BackgroundExtracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system.Sources of dataThis systematic review used data derived from the Physiotherapy Evidence Database (PEDro; , 23 October 2015, date last accessed).Areas of agreementESWT is effective and safe. An optimum treatment protocol for ESWT appears to be three treatment sessions at 1-week intervals, with 2000 impulses per session and the highest energy flux density the patient can tolerate.Areas of controversyThe distinction between radial ESWT as ‘low-energy ESWT’ and focused ESWT as ‘high-energy ESWT’ is not correct and should be abandoned.Growing pointsThere is no scientific evidence in favour of either radial ESWT or focused ESWT with respect to treatment outcome.Areas timely for developing researchFuture randomized controlled trials should primarily address systematic tests of the aforementioned optimum treatment protocol and direct comparisons between radial and focused ESWT.

The persistence of tropical coral reefs is threatened by rapidly increasing climate warming, causing a functional breakdown of the obligate symbiosis between corals and their algal photosymbionts (Symbiodinium) through a process known as coral bleaching. Yet the potential of the coral-algal symbiosis to genetically adapt in an evolutionary sense to warming oceans is unknown. Using a quantitative genetics approach, we estimated the proportion of the variance in thermal tolerance traits that has a genetic basis (i.e. heritability) as a proxy for their adaptive potential in the widespread Indo-Pacific reef-building coral Acropora millepora. We chose two physiologically different populations that associate respectively with one thermo-tolerant (Symbiodinium clade D) and one less tolerant symbiont type (Symbiodinium C2). In both symbiont types, pulse amplitude modulated (PAM) fluorometry and high performance liquid chromatography (HPLC) analysis revealed significant heritabilities for traits related to both photosynthesis and photoprotective pigment profile. However, quantitative real-time polymerase chain reaction (qRT-PCR) assays showed a lack of heritability in both coral host populations for their own expression of fundamental stress genes. Coral colony growth, contributed to by both symbiotic partners, displayed heritability. High heritabilities for functional key traits of algal symbionts, along with their short clonal generation time and high population sizes allow for their rapid thermal adaptation. However, the low overall heritability of coral host traits, along with the corals' long generation time, raise concern about the timely adaptation of the coral-algal symbiosis in the face of continued rapid climate warming.

The effects of climate change over the last few decades have pushed the majority of reef-building corals close to their upper thermal limit. Upon exposure to thermal stress, the intracellular formation of harmful oxygen intermediates can lead to the disruption of the obligate symbiosis between the coral host and their dinoflagellate endosymbionts (zooxanthellae), a process known as coral bleaching. Applications of molecular techniques to cnidarian research have recently enhanced our understanding of the magnitude of corals' transcriptional response to various stressors. In the present study, we developed a quantitative real-time polymerase chain reaction assay to assess expression levels of 4 genes involved in the corals' oxidative stress response (HSP70, MnSOD, ferritin, Zn 2+ -metalloprotease) after exposure to laboratory-controlled thermal stress. Using the IndoPacific reef coral Acropora millepora, our study provides the first population-scale analysis of antioxidant gene expression in coral. Despite the significant up-regulation of those 4 genes in the thermally stressed samples relative to non-stressed samples, our results show that there is an enormous intraas well as inter-colony variation in transcript abundance at a particular point in time. We discuss the potential roles of ferritin and Zn 2+-metalloprotease in the break down of the intra-cellular Fe 2+ -homeostasis and in coral host cell detachment, respectively, during bleaching conditions. Our results emphasise the importance of measuring inter-individual variation to gain an insight into the population response to a common and increasingly encountered environmental stressor.

There is an increasing interest by doctors and patients in extracorporeal shock wave therapy (ESWT) for chronic plantar fasciopathy (PF), particularly in second generation radial extracorporeal shock wave therapy (RSWT). The present review aims at serving this interest by providing a comprehensive overview on physical and medical definitions of shock waves and a detailed assessment of the quality and significance of the randomized clinical trials published on ESWT and RSWT as it is used to treat chronic PF. Both ESWT and RSWT are safe, effective, and technically easy treatments for chronic PF. The main advantages of RSWT over ESWT are the lack of need for any anesthesia during the treatment and the demonstrated long-term treatment success (demonstrated at both 6 and 12 months after the first treatment using RSWT, compared to follow-up intervals of no more than 12 weeks after the first treatment using ESWT). In recent years, a greater understanding of the clinical outcomes in ESWT and RSWT for chronic PF has arisen in relationship not only in the design of studies, but also in procedure, energy level, and shock wave propagation. Either procedure should be considered for patients 18 years of age or older with chronic PF prior to surgical intervention.