Medicine:Low-intensity pulsed ultrasound

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Low-intensity pulsed ultrasound

Low-intensity pulsed ultrasound (LIPUS) is a technology that can be used for therapeutic purposes. It exploits low intensity and pulsed mechanical waves in order to induce regenerative and anti-inflammatory effects on biological tissues, such as bone,[1] cartilage, and tendon.[2] Even if the real mechanism underlying its effectiveness has not been understood yet, it is plausible that the treatment relies on non-thermal phenomena, such as microbubbles and microjets induced by cavitation, acoustic streaming, and mechanical stimulation.[3][2]

Technique

LIPUS uses generally 1.5 MHz frequency pulses, with a pulse width of 200 μs, repeated at 1 kHz, at a spatial average and temporal average intensity of 30 mW/cm2.[4]

Medical uses

Starting around the 1950s this technology was being used as a form of physical therapy for ailments such as tendinitis.[5]

As of 2009 research for the use of LIPUS to treat soft tissue injuries were in the early stages.[4] As of 2012 it was being studied for dental problems.[6]

Low intensity pulsed ultrasound has been proposed as a therapy to support bone healing after fractures,[1] osteomies, or delayed healing. A 2017 review, however, found no trustworthy evidence for the use of low intensity pulsed ultrasound for bone healing, mostly based on the large pragmatic randomized controlled trial published in 2016.[7][8] An associated guideline issued a strong recommendation against its use in bone healing.[9] Evidence as of 2023 was insufficient to justify its use to prevent non healing of bone fractures.[10] Tentative evidence supports better healing with the use of the system in long bones that have not healed after three months.[11] Some reviews suggested inconclusive evidence of benefit.[12][10] One industry supported meta-analysis suggested it as a potential alternative to surgery for established nonunions.[13] Most studies suggesting benefit were funded by manufacturers of ultrasound devices.[7]

In 2018, a study published in the journal Brain Stimulation, reported that experiments on mice showed that whole-brain LIPUS therapy markedly improved cognitive dysfunctions without serious side effects by enhancing specific cells related to dementia's pathology. Clinical trials are underway.[14]

In vitro experiments have confirmed the LIPUS capability to regulate cell proliferation and differentiation as well as the opening of cell membrane channels.[2]

References

  1. ↑ 1.0 1.1 El-Bialy, Tarek; Tanaka, Eiji; Aizenbud, Dror (June 25, 2018). "Mechanism of LIPUS on Dentofacial Bioengineering". Therapeutic Ultrasound in Dentistry: Applications for Dentofacial Repair, Regeneration, and Tissue Engineering. Springer. ISBN 9783319663234. https://books.google.com/books?id=K4xlDwAAQBAJ&q=%22LIPUS%22&pg=PA12. 
  2. ↑ 2.0 2.1 2.2 Jiang, Xiaoxue; Savchenko, Oleksandra; Li, Yufeng; Qi, Shiang; Yang, Tianlin; Zhang, Wei; Chen, Jie (2018). "A Review of Low-Intensity Pulsed Ultrasound for Therapeutic Applications". IEEE Transactions on Biomedical Engineering 66 (10): 2704–2718. doi:10.1109/TBME.2018.2889669. ISSN 0018-9294. PMID 30596564. 
  3. ↑ Lin, Guiting; Reed-Maldonado, Amanda; Lin, Maofan; Xin, Zhongcheng; Lue, Tom (2016). "Effects and Mechanisms of Low-Intensity Pulsed Ultrasound for Chronic Prostatitis and Chronic Pelvic Pain Syndrome". International Journal of Molecular Sciences 17 (7): 1057. doi:10.3390/ijms17071057. ISSN 1422-0067. PMID 27376284. 
  4. ↑ 4.0 4.1 Khanna, A; Nelmes, RT; Gougoulias, N; Maffulli, N; Gray, J (2009). "The effects of LIPUS on soft-tissue healing: a review of literature.". British Medical Bulletin 89: 169–82. doi:10.1093/bmb/ldn040. PMID 19011263. 
  5. ↑ Miller, Douglas; Smith, Nadine; Bailey, Michael; Czarnota, Gregory; Hynynen, Kullervo; Makin, Inder (April 2012). "Overview of Therapeutic Ultrasound Applications and Safety Considerations". Journal of Ultrasound in Medicine 31 (4): 623–634. doi:10.7863/jum.2012.31.4.623. ISSN 0278-4297. PMID 22441920. 
  6. ↑ Rego, E. B. (2012). "Current Status of Low Intensity Pulsed Ultrasound for Dental Purposes". The Open Dentistry Journal 6: 220–5. doi:10.2174/1874210601206010220. PMID 23341848. 
  7. ↑ 7.0 7.1 Schandelmaier, Stefan; Kaushal, Alka; Lytvyn, Lyubov; Heels-Ansdell, Diane; Siemieniuk, Reed A. C.; Agoritsas, Thomas; Guyatt, Gordon H.; Vandvik, Per O. et al. (22 February 2017). "Low intensity pulsed ultrasound for bone healing: systematic review of randomized controlled trials". BMJ 356: j656. doi:10.1136/bmj.j656. ISSN 1756-1833. PMID 28348110. 
  8. ↑ Group, TRUST Investigators writing; Busse, Jason W.; Bhandari, Mohit; Einhorn, Thomas A.; Schemitsch, Emil; Heckman, James D.; Tornetta, Paul; Leung, Kwok-Sui et al. (2016-10-25). "Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): randomized clinical trial" (in en). BMJ 355: i5351. doi:10.1136/bmj.i5351. ISSN 1756-1833. PMID 27797787. PMC 5080447. https://www.bmj.com/content/355/bmj.i5351. 
  9. ↑ Poolman, RW; Agoritsas, T; Siemieniuk, RA; Harris, IA; Schipper, IB; Mollon, B; Smith, M; Albin, A et al. (21 February 2017). "Low intensity pulsed ultrasound (LIPUS) for bone healing: a clinical practice guideline.". BMJ (Clinical Research Ed.) 356: j576. doi:10.1136/bmj.j576. PMID 28228381. http://repub.eur.nl/pub/98256. 
  10. ↑ 10.0 10.1 Searle, Henry Kc; Lewis, Sharon R.; Coyle, Conor; Welch, Matthew; Griffin, Xavier L. (2023-03-03). "Ultrasound and shockwave therapy for acute fractures in adults". The Cochrane Database of Systematic Reviews 2023 (3): CD008579. doi:10.1002/14651858.CD008579.pub4. ISSN 1469-493X. PMID 36866917. 
  11. ↑ Higgins, A; Glover, M; Yang, Y; Bayliss, S; Meads, C; Lord, J (October 2014). "EXOGEN ultrasound bone healing system for long bone fractures with non-union or delayed healing: a NICE medical technology guidance.". Applied Health Economics and Health Policy 12 (5): 477–84. doi:10.1007/s40258-014-0117-6. PMID 25060830. 
  12. ↑ Lou, S.; Lv, H.; Li, Z.; Zhang, L.; Tang, P (1 September 2017). "The effects of low-intensity pulsed ultrasound on fresh fracture: A meta-analysis". Medicine 96 (39): e8181. doi:10.1097/MD.0000000000008181. PMID 28953676. 
  13. ↑ Leighton, R.; Watson, J.T; Giannoudis, P.; Papakostidis, C.; Harrison, A.; Steen, R.G. (May 2017). "Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis". Injury 48 (7): 1339–1347. doi:10.1016/j.injury.2017.05.016. PMID 28532896. 
  14. ↑ "Whole-brain LIPUS therapy improves cognitive dysfunction in mice simulating dementia, Alzheimer's" (in en). News-Medical.net. 2018-07-20. https://www.news-medical.net/news/20180720/Ultrasound-waves-applied-to-the-brain-improve-cognitive-dysfunction-in-mice-simulating-dementia-Alzheimers.aspx. 



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