of sharp/surgical debridement - a randomized, double-blinded, sham-controlled, multicenter study was conducted in hospital-based and private wound care clinics. Patients (55 met criteria for efficacy analysis) received standard of care, which included products that provide a moist environment, offloading diabetic shoes and socks, debridement, wound evaluation, and measurement. The "therapy" was either active 40 KHz ultrasound delivered by a saline mist or a "sham device" which delivered a saline mist without the use of ultrasound. After 12 weeks of care, the proportion of wounds healed (defined as complete epithelialization without drainage) in the active ultrasound therapy device group was significantly higher than that in the sham control group (40.7% versus 14.3%, P = 0.0366, Fisher's exact test). The ultrasound treatment was easy to use and no difference in the number and type of adverse events between the two treatment groups was noted. Of interest, wounds were debrided at baseline followed by a quantitative culture biopsy. The results of these cultures demonstrated a significant bioburden (greater than 10(5)) in the majority of cases, despite a lack of clinical signs of infection. Compared to control, this therapeutic modality was found to increase the healing rate of recalcitrant, diabetic foot ulcers.

PURPOSE:To investigate the accelerating effects of low-intensity pulse ultrasound stimulation (LIPUS) on the fracture healing of distal radius.

METHODS:A total of 81 patients with distal radius fracture were randomly divided into two groups: the ultrasound treatment group and the control group. Patients in the ultrasound treatment group were immobilized in a below-elbow cast and received LIPUS treatment 15 min/day, while the control group were immobilized by a plaster support and cast. The patients were followed up every week and took X-ray films. The initial and healed X-ray films and the gray value of fracture site were analyzed by Photoshop software. The effect of reposition was evaluated based upon Steward recommended by Dienst, combining with Aro's measuring method.

RESULTS:Clinical fracture healing time in ultrasound group was significantly shorter than that in the control group (32.04± 2.58d vs. 40.75 ± 5.12d, p<0.01). In addition, the grey value changes of fracture sites of the ultrasound group were much higher than that of the control group. The reposition effects of fracture healing had no difference between the two groups (p>0.05).

CONCLUSION:Low-intensity pulse ultrasound stimulation could accelerate fracture healing of the distal radius and promote local bone formation.

Chronic pelvic pain is a condition that can be caused by pudendal neuralgia, interstitial cystitis, piriformis syndrome and neuropathy of the ilioinguinal, iliohypogastric and genitofemoral nerves. Based on three case reports this article discusses the clinical effectiveness of pulsed high-frequency radiofrequency (PRF) treatment applied to the pudendal nerve under ultrasound guidance in medicinally treated patients with chronic pelvic pain.