Michael Chang, M.D., Ph.D.
Department of Physical Medicine & Rehabilitation
E-mail: mwc@u...
TITLE:
"Development of Personalized Extracorporeal Shock Wave Treatments"
ABSTRACT:
Statistically-based clinical medicine often cannot meet patients’ high
expectations
for therapeutic safety and efficacy. The nature of patient care by
clinicians is
deterministic, and it is a process of problem-solving, much like the
designing or
construction of chemical plants, bridges, automobiles and airplanes is
by engineers.
With advances in the understanding of disease pathophysiology and
therapeutic
mechanisms, personalized patient care based on science and engineering
principles
are becoming realistic.
Over the last 25 years, extracorporeal shock wave lithotripsy (ESWL)
has become
the number one treatment of choice for kidney and ureteral stones.
Shear stresses
and cavitations, both are physical effects of shock waves, work
synergistically for
stone disintegration. Occasionally, ESWL cannot achieve desired
clinical outcomes
and ESWL-related complications have been reported.
For well over 10 years, extracorporeal shock wave therapy (ESWT) has
been
effectively applied with rarely reported complications to treat many
musculoskeletal
conditions such as tendinopathies, enthesopathies, and non-unions.
Shock wave has
been shown, both in-vitro and in-vivo, to lead an up-regulation of
various tissue
growth and angiogenic factors, and therefore it can be used to
accelerate wound
healing, increase perfusion in ischemic myocardium, reverse clinical
course for
femoral avascular necrosis, and enhance the survival of skin grafts.
Other potential
therapeutic efficacies were also demonstrated for treating chronic
pain, disruption
of bacterial biofilms, and the reversal of heterotopic ossifications.
The understanding of shock wave’s treatment mechanisms is imperative
for the
growing number of ESWT applications involving different pathological
tissues at
various anatomical regions. Personalized treatments based on scientific
and
ngineering principles can be developed and optimized for individual
patients.
The ultimate therapeutic objective is to achieve a maximal desired
efficacy while
minimizing any collateral injury/complication.